The American Red Cross is experiencing a severe blood shortage. The lack of blood drives and a decline in donors has created the worst shortage in over a decade.
Meanwhile, more than 20 lawmakers, including Oregon’s U.S. Senators Ron Wyden and Jeff Merkley, have called for a change in federal policy. Currently, men who have sex with men must abstain for 3 months in order to be eligible to donate blood.
Angel Montes is a regional donor services executive with the American Red Cross. Jonathan Frochtzwajg is the public policy manager with the Cascade AIDS Project and Prism Health. They join us with details.
The following transcript was created by a computer and edited by a volunteer:
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. Earlier this month, for the first time ever, the American Red Cross announced a nationwide blood crisis, a shortage of blood and platelets that could put patients at risk. Two weeks later, local officials say that the situation is still dire. In a few minutes we’re going to hear about one solution that’s being proposed: ending the three-month deferral policy on blood donations from men who have sex with men. We start with Angel Montes, the regional donor services executive for the Cascades Region of the American Red Cross. Welcome to Think Out Loud.
Angel Montes: Thank you so much, Dave, for having us on.
Miller: Can you give us a sense for the blood supply levels right now in this region?
Montes: Yes, of course. I can give you a sense of what’s happening in the region and also across the country. We are still facing an unprecedented national blood crisis due to the lack of blood donations. This is the worst shortage that we’ve had in a very long time. I’ve said this before: in the 18 years that I’ve been with this organization, I haven’t seen it this bad. As an organization, we provide 40% of the nation’s blood supply. But at any given point we have less than a one day supply of the critical blood types like O positive or O negative, which our hospitals are in critical need of. In addition, the dangerously low blood supply that we currently have, the inventory that we have available, is forcing doctors to make those difficult decisions about who is going to receive the blood and who is not going to. Like I said, we’ve never dealt with this type of situation. At times about one quarter of all hospital blood needs are not being met. So, Dave, that’s where we’re finding ourselves right now with this critical shortage all over the country and here locally.
Miller: A quarter of blood needs in any given hospital right now might not be being met. What does that mean in practice?
Montes: We recently had a discussion with a doctor from OHSU who openly stated how difficult it was for her and for the medical staff at the hospital to be able to communicate directly to a family that, at this time we don’t have the blood, so your surgery or the care that you need, it needs to be delayed. So it’s definitely had an emotional impact on the hospital staff. Especially based on my previous discussion that I had with the individual at OHSU that it became really personal to her. She has never dealt with a situation where she’s been telling people that they have to wait, that they have to be in pain because of the lack of product that we have.
Miller: In other words, in some cases surgery is being delayed because that surgery can’t be done unless people can get transfusions of blood?
Montes: That’s correct.
Miller: Can you give us a sense for the people who might be most impacted right now by this shortage? Who most needs blood or uses the blood products that the American Red Cross and others provide?
Montes: Of course. We have accidents that happen [creating] the urgent need for blood. [We have] cancer patients – those individuals are constantly receiving blood transfusions. And, again, they’re already living a very painful experience, so to not be able to get that product in a timely manner is causing pain. In addition, we also have premature babies that also need blood products, immediate blood products. So, when we’re not able to provide the red cells or the blood products that the hospitals need at any given time, it causes pain for those individuals that are in constant need and for individuals that have a random accident and they immediately need blood in order to be able to live. So those are the individuals that we’re most concerned about and why we work every single day to make sure that we stabilize our blood drive inventory to be able to provide the products the hospitals need.
Miller: What are the different reasons you’ve identified for the current shortage?
Montes: There’s multiple reasons. The first one, I would say it’s the prolonged pandemic. That’s been a severe issue for many organizations and especially the blood industry. In addition, because of the pandemic, we had a 10% decline in the number of people donating blood. That could be maybe because they feel unsafe or other reasons that keep them from being able to come out and [keep them from] donating that product. Also our high schools and colleges have been our largest supporters historically. That’s where we collect the most units of blood. Unfortunately we’ve seen a 62% drop and the amount of blood drives that those sponsors are hosting.
Miller: So it’s not simply that fewer people want to go to donate blood, but there actually are fewer drives themselves that could produce that blood.
Montes: That’s correct, especially in those opportunities – the large universities, the colleges, the high schools – where we collect the most blood historically. We’re not able to tap into that donor base, because either the high schools could be virtual or they’re not allowing us in for various reasons. That’s true for universities and colleges as well. So that 62% drop in actual blood drives, like you said, limits the ability for us to collect those units from that donor base. It should also be noted that we saw nearly a one-quarter drop in Generation Z donors. Gen Z donors from 2019 made up about one-quarter and now, in 2021, they just make up about 10%. So again, those young donors, the ones that we need to make lifetime donors, are not presenting to donate blood as well. And the final thing that is–
Miller: It seems like you’re saying that that could be a much longer-term concern than the omicron variant of which is a month-long wave. You’re concerned that you may actually be losing a generation of blood donors?
Montes: We’re concerned that we’re not able to have the opportunity right now to educate those young donors to be able to be lifetime donors. Because the goal for the American Red Cross for any blood donor is not to just donate one time. We are encouraging donations every 56 days which is when, based on FDA regulations, you can donate blood. So, yes, it’s unfortunately keeping us from being able to tap into those high schools, colleges, universities – that youth that is going to carry forward the success of our blood collections in the future.
Miller: A few weeks ago, as I noted, the National Red Cross put out the word that we were facing a crisis. Did that lead to an increase in donations?
Montes: We have seen an increase in donations, and that’s something that we’re extremely grateful to the population and all of our blood donors. The one thing that I would say, though, and I go back to the idea of donating every 56 days, is that we typically will see a spike and then it’ll die down. What we really need right now in order to stabilize the inventory across the country and here locally is consistent donations, every 56 days if possible, by donors that are able to donate. That will help us stabilize. So, don’t just donate once, plan 56 days from now to set up your next appointment and then 56 days from then. So that way the inventory can continue to stabilize.
Miller: Are certain blood types in particular demand right now?
Montes: Yes. Right now the blood types that we are in critical need of are O negative and O positive. O positive is the semi-universal blood type. That can be transfused into any person with a positive blood type. And then O negative, that’s universal, so that can go into any patient that needs it. That’s the type that our hospitals will always ask for. Because, if there’s a patient that comes in losing a lot of blood or a premature baby or a cancer patient that needs immediate transfusions, that O negative blood is one that can be transfused immediately. So we definitely are encouraging people that have that blood type to please come in, roll up your sleeve and help us save a life.
Miller: Angel Montes, thanks very much for joining us.
Montes: Thank you very much.
Miller: Angel Montes is a regional donor services executive for the Cascades Region of the American Red Cross.
The [national blood] shortage has led to renewed calls for the federal government to lift one specific restriction on blood donations. Currently, if a man has had sex with another man in the last three months, he cannot donate blood. More than 20 U.S. lawmakers, including Oregon’s U.S. Senators Ron Wyden and Jeff Merkley, say it’s time to scrap that policy. Jonathan Frochtzwajg is public policy manager for Cascade AIDS Project and Prism Health, and he joins us with more. Jonathan, welcome to Think Out Loud.
Jonathan Frochtzwajg: Thank you. Thanks for having me.
Miller: Can you explain more fully the federal donation policy that’s in place right now that you and many other people are calling to be changed?
Frochtzwajg: Sure. This is a policy from the Food and Drug Administration that covers all blood banks in the United States. As you said, currently it bans any man who has had sexual contact with another man in the last three months from donating blood. But that’s actually a relatively new rule that has been in place since 2020 in response to the COVID-19 pandemic’s impact on the blood supply. Originally, when the policy was put in place back in 1985, it completely banned donations from gay, bisexual and other men who have sex with men. Then that restriction was loosened in 2015 to allow men who had not had sexual contact with another man for one year to donate, and then down to three months under the current policy.
Miller: How has HIV testing and treatment and the science of HIV changed over the course of that time? Because you just outlined policy, with respect to blood donations, going back to the 1980s. But there have been a ton of significant changes in terms of treatment and testing since that time, since the early days of the AIDS epidemic, and it seems like they’re important to cover here. So, what are the important ones with respect to blood donations?
Frochtzwajg: Right. The policy on blood donations has not kept up at all with our knowledge of HIV. HIV is now a chronic but manageable condition. It’s completely preventable. And I think most relevant to blood donations is, since the blood donor ban was put in place, HIV testing technology has gotten just exponentially more advanced and extremely accurate. Every blood donation is tested for HIV and other bloodborne pathogens. And, as a result of the incredible accuracy of modern technology, the risk of HIV being transmitted through a blood transfusion is insignificant. You’re about three times more likely to be hit by lightning.
Miller: According to the CDC, though, men who have sex with men account for 69% of new HIV diagnoses in the US. And in the early days of infection, as I understand it, it is possible to be infectious but not to test positive. That’s not to say the tests aren’t effective. But, if I understand correctly, the idea behind this waiting period – even if there could be serious scientific disagreements about how long it should be – the idea of some waiting period is to prevent a false negative. Somebody has recently gotten infected and they are infectious but it wouldn’t be picked up by the test. That’s the fear. So what kind of blood donor policy in your mind would be both fair but also safe?
Frochtzwajg: That’s a great point. The problem is asking exclusively about sexual contact between men. When we think about managing the extremely small risk of a test not detecting HIV during that brief window period between infection and when the virus can be detected.. when we think about that risk, asking about sexual contact between men only is just not the best way to do it. We should be asking about risky behaviors regardless of who someone is and who they have sex with. For example, under the current policy, a gay man who always uses condoms and gets tested regularly for HIV and would therefore be quite low risk would be banned from donating blood, but a straight person who never uses condoms and has never been tested for HIV and would therefore be higher risk would not be banned. So the way we’re going about it currently just doesn’t make a whole lot of sense.
Miller: What are the social effects or emotional effects of a policy like this that only specifically targets men who have sex with men?
Frochtzwajg: I think it reinforces HIV stigma. It stokes fear of HIV that’s out of all proportion to the facts about HIV. That makes life harder for people living with HIV who have to deal with that stigma around their condition. It makes our jobs at Cascade AIDS Project harder in terms of preventing new HIV infections. Because the more stigma there is around HIV, the less able we are to have open, rational conversations with folks about things like safer sex and regular testing and PrEP, the once-a-day pill to prevent HIV. I also think it contributes to mistrust of the medical establishment among LGBTQ people. I think the fact that this policy, that’s rooted in homophobia and not based in evidence, has been on the books for so long sends the message to LGBTQ folks that there is still bias and discrimination in healthcare.
Miller: Jonathan, thanks very much for your time today. I appreciate it.
Frochtzwajg: Thank you.
Miller: Jonathan Frochtzwajg is the public policy manager for Cascade AIDS Project and Prism Health.
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