Why does the American Red Cross frequently ask for blood donations?1 The facts are that at any moment countless patients depend on life-saving blood products which must be continuously replenished by donors. This dynamic balance of supply and demand must be approached with thoughtful analysis of the past as today’s blood establishments plan for the future.
A recent commentary published in Transfusion by Tran et al. examines donor demographics, the overall decline in blood donations over the last 20 years, and current and future societal and economic challenges faced by blood donors and blood collectors.2 Decreased overall transfusions partly reflect the positive changes from evidence-based medicine promoting responsible blood usage in the past 15 years, encouragement of patient blood management, adhering to transfusion criteria, and less invasive or ‘bloodless’ surgery techniques allowing certain procedures to be performed in the outpatient setting.
The National Blood Collection and Utilization Survey (NBCUS) has obtained blood collection and utilization data from US hospitals and blood establishments since 1997.3 The most recent NBCUS report, which contains 2021 data, documented the temporary but critical blood shortage during the COVID-19 pandemic, resulting in a public health crisis and national donation appeals.4 In the US, lockdowns and increased safety measures led to countless school, college, and workplace closures which disrupted people’s work locations, schedules, and availability to donate blood. Even as schedules stabilized after the pandemic, a larger proportion of workers than ever before continued to work remotely (12.8% in 2023 compared to 5.2% before 2019) or in a hybrid work setting (28.2% in 2023), making scheduling workplace or college-based blood drives challenging. Societal and economic factors have also contributed to the blood supply not yet stabilizing to pre-pandemic levels. These factors include polywork. The concept of polywork is not new, but as the cost of living continues to increase, more individuals are working at two or three jobs to make ends meet, diminishing their time for other activities including blood donation. A hopeful trend noted by Red Cross Biomedical Services President Chris Hrouda was a 20% increase in 16- to 24-year-old blood donors between July 2021-June 2022 and the following 12-month period.
People over 65 years of age, many of whom are retired or partially retired, currently donate more whole blood and platelets than any other demographic group. Donating apheresis products (red cells, platelets, and plasma) requires a larger time commitment than whole blood donation, and though the older generation may have more time to donate, a younger generation of donors must rise to meet the coming need. Breaking down blood product usage between 2019 and 2021 showed stable red cell demand and a 3% decrease in platelet usage but a 16% increase in plasma and cryoprecipitate use. And platelet usage is expected to increase to meet the health needs of people aged 65 and older, who are anticipated to number over 88 million by the year 2050.
Blood establishments are rightfully held to exacting regulations and standards to produce the safest blood possible. However, blood collection and manufacturing costs must be acknowledged as additional safety measures–such as enhanced bacterial mitigation, new pathogen inactivation technology, or new infectious disease testing–are required. Additional factors such as hospital mergers and acquisitions have increased the bargaining power of health care systems, causing many blood establishments to operate with negative margins.
The myriad challenges faced by the Red Cross and other blood establishments will require continued and effective engagement with current donors while enticing new donors, as well as the flexibility to modernize supply chain processes, respond to the medical community’s requests for additional products like whole blood or cold-stored platelets, and innovate. What an exciting time to be in blood banking!
1. https://www.redcrossblood.org/. Accessed 6 Jun 2024
2. Tran MH, Niu C, Kelley W. Why are we donating less? Transfusion. 2024;64:1154-60. https://doi.org/10.1111/trf.17861
3. National Blood Collection & Utilization Survey. https://www.hhs.gov/oidp/topics/blood-tissue-safety/surveys/national-blood-collection-and-utilization-survey/index.html. Accessed 6 Jun 2024
4. The Red Cross says there’s a blood shortage nationwide. Here’s how you can help. https://www.npr.org/2022/01/11/1072154905/red-cross-blood-crisis-pandemic. Accessed 6 Jun 2024
