“Bad Blood: The 9/11 Blood Donation Disaster”
by Douglas Starr
The New Republic, July, 2002
Dear Mr. Orr,
As we approach the anniversary of September 11, one painful lesson is becoming clear: the nation’s blood-collection response was a fiasco.
That conclusion might seem counter-intuitive, given all the blood that was collected. But the collection was unnecessary, and led to unprecedented waste. The problem had little to do with incompetence and avarice, as portrayed by scattered press reports, but with a basic misconception about blood as a resource. Blood-giving in times of crisis may soothe our sense of wounded nationhood and answer a need for communal action. But in terms of the nation’s blood supply, the notion is obsolete.
The practice of mass blood-giving began during the prolonged medical crisis of World War II. Linking blood drives to battles attracted donors by the thousands, since it was a way homebound Americans could show patriotism. The approach worked when blood banking was a simple enterprise, but life has become more complicated since then. We no longer accept the appalling disease rates that accompanied transfusion during those early days. Today’s donors face dozens of probing questions about their lifestyles and habits. Their blood undergoes a battery of lab tests for diseases unknown a few decades ago, such as HIV, HTLV and Hepatitis C.
In short, blood banks do not resemble MASH units anymore — they’re modern pharmaceutical labs requiring sustained, controlled input. Old-fashioned mass appeals overwhelm the system, causing bottlenecks and errors.
That’s what happened in the weeks after the plane crashes in New York, Washington and Pennsylvania. Within hours, health officials knew they had more than enough – few people can survive the catastrophes that occurred. But compelled by a sense of civic generosity, the uninformed encouragement of President Bush and the irresponsible urgings of the Red Cross’s then-CEO, Dr. Bernadine Healy, American donors turned out en masse. The situation became so unmanageable that the FDA issued emergency waivers to allow centers to take blood under previously unacceptable conditions.
The dimensions of those errors later became clear. Tens of thousands of pints had to be discarded because they exceeded their expiration dates; thousands of other units never got tested. The blood collected under the FDA waiver was never used because no-one wanted to risk the liability of using second-rate blood. The response to the crisis produced a rebound effect among many Americans, and donation rates plummeted to near-record lows.
With the system now facing its worst shortage in years, blood bankers must replace the old crisis model with one that can serve the needs of a modern blood system — a less romantic model perhaps, that favors convenience and efficiency over patriotism. Without such a model local emergencies, nagging shortages and postponed surgeries will become routine.
I’d like to propose an article on the crisis in blood-banking triggered by 9/11 — a look at the changes that have taken place over the years, the events that unfolded in the wake of the disaster, and at the new policies that must inevitably result.
My credentials: I’m a veteran journalist and co-director of the Knight Center for Science and Medical Journalism at Boston University. My book, BLOOD: An Epic History of Medicine and Commerce (1998, Knopf) won a Los Angeles Times book prize and will soon appear as a PBS documentary. Would your readers be interested?
Cordially, Douglas Starr