Blood donation and the Boston Bombings

Last week’s events in Boston were intriguing to watch, and at the heart of much of the early coverage was the issue of blood donation. The twittersphere was ignited by NBC Sports Network telling of competitors running past the finish line toward the nearest hospital to donate their blood. These warming tales of altruism amidst crisis were ubiquitous in media reportage, which encouraged mass attempts to donate. In fact, the mantle was assumed by so many that the Red Cross had to issue a press release to advise that it had reached its stock quota, but that it did require ongoing public support to cope with the 70,000 small and great disasters it responds to throughout a given year.

As President Obama spoke at the interfaith memorial service in Boston’s Cathedral of the Holy Cross, he remarked that those lining up to give blood are the same as those who offer shelter, food, a phone call or a car ride to others in need. “That's love,” he said. And indeed, love may well have something to do with it. But in the case of disaster-inspired blood donation, that impetus to give blood – without having it requested, or perhaps having never even done it before – is an individual’s attempt to assist with or remedy a disaster with which they have few other meaningful ways of engaging. It's through their bodies [significantly] alone that they feel they are most able to do this. Indeed, this ad hoc donation isn’t a solitary phenomenon. Since systematic blood donation was introduced after WWII – before the introduction of the National Health Service – disastrous events have triggered spontaneous mass acts of donation, with those donating not realising that blood for immediate post-disaster transfusion will very often already be available; for instance, July 2005’s London bombings saw the national blood service spring into expeditious action. Nearly 1500 units of blood were dispatched before it returned to normal service on the same afternoon.

Cathedral of the Holy Cross, April 18, 2013 (PHOTO: REUTERS / BRIAN )

In these narratives of altruism it is often forgotten that there is an incredible underlying organisational rhythm in the workings of blood donation systems. In Madrid’s main blood bank, nearly an hour’s drive away from the bustle of the capital’s core, it might be surprising that the heart of this system of blood procurement, storage, and dispatch, is not a frosty plasma fridge or a line of whirring centrifuges. Rather, it is the shelves of worn folders, each containing the daily data provided every morning by Madrid’s hospitals. The bank can predict the ebbs and flows of blood donation: summertime will see a drop in donations as people vacate the city for their holidays, but this is met by a similar dip in blood demand. These intimate understandings of supply and demand prompted the UK blood service’s preemptive drive to collect a 30% surplus of its O- stocks (the universal blood group) in response to concerns of a donation dip during the Olympics. After all, royal jubilees and national sporting events halt the regular donation patterns that the UK generally enjoys. This has a different, perhaps graver, effect on the UK’s blood supply than an horrendous and unanticipated disaster in which hundreds are killed or injured.

Outside the Madrid Blood Bank, (Ros Williams)

With this week’s crisis in Boston, and those like it, in mind, the UK blood service faces the challenge it has always had of mobilising post-disaster altruism in such a way that concerned members of the public will become consistent donors who can add their blood to the already efficient system. Regular calls for particular groups of blood donors, donor drives that stimulate regular donation by individuals, booking people in for future donation appointments (as the Red Cross has been doing in response to Boston and as will have been done for many of the more than 10,000 who called the give blood helpline in a 24hr period after the 2005 London bombings) – these are all ways of sustaining blood donation. Ultimately, the need to channel post-disaster donator energy into long-term donation begs the question: how it is that people can be made more aware of the need for consistency over one-off public-spirited donations?

If we zoom out to the governance of the wider public donation system that exists in the UK, the NHS blood and transplant service comprises several operating units, each with its own objectives. Along with the blood components unit, there is the stem cell donor and patient services unit that encompasses both the British Bone Marrow Registry and the NHS’s umbilical cord blood bank. For this unit, one of the key concerns is securing a sufficiently diverse collection of stem cells from a wide variety of immunotypes so that people with blood malignancies like leukemia can receive stem cell therapy. This unit is key to the research and development programmewhich, sustained by NHS blood and transfusion service funding, works within areas as diverse as blood cell manufacture from stem cells and molecular diagnostics.

As the Anthony Nolan Trust has pointed out, along with an All-Party Parliamentary Paper released last year that the charity co-authored, there is a significant dearth of certain groups of people (this is often translated into “asian” or “black and minority ethnic” people) donating umbilical cord blood or registering as bone marrow donors. Specific blood drives will often be set up in response to individual patients who require treatment but cannot find a match. But again, singular ad hoc donor recruitment drives in response to individual illness – whilst crucial – cannot hope to capture the long-term sustained attention of a nation full of potential donors.

Back in 2011, the coalition government announced that it would be investing £4m in a collaborative project between the NHS blood and transplant service and Anthony Nolan to provide a single point of access registry for all British stem cell donors. How, then, might the NHS successfully harness people’s altruistic desire to donate, and bring into the public discourse a more nuanced understanding of the importance of individual, consistent donation across various communities and groups? Perhaps more importantly, how can collaboration with charities and other bodies assist in this endeavour?

Thanks to Holly Steel, Nik Brown and Alice Bell for their thoughts on this piece