The Wall Street Journal - Monday, 14 October 1996
Marilyn Chase, Wall Street Journal Staff Writer

My reader argued that cancer doesn't always disqualify a donor, and asked for clarification on who can and can't give.

Fair enough. With five million U.S. citizens needing blood transfusions every year, 320,000 needing tissue transplants, and 48,000 patients on waiting lists for scarce organs, getting qualified donors to give is a huge and evolving health issue worthy of an update.

Generally, anyone can volunteer to give blood as long as he or she is at least 17 years old and weighs at least 110 pounds. To volunteer to be an organ or tissue donor, if you're over 18, just sign a donor card or indicate your wish on a driver's license.

It's not as easy as that, of course. To keep anatomical gifts safe, donations are regulated, tested and culled under a patchwork of public and private collaborations. Rules for blood donations and tissue transplants are set by the U.S. Food and Drug Administration, which works closely with the private American Association of Blood Banks and the American Red Cross. The Health Resources and Services Administration regulates organ transplants and manages a computer network that helps match up donors and recipients.

From living donors' gifts of blood to posthumous donations of tissue and organs, each kind of anatomical gift has its own rules.

Blood donations undergo lab tests for the AIDS virus, hepatitis B and C, syphilis, and human t-lymphotropic viruses I and II, which are linked to a type of leukemia. Having malaria defers your ability to give blood for at least three years. Recently, amid mounting concern, blood banks began asking donors if anyone in their family ever suffered from the brain disorder Creutzfeldt-Jakob disease.

IF SOMEONE HAS a history of cancer, "they're thanked for their effort, but we can't accept them as a donor," says Richard Davey, chief medical officer of the American Red Cross's biomedical-services division. Basal cell carcinoma, a nonlethal skin cancer, "is one of the few exceptions we would make," he says. Blood banks' medical directors are given some discretion to decide individual cases.

Donors are quizzed about their lifestyle to further trim the risk of transmitting disease. If they have ever injected street drugs or steroids, they're ruled out. Acupuncture, tattooing and ear or body piercing -- which also may involve unsterile needles -- disqualify donors for 12 months.

Taking the prostate drug Proscar or the acne drug Accutane makes you ineligible for a shorter period, since either can damage a fetus if the blood is given to a pregnant woman.

With the advent of AIDS in the '80s, blood banks began peering into donors' intimate lives to reduce HIV risk. Questions are worded to focus on behavior (mainly sex between men), rather than on labels that stigmatize and trigger denial, says Leslie Holness, FDA medical officer for blood donations.

All this makes it tougher to roll up your sleeve today than ever before. "The questions are more numerous, probing and specific than in the past," says Dr. Davey. "It's a credit to our donors that they go through this every time." And while the risk isn't zero, the combination of lab tests and questionnaires has reduced the chances of getting AIDS from a blood transfusion today to as little as two in a million.

DONORS OF tissue -- from skin grafts to heart valves and corneas -- are also subject to AIDS and hepatitis tests. Further, banks must track tissue from donor to recipient, so any medical mishaps can be traced.

Randy May, president of the American Association of Tissue Banks, says cancer patients -- like the breast-cancer survivor -- are generally barred from donating tissue. Exceptions may be made for people who have had small, nonlethal skin cancer or very early cervical carcinoma that shows no risk of spread.

"We have to be extremely hard-nosed about our restrictions," Dr. May explains. "The advantage is that it gives great peace of mind to our recipients. If you have a child who needs a heart valve, you can feel confident they won't get a disease."

Donors of organs -- hearts, lungs, livers and kidneys -- are tested for HIV by law, says Gwen Mayes, operations chief for HRSA's division of transplantation. Under standard practice, donors also are tested for hepatitis and cytomegalovirus. Doctors also perform blood chemistry tests, and take as detailed a medical history as can be obtained from the donor's medical records and family members.

Again, experts say most organ banks decline donations from cancer survivors, with a similar list of exceptions.

However, critical shortages of donor organs are driving banks to reconsider other things that once would once have barred a transplant -- age, for example. "When I started back in 1982, the upper age limit for a male heart donor was 35," says Ms. Mayes. Now, programs evaluate donors in their 60s.

So for many people wondering, "Am I too old to be a donor?" Ms. Mayes says it's not too late for them to share the wealth. (Note: This is the first of a two-part series. Next: What choices do blood or organ recipients have?)

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