National Blood Supply Shortage: An Urgent Call to Action for Healthcare Professionals

Every two seconds, a patient in the United States requires a blood transfusion.¹ Whether for cancer treatments, surgeries, chronic illnesses, or traumatic injuries, 42,000 units of red blood cells, platelets, and plasma are required each day.¹

As recently as August 2024, the American Hospital Association issued a Special Bulletin highlighting the nation’s critically low blood supply.² This appeal echoed warnings issued by the American Red Cross, America’s Blood Centers, and the Association for the Advancement of Blood and Blood Therapies (AABB), highlighting how the national blood inventory was greatly impacted by severe weather, including the summer’s intense heat and a tropical storm causing floods, power outages, and travel hazards, as well as a cyberattack on a multistate blood supplier.

Unfortunately, this shortage is not an isolated event. As demonstrated by the AABB’s weekly blood supply report (see figure below), the supply of O-type positive and negative blood has been consistently below the optimal supply level since 2017 and has drifted into critically low levels every year since 2019.³ If handling day-to-day needs is challenging with the current low blood supply, a mass casualty incident from any cause—natural disaster or human action—could create an especially difficult situation due to the large amounts of blood required in a sudden-onset emergency.

Reprinted with permission from the AABB

In a 2020 report to Congress issued by the U.S. Department of Health and Human Services (HHS) entitled Adequacy of the National Blood Supply, the authors cite several reasons for continuing shortages, including “threats to the traditional blood donor recruitment model; financial and operating stress faced by nonprofit blood centers; a lack of an integrated data system to monitor blood collection and utilizations as well as donor and patient safety; emerging infectious diseases; challenges associated with the supply chain; and inadequate investment in research and innovation.”⁴

Reducing the Blood Demand

For the past two decades, great strides have been made to reduce the demand for blood products through the implementation of patient blood management (PBM) strategies.⁵ Initially applied to surgical patients, the goals of PBM programs were: “1) improving red cell mass, including treatments such as erythropoiesis-stimulating agents and iron and vitamin supplements; 2) minimizing blood loss, e.g., by optimizing surgical and anesthetic techniques, treatment with tranexamic acid (TXA), and autologous blood salvage; and 3) harnessing and optimizing the tolerance of anemia by promoting maximum pulmonary and cardiac function and the use of a restrictive transfusion threshold.”⁶ More recently, efforts have been made to expand PBM strategies into nonsurgical fields such as critical care, obstetrics, and in caring for heart and liver failure patients.⁶

Increasing the Blood Supply

Reducing the demand side of the national blood shortage equation alone is not sufficient to meet the country’s needs. As emphasized by the 2020 HHS report to Congress, recruitment and retention of blood donors is the most significant challenge facing blood centers today.⁴ Only 3 percent of eligible donors in the U.S. actually donate blood.¹ That donor pool appears to be shrinking over time, particularly in the age group of potential donors under 50 years old.¹ From 2019 to 2021, donations from individuals 16 to 18 years old decreased by 60.7 percent, and donations from individuals 19 to 24 years old decreased by 31.9 percent.¹ Disruptions of blood drives in high schools, colleges, and work places due to COVID-19 lockdowns and virtual study and work are inevitably to blame for much of these reductions.

As the existing pool of older donors continues to age, and more of them become ineligible to donate or they become donation recipients themselves, the number of younger donors required to replace them will increase. This dynamic is magnified even more among certain racial and ethnic minorities, where greater volumes of blood are needed due to a higher prevalence of sickle cell disease and other blood disorders. Blood matching within these groups is more likely to be compatible, resulting in less antibody formation (alloimmunization).

In the United States, the blood supply is almost completely dependent on volunteer donations. Researchers have cited different attitudes and values across generations to explain the variation in blood donation patterns among various age groups.⁷ Behind this theory is the idea that individuals born in the same time period have broadly lived through common events that have shaped their worldview and values. For example, World War II is often cited as having profound effects on the silent generation, born between 1925 and 1945. This generation of older donors is often characterized as more likely to value conformity, obligation, loyalty, and thrift.⁷

To engage younger generations (e.g., millennials and Gen Z) in blood donation, a deeper understanding of their values and worldview is needed. According to Eric Gehrie, MD, MS, a former executive medical director of the American Red Cross: “The earlier that we can connect with someone [the better]. [If] they donate in high school, they typically will become lifelong donors.”⁸

To increase the percentage of younger donors and increase the diversity (both ethnic and racial) of donors, the 2020 HHS report to Congress recommends:

Fund a national blood donation campaign designed to build a broad-based commitment to regular blood donation that achieves a diverse and robust donor base to meet patient needs. The publicly funded campaign should feature influencers reflective of the targeted groups below, as well as national leaders, and should run for five years to achieve sustained improvement.⁴

Which “national leaders” would have the most sway to drive home this message in today’s society? In survey after survey, nurses, veterinarians, dentists, medical doctors, and pharmacists rank among the most trusted professions in the United States.⁹ Because healthcare professionals are also most intimately connected to the consequences of not having enough blood to care for the patients entrusted in their care, are they not the ideal advocates to convince more people to become blood donors?

Healthcare Professionals Should Lead by Example

Albert Schweitzer, the philosopher and physician once said, “Example is not the main thing [in influencing others]. It is the only thing.”¹⁰ Healthcare professionals not only have the credibility and expertise to educate the public about the need for an adequate blood supply, but they are also in the best position to literally roll up their sleeves and lead by example. I encourage all clinicians to donate blood if they are able, and to talk to their colleagues, patients, friends, and family about the importance of blood donation.

For more information on donating blood with answers to frequently asked questions, see the American Red Cross resources, including the Be a Hero Donor Guide at redcross.org/give-blood.

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References

1. America’s Blood Centers. Understanding the state of the nation’s blood supply. January 10, 2024. https://americasblood.org/news/understanding-the-state-of-the-nations-blood-supply/
2. American Hospital Association, AHA Special Bulletin. Red Cross, America’s Blood Centers, AABB say U.S. faces critical blood and platelet shortages. August 7, 2024. https://www.aha.org/special-bulletin/2024-08-07-red-cross-americas-blood-centers-aabb-say-us-faces-critical-blood-and-platelet-shortages
3. Association for the Advancement of Blood & Biotherapies, Weekly Blood Supply Report. https://www.aabb.org/for-donors-patients/weekly-blood-supply-report
4. U.S. Department of Health and Human Services. Adequacy of the national blood supply. Report to Congress, 2020. https://www.aabb.org/docs/default-source/default-document-library/positions/hhs-report-to-congress-on-the-adequacy-of-the-national-blood-supply.pdf
5. Franchini M, Marano G, Veropalumbo E, et al. Patient blood management: A revolutionary approach to transfusion medicine. Blood Transfus. 2019 May;17(3):191-195. doi:10.2450/2019.0109-19. PMID: 31246561; PMCID:PMC6596379.
6. Franchini M, Muñoz M. Towards the implementation of patient blood management across Europe. Blood Transfus. 2017;15:292–3. doi:10.2450/2017.0078-17.
7. Scholz C. Generation Y and blood donation: The impact of altruistic help in a Darwiportunistic scenario. Transfus Med Hemother. 2010;37(4):195-202. doi:10.1159/000318023. Epub 2010 Jul 14. PMID:21048826; PMCID:PMC2928841.
8. Edwards E. Blood donations have fallen to catastrophic levels. Experts say young people need to step up. NBC News. January 14, 2024. https://www.nbcnews.com/health/health-news/blood-donations-are-falling-catastrophic-levels-young-people-need-step-rcna133430
9. Brenan M, Jones J. Ethics ratings of nearly all professions down in U.S. Gallup. January 22, 2024. https://news.gallup.com/poll/608903/ethics-ratings-nearly-professions-down.aspx
10. Schweitzer, A. “Albert Schweitzer Quotes: 61–88 of 88 Quotes.” QuotesCosmos.com. Last modified August 5, 2021. https://www.quotescosmos.com/people/Albert-Schweitzer-quotes-3.html#7

Our thanks to Brent Lee, MD, MPH, FASA. Dr. Lee is an anesthesiologist and the Director of Clinical Excellence and Performance Improvement at North American Partners in Anesthesia. Dr. Lee received a master of public health degree from the Harvard School of Public Health in Boston, MA, and previously served in the U.S. Public Health Service as an Epidemic Intelligence Service Officer at the CDC. He received his medical degree from Brown University School of Medicine, completed his anesthesia residency at Georgetown University Hospital, and completed a fellowship in trauma anesthesia at the University of Maryland / Shock Trauma Center. Dr. Lee is a Fellow of the American Society of Anesthesiologists (ASA) and serves on the ASA’s Committee on Trauma and Emergency Preparedness.

The opinions expressed here do not necessarily reflect the views of The Doctors Company. We provide a platform for diverse perspectives and healthcare information, and the opinions expressed are solely those of the author.

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