When donated blood is wasted

When donated blood is wasted

This week my toughest case involved futile care.  We admitted a patient with very advanced cancer, dying naturally at home on hospice. Because of last minute family intervention, the patient ended up spending 48 hours on super-max support, dying quite horribly with tubes and lines in every natural and unnatural orifice.  Liver failure, lung failure, kidney failure, bleeding, blood clots and overwhelming sepsis guaranteed, without any hope, that the body distorted by brutal medical care, four rounds of CPR, 23 doctors and $3000 per hour, ended in death.

As I relived this disaster, and tried to clear my head by running a few miles further on the treadmill, my focus fell on the concept of waste. The waste in the pain of the patient and family.  Waste of dollars and cents. The waste of valuable intensive care unit space, while the emergency room overflows with patients who could be saved. The waste in the time, expertise and energy, which burns out highly trained, passionate, medical personnel.

Moreover, my interest focused on a type of waste I have missed in prior similar cases. The loss and waste of a precious, special resource. The waste of blood.

I do not mean the patient’s blood, which spilled across gowns, bed and floor. Rather I mean the plasma, cryoprecipitate, platelets and red cells which where poured into and through the dying body.  Blood products, which, especially with the lull in summer donations, are so difficult to replace.

I have donated blood without being particularly introspective.  It is simply “the right thing” to do. However, if I am honest, I have this ideal fantasy of my gift making a difference.  Somewhere, there is a man, woman, maybe even a small child, who, in their moment of desperation, are given the opportunity, by me, to heal.   Perhaps, I am being naïve, but there seems to be a social contract that says that my donation will be used with respect and care.  I feel violated by the idea that someone may callously dispose of this given part of me, in a futile battle, or even worse use my blood to amplify suffering.

I know it is time for me to grow up and realize that I live in a complex society and understand that others will use my contributions according to their definition of need.  I buy into an insurance pool, some of which is used for poor quality care.  I pay taxes, which are not always used as I might wish.  I accept sending my kids to schools, which may teach somewhat differently than I might choose. We all lose some element of personal freedom each day, in order to guarantee the safety of the whole.  I should relinquish any emotional attachment to that which is donated, realizing for it to be truly be a gift, it must be without bond.  However, somehow, the personal nature of wasting blood donations sticks in my craw.

I do not have a real solution for this problem. It is not practical to require a family in crisis to replace the donation, and I am not certain that would address the squander of a magical resource, nor the societal harm that comes from breaking a contact based on healing.  Nonetheless, perhaps this dilemma opens up another way of measuring futility. Not in money, nor in the willingness to suffer or cause suffering, but might we measure whether care is reasonable or necessary, by our willingness to consume such a perfect resource?

As an extreme example, what if this family had demanded a liver transplant?  How about a kidney? Open-heart surgery?  These would be ridiculous requests. Wasting blood seems less a waste, because it is easier to replace.  Nevertheless, what about if we were all more conscious of the true “cost” of the care we were demanding and the societal obligation we are assuming.  Might we be more cautious of what we request and what we are willing to “spend?”

Societies, like very large families, sacrifice and care for one another. However, we must never forget that in that web of life there is not only a responsibility to provide, but also for what we demand.  This balance, this obligation, creates vitality in our community and provides life to all of us.  We risk the whole when we assume precious gifts are ours to waste.

James C. Salwitz is an oncologist who blogs at Sunrise Rounds.

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  • Marc

    Why on earth did you admit him?

    • Mark S.B.

      Because this person was dying quite horribly with tubes and lines in every natural and unnatural orifice. This means bodily fluids where coming out of every orifice. That’s why they admitted this person, you idiot.

      • http://joannevalentinesimson.wordpress.com/ ValPas

        Mark, read carefully. The patient was dying naturally at home on hospice care. Some hysterical family member no doubt sent for the EMS and they had to admit the dying patient. Probably that family member had not given enough attention or love to the patient previously and was on some extreme guilt trip and willing to sacrifice the patient’s comfort and society’s resources so s/he could say “We did everything we could for …”

  • Jan

    Some doctor (or NP, PA) ordered the blood transfusions, right? Not the family. Not the patient. A doctor. Why? Was it easier to waste the resources than to have a difficult talk with the family or patient? (And I ask this as a regular blood donor; it takes at least an hour out of my day to donate, and I can’t do my usual sports for about 24 hours after. Why did a doctor waste my blood?)

  • drgn

    Somehow this seems like a bad metaphor of what is happening in US healthcare. All kinds of waste that is akin to wasting ones blood.

  • Guest

    This happens daily, probably at hundreds of hospitals around the country. I can’t count the number of futile cases I’ve been personally involved in where blood/blood products/OR personnel/OR time/hospital staff/hospital personnel/health care resources were a complete waste.

    Yet this country is such a mess that any discussion of “rationing” summons Sarah Palin and her ilk to screech about “DEATH PANELS!!!!”

    • Guest

      Sarah Palin is the former one-term governor of one of our least-populated states, and a lady who ran for vice president more than five years ago and lost.

      Why are you still letting her live in your head rent-free like this?

      • Guest

        Ok, obviously you missed the forest for the trees; sorry to mention Sarah Palin. The point of the post (since you missed it) is that futile care and wasting of resources is nothing new. However, this will continue as long as Americans demand everything be done no matter how futile or at what cost (unless they are footing the bill, of course, and then it’s a different story).

        Is that better?

        • Lola

          Which is only one reason that medical savings accounts are a better option than insurance.

          • Disqus_37216b4O

            Absolutely.

  • PoliticallyIncorrectMD

    Any heroic / life sustaining measures including CPR, mechanical ventilation, hemodialysis or blood transfusion (which is essentially tissue transplantation) should only be offered to selected patients and only as a bridge, while underlying medical condition is being mitigated – which is clearly not the case when somebody is dying from advanced cancer. Unfortunately, our culture of political correctness morphed common-sense-based healthcare delivery into restaurant-like service where patients and families are entitled to pick and choose form the menu of services, usually without regard to indications and cost and frequently without paying for it. What is even worse that medical community is accepting this in attempt to increase patient satisfaction scores and to avoid litigation.

  • EmilyAnon

    If a patient has an advance directive that says no heroic measures or other such legal wording, will the doctor/hospital cave in if the family objects to the clause? In another thread here, some doctors suggested that, fearing a lawsuit, this can happen. Which makes me wonder how binding is the advance directive.

    • Peta

      In Florida, you can have an Advance Directive which some people call a “Living Will”, and you can also appoint a Healthcare Surrogate. You can do one, the other, or both. I’m not sure what happens if your Living Will says “no heroic measures” but your healthcare surrogate (if you’ve named one) says “no, no, do everything to save her!”

      To my mind, the Advance Directive that you’ve signed while still “of sound body and mind” should rule the day, but knowing our legal system it wouldn’t surprise me that if a family member is insistent enough, a doctor might over-ride it. The dead and dying don’t sue; the living and aggrieved might.

      • f. lusu

        on my first appointment to see my new GP, i noticed that along with the usual paperwork, there was living will form to take home and fill it out if we wanted to. it would then go into our chart. it was a good opportunity to have discussions with all my family members and for me to appoint the toughest one to do as i directed. do most GPs give out such forms?

        • Mike Trene

          It was my lawyer who gave me a packet of living will information and forms, when I went in to have him help me prepare a will. He said “As long as we’re planning for the future, it’s probably a good time to think about this as well”. I filled out the living will, and had it witnessed at the same time and by the same people who witnessed my will-will. I didn’t involved my doctor at all (I don’t really have a doctor anymore anyway, just a rotating “team” of “providers”).

  • Mark S.B.

    Would it have been better to use more morphine and save the blood and let this person die with dignity. For what reason would people want to expand the life of a suffering person.
    Its sick to extend suffering of a person, especially in a person this sick.
    Let them go and stop the suffering, they’ve suffered enough.

    • http://joannevalentinesimson.wordpress.com/ ValPas

      I so agree! See my response above.

  • http://joannevalentinesimson.wordpress.com/ ValPas

    This is SUCH a good article. I may link it in a blog I do on Caring for Your Body. The waste of blood is a fine metaphor for our wasteful, throw-away culture and our cavalier disregard for limited resources of the planet. The suffering patient becomes a metaphor for what our children’s children will suffer as a consequence of our waste.
    The elderly need to take back control of the end of their lives. When I turned 50, I made a Living Will, and I told my children, “From now on, if anything serious happens to me, I do not want ANY extreme measures, please.” I had had a very good life till then, and I figured that the rest was just gravy and shouldn’t be a cost to society.

    • Mark S.B.

      ValPas, I suffer from chronic pain and I know what its like to have ongoing intractable pain in my body I cant do anything about for the past 20 years. When my time comes I want to die with dignity, I suffered enough in this life time for 5 people. I don’t want my life extended only to suffer more. I’ve had a good life, I’m 57 now, have my ongoing chronic pain under control but its sure getting old.
      I feel bad for any person suffering and a family member extends their life, thinking don’t give them anymore morphine they may get addicted when their about to make a spiritual graduation.

  • bill10526

    An excellent post. As a society we really can’t afford the open ended commitment to “family concerns”. This post shows how “wasted dollars” are tied to real objects, such as the community blood supply.

    • Guest

      It scares me that you put “family concerns” in airily dismissive scare-quotes.

      Are you one of these who thinks the government should take the place of the family?

      • bill10526

        Actions are constrained by physical laws (No one can go faster than light.), the market (I can’t afford a BMW.), and laws (I can’t punch someone in the nose willy nilly.). In end of life cases all the constraints are turned off if some in a family are ungrounded in reality. To frame the issue as a contest between families and government does not make sense. Just consider the actions of Charles Manson’s hippie family.