New blood

Last year, I donated blood for the first time.

My blood type is O+. As the most common blood type, both in the United States and globally, it tends to be hit hard by shortages. This is due to the fact that O+ blood can be given to anyone who is Rh-positive, but people who are O+ can only receive that or O- blood.

I wanted to do my part and help someone in need. The donation itself was fairly easy, taking roughly ten minutes. Afterward, I was given juice, a cookie, and a T-shirt. I'm not going to pretend everything went smoothly—I started feeling faint on the way home—but seeing where my donation went made it all worthwhile.

"The die is cast"

Historically, blood donation—and indeed, blood transfusion—were not nearly this easy. The circulatory system wasn't even truly understood until the seventeenth century, when English physician William Harvey disproved the long-accepted theory, held in the West for roughly fifteen hundred years, that blood was created in the liver and ebbed and flowed throughout the body like the tides. Harvey had reservations about how his new theory of continuous circulation would be greeted, writing in his seminal work De motu cordis,

". . . I not only fear injury to myself from the envy of a few, but I tremble lest I have mankind at large for my enemies, so much has wont and custom become second nature. Doctrine once sown strikes deep its root, and respect for antiquity influences all men. Still, the die is cast, and my trust is in my love of truth and the candor of cultivated minds."

Several decades later, in 1667, the French physician Jean-Baptiste Denys performed the first recorded transfusions on human subjects—albeit with non-human blood. However, it was only in 1818 when the first human-to-human transfusion would be attempted by James Blundell. His experiment was a success, but I need to stress that it was an extremely lucky success. Matters of germ theory and pain control aside, there was another problem that would lead doctors to view blood transfusion with skepticism for the rest of the nineteenth century.

New knowledge

Successes like Blundell's were rare. The majority of transfusion patients did not survive—a situation that persisted after germ theory and anesthesia went mainstream—and doctors were at a loss to explain why. By the late nineteenth century, most were unwilling to perform a procedure that seemed far too risky.

This changed after 1900, when Austrian physician and researcher Karl Landsteiner discovered the existence of several different blood types. This, combined with his later discovery of a protein called Rhesus factor, led to the realization that blood incompatibility had caused those patient deaths. This new knowledge paved the way for transfusion to become the routine medical procedure it is today.

However, blood transfusion is highly reliant on blood donation. Approximately 118.5 million donations are made globally each year. This may seem like a lot, but someone needs blood every two seconds just in the United States alone. The situation is worse in lower-income countries. According to the World Health Organization, there are at least sixty countries that, for every thousand people, collect fewer than ten donations.

Safety is another factor. In high-income countries, nearly 100% of donated blood is tested for diseases such as HIV, syphilis, and hepatitis. Low-income countries, by contrast, have an average testing rate of 76%. There is also a greater risk of infection from dirty catheters or tubing.

What can be done?

Obviously, we've come a long way from the days of James Blundell. We know that blood transfusions can be performed safely, but two problems still present themselves: the lack of training and clean equipment, and blood shortages stemming from what I can only characterize as sheer apathy on the part of potential donors.

So, what can be done?

One possible solution is to incentivize blood donation. This, however, is potentially dangerous. It takes roughly four to eight weeks for the body to replace the donated red blood cells, and someone living in a country with less oversight could conceivably sell more blood than their body can tolerate. It also introduces an ethical concern. Is it really a donation if you're being paid?

A truly good substitute

But what if we didn't actually need blood to save a life?

This question has been asked since William Harvey's day. I've already talked about the use of sheep's blood in the first experimental transfusion—other fluids such as milk, wine, beer, and even urine (!) have been suggested as substitutes through the centuries. The problem is that none of these are able to perform any of the functions of blood.

It's not simply a matter of replacing one fluid with another. Blood transports oxygen and nutrients throughout the body, helps to regulate body temperature, and forms clots in wounds, among other things. When you take white blood cells, platelets, and plasma into account, it becomes quite clear that blood is too specialized to be replaced by just anything. A truly good substitute would have to be able to imitate these capabilities, something that has eluded researchers for years.

Until, quite possibly, now.

A long road ahead

In May, it was announced that researchers at the National Defense Medical College in Japan have created artificial blood using synthetic hemoglobin and platelet substitutes. In testing on rabbits, it has shown the ability to transport oxygen, as well as the ability to clot. Compared with real blood, it does not require refrigeration and comes in the form of a powder that just needs to be mixed with sterile water. This makes it easy to transport to poorer countries, field hospitals, and areas hit by disasters. The icing on the cake? It is truly universal. Anyone with any blood type can safely receive it.

This would solve the issue of blood shortages and significantly decrease the need for testing. It is still in its trial phase, however. The Japanese researchers are moving toward expanded animal testing, with the goal of starting human trials in the next several years. We still have a long road ahead of us. While we wait for the results, I have a request. If you are a healthy adult, please consider giving blood. Ten minutes can save a life—and you even get a free cookie out of it.