The New York Times - November 16, 1986
Judy Glass

Even so, hospitals, blood banks and physicians are receiving an increasing number of calls from people who want an alternative to anonymous blood donations. In response, a number of hospitals have set up programs in which people can store their own blood for transfusions or have others donate blood designated for them only.

While blood bank officials favor the warehousing of a patient's own blood, called autologous blood donations, they oppose the idea of designating blood for one specific person for a variety of reasons.

"Over all, designation programs threaten the public blood supply that the majority of transfusion patients rely on," said Dr. Theodore Robertson, division director of Long Island Blood Services, which supplies most of the blood for all 41 hospitals in Nassau and Suffolk Counties and Queens, as well as for two dialysis centers.

Autologous and designated donations can be used only in elective surgery. Transfusions performed in emergency situations, for trauma and chemotherapy, are drawn from the inventory supplied by Long Island Blood Services.

"If all hospitals decided to operate their own programs, it would defuse the larger supply and threaten the availability of blood donated by anonymous volunteers," Dr. Robertson said.

He added that a designated donation program requires two separate systems, additional costs and a separate method of organization.

But Dr. Paul Kalish, director of pathology at Glen Cove Community Hospital, which allows both warehousing and designating of blood, defended the designation practice.

"There are patients who refuse to receive bank blood - even at the threat to their lives," he said. "My attitude is that people who take that position are somewhat irrational, but we are attempting to respond to their request."

The fear of tranfusions has been spurred by concern over AIDS, or acquired immune deficiency syndrome. In some cases people have contracted AIDS as the result of receiving transfusions of tainted blood.

Such fears have been heightened by press reports, blood officials say, despite a campaign by the Greater New York Blood Program and its affiliates, like Long Island Blood Services, to dispel anxieties.

The officials point out that AIDS cases resulting from blood transfusions occurred almost exclusively before the disease, and those most at risk of contracting it, were identified.

Those with the highest risk - male homosexuals, intravenous drug users and their sexual partners - are now not permitted to donate blood. A new screening test enables blood banks to detect a prospective donor's exposure to the disease. In addition, potential donors must fill out a detailed questionnaire and answer questions orally on their medical and social histories.

AIDS, which destroys the immune system's ability to fight off other diseases, is caused by the HTLV3 virus. Those exposed to the virus develop antibodies that appear in the blood, even though they may never develop AIDS itself. If the screening tests detect antibodies in the blood, the blood is not used for transfusions.

"The test is not 100 percent perfect, but the public perceives a far greater problem than actually exists," said Dr. Kalish of Glen Cove Community Hospital.

The hospital is the first community hospital on Long Island to set up its own blood bank, but it still receives 95 percent of its blood from Long Island Blood Services.

The hospital's program that allows patients to store their own blood prior to surgery has become increasingly popular at other Long Island hospitals as well. The program is endorsed by Long Island Blood Services, which assists hospitals in operating it.

The warehousing of a patient's own blood is acceptable because the only completely safe blood is your own, doctors agree. Patients can donate up to four units of their own blood every week until a week before surgery, if they do not have any disqualifying conditions and are able to produce new blood cells at an acceptable rate.

The complete safety of the blood "would make it the most desirable source of transfusion even if AIDS and other diseases did not exist," Dr. Kalish said. However, only basically healthy people facing elective surgery can supply their own blood.

But blood designation programs, like that at Glen Cove, are strongly opposed by officials of blood centers.

Blood designation is a throwback to the years before hospitals were supplied by community blood programs. In those days, hospitals and patients would solicit friends and organizations to donate or replace blood used.

"Patients who want only their own friends' or relatives' blood now believe that it is safer because they believe that they can account for the life styles of those close to them," Dr. Kalish said.

But the Greater New York Blood Program takes the position that blood earmarked for one patient is actually less safe because those asked to donate are under pressure and might be less than candid about their medical history during screening tests.

All blood programs depend on the honesty of applicants during the screening process. About 13.5 percent of volunteers at the blood program are rejected each year after screening, Dr. Robertson said. Blood from rejected donors can be used for research, however.

Designated donors are screened the same way as anonymous donors. However, blood-bank officials say that people asked to donate by a relative or friend no longer feel anonymous. The confidentiality of the blood screening process is violated and designated donors may be less than candid about their medical or social history - especially if they have something in it they do not want revealed.

The recipient usually knows whether someone he or she has asked has donated, Dr. Robertson said. If a person is pressured he may "forget" that he had hepatitis or that the person he lives with had hepatitis or that he experimented with drugs five years ago or had a transfusion since 1977. This makes a designated donor less safe than the anonymous donor, Dr. Robertson said.

Blood-bank officials also say that the existence of independent blood programs could confuse people further and put an unnecessary burden on hospitals and physicians to meet their needs. For example, a patient may inadvertently place himself at increased risk by delaying treatment until sufficient designated-donor blood is available.

Most of the blood accepted by blood banks comes from repeat donors who, once they pass screening, can give up to five times a year.

"All the blood collected on Long Island is distributed on Long Island," Dr. Robertson said, "so that if you are transfused on Long Island, chances are it was donated on Long Island." About a quarter to a third of the blood distributed by Long Island Blood Services originates in Europe, he said.

Last year, 15,060 people donated blood to Long Island Blood Services; 13,888 have donated so far in 1986, with a goal of 18,000. "Yet we are always running on the ragged edge of shortages," Dr. Robertson said. "We need every donation we can get."

Long Island Blood Services has a computerized program that provides all types of blood and blood products at any time in accordance with hospitals' needs. A few of the major care centers - like North Shore Community Hospital, the Nassau County Medical Center, the Long Island Jewish Medical Center, the State University at Stony Brook Medical Center, the Queens Hospital Center and Jamaica Hospital in Queens - maintain their own blood banks in addition to the supply from Long Island Blood Services.

But Glen Cove is the first community hospital to do so, Dr. Robertson said. "All those that had them in the past gave them up in favor of the regional blood bank," he added.

Blood-bank officials say that smaller hospitals attempting to maintain their own blood systems risk liability problems if blood earmarked for certain people within a larger group of patients is misdirected, lost or destroyed.

Even though it is opposed to the practice, Long Island Blood Services occasionally assists hospitals by collecting and transferring designated blood.

Since designated blood is more expensive to collect and can only be used for the designated recipient, the blood is transferred as whole blood to hospitals on a nonreturnable basis, and a surcharge is added to the Greater New York Blood Program processing fee.

Dr. Kalish said the autologous and designated donation programs at Glen Cove Community Hospital were set up in response "to a pressing demand from the community."

He added that the programs are safe and will not harm the community blood supply. "The majority of designated donors are already regular donors," he said. "If their blood is not compatible with the recipients we'll take it anyway if they meet the standards."

"I think this service has to be provided and I see nothing wrong with providing it," Dr. Kalish added. "Many hospitals do not want to get involved, and we are not actively encouraging the designated donations. However, we are promoting and publicizing our autologous donation program aggressively.

"Designated donation is not the answer to society's ills," he went on. "It's an essential service because of the publicity and concern about transfusions."

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