Sunday, September 24, 2006

A UNIVERSAL QUESTION

If you know yourself to be a universal blood donor, one whose donated blood can be used by others regardless of their blood type, are you obligated to refrain from doing anything that might take you out of the donor pool?

An e-mail from Melanie McDonald, a reader in Stanton, Calif., raised that tricky question.

McDonald has O-negative blood, making her blood compatible with people of any other blood type. Now 50, she has been donating blood for more than 15 years. She also likes to travel, but is hesitant to go abroad because she worries about the medications and vaccines that she would have to take to avoid diseases such as malaria and hepatitis.

"I think this would restrict my being able to donate blood," she writes. "Morally, I feel I have an obligation to keep my blood `pure."'

She's quite right, but the restriction has nothing to do with any medications she might take. After returning from countries where malaria is a problem, donors are supposed to go a year without showing any symptoms before they resume giving blood, regardless of whether they took antimalarial medications before traveling.

Does McDonald have a responsibility to refrain from visiting such countries because she is a universal blood donor? Of course not.

The right thing for McDonald to do -- for any traveler to do -- is to take the appropriate medications and to not expose herself recklessly to any diseases she might inadvertently bring back into her country. She should also make sure to alert blood banks to which she's been giving blood that she will be unavailable for a year.

Even if McDonald did spend her life trying to keep her blood "pure" so that it would be ready for donation, there's no guarantee that she'd be successful -- as she learned a few years back, when she was deemed too anemic to donate. Although McDonald is among what is estimated to be only 1 in every 15 people in the United States who have O-positive blood, she should not be expected, by others or by herself, to lock herself up to keep from being exposed to anything that could possibly taint her blood.

Sure, if she's torn between traveling to a country that has a history of malaria and one that doesn't, I'd encourage her to choose the former. But she has no ethical obligation to do so.

She shouldn't worry about setting a bad example for others, either. Even if she takes an occasional year off from giving blood, the fact that she's been regularly donating for almost two decades and plans to continue to do so is behavior for others to emulate, regardless of their blood type.

5 comments:

Carroll Straus said...

"Pure blood"

I have to wonder about the motivations that drive someone to ask a third party to relieve them of an obligation that have imposed on themselves.

We all have an inner moral ccompass that defines how we interact with the world. (Leaving aside the difficult issues of sociopathic personalities.) If it is wrong for me to hurt animals in any way, I cannot have my cat declawed. If my neighbor grew up on a farm and saw animals branded or neutered every day and sees this as an ordinary acceptable fact of life, she can have her cat de clawed without loss of HER moral compass.

Neither is more ethical than the other.

If someone who has donated blood for the majority of her adult life truly regards this as a moral obligation, it is. If her true question is, "have I paid my dues, and may I now act to suit myself?" the answer may be yes-- or it may not. Only SHE can make that call!

Anonymous said...

I read with special interest the woman who feared to travel because she has type o negative blood and did not wish to get any disease that would limit her ability to continue to be the selfless donater she is. However, there is another reason she should be concerned about potential illness: that she is highly likely, both in the United States, but even more so when traveling in other countries, to be unable to RECEIVE blood. Search the web on type o-negative and you will find it full of warm statements that it is the universal donor, and that such people are "very special." The thanks ring hollow when you know how o-negs are treated when they get ill. The universal donor is also the most limited recipient. In countries where there is not a highly organized blood donation system, the concerned o negative traveller should be aware that she is likely to die if she gets into a situation where she needs blood herself because none will be available to her. When living overseas, I came home to have a baby even though an acceptable hospital and doctor were available to me because the black market in healthy o-neg blood is so ubiquitous that I was told by health professionals that the only way to assure a donation was to find an o-neg friend, and have them be at the ready for an arm to arm donation in case of emergency. If my friend were to go to the hospital lab and donate, they would have had to personally stay with the blood bag every second from the donation to my arm because at any moment, someone could walk behind the screen, switch the bag, and who knew what blood I would receive. Of course, an autologous donation would have been a joke. While the United States is better, and organized, they also divert blood wastefully away from those precious o-neg donors when they need it. Whenever any blood bank says they are running out of blood and rationing, it is without question that what they really mean is that they are running out of o-negative blood and they are rationing that one, including rationing health care to o negative patients in ways they would not ration it to patients with other blood types. It is already a standard of medical ethics question: If an o-negative patient is critically ill, and who if they were any other blood type would undoubtedly recieve aggressive intervention, may be denied the blood that they need because it will be given to other people because the o negative blood they need is critically needed for emergencies for other blood types. Much of this occurs because someone did not bother to type other people's blood. We all are asked when we go to the hospital dozens of questions about our medical history, but they rarely ask what our blood type is, and do not display it prominently anywhere on our records. This is simply sloppiness, laziness, and waste of precious blood. They know our allergies and what medications we take, and they certainly know our health insurance provider. Why can't blood type for every patient be as prominently known? If everyone had their blood type on their insurance card, you better believe the hospitals would know what is was. If it was tattooed behind everyone's ear, the blood shortages, meaning the o-neg blood shortages, would practically cease. All organ recipients on waiting lists are waiting for their chance at life, but an o negative on a waiting list is almost certainly waiting for an organ that will never come. When the o-neg first becomes ill, they are not at the top of the list, so any o negative organs are sent to recipients with other blood types until the o-neg is very ill, and once the o negative is finally to the top of the list because they are now the sickest, they are likely to die before another o-neg organ is available for them, or the o-neg has become so ill that the medical "ethicist" may be afraid to waste that last o-neg organ when someone else has a better chance. In spite of this incredible unfairness, the American Red Cross has done nothing to encourage people to have EVERYONE's blood type placed on their driver's license, or have blood types prominently displayed on EVERY medical chart or on EVERY health insurance card. Don't tell me they are worried about health privacy: The American Red Cross routinely sends postcards through the mail to o-negatives to remind them to donate regularly with their o-negative blood type diplayed prominently on the postcard. They are clearly not a bit worried about health privacy of their "special donors." So they ask this 6 - 8 pecent of the population to donate again and again, thanking them for being so special. And o-negs do, they donate blood at between a 30% to 50% higher rate than the rest of the population, Then the Red Cross and the Organ Donation organizations let them die by their negligence to to take any action to limit the wasteful use of this precious resource. How ethical is that?

Cybercepter said...

You noted O-Positive Blood 1 in 15

Anonymous said...

I have O Negative CMV negative blood, and donate regularly.

The post made by another Anonymous person above, from Sept 25 2006 mentions a /lot/ of my concerns.

I always wonder if a lot of O Negative blood is used in situations where there /is/ time to type the blood of the recipient.

And I wonder what will happen if I need blood in an emergency situation.

So I donate. Hoping that /this/ pint that I donate today will help someone else with my rare blood type. But deep down I know it is more likely going to help some random person who has never given blood donation a thought, who /doesn't/ have O negative blood.

And each time I donate, I feel a little more like a sucker, and a little less likely to donate the next time. Those chipper little cards that declare me a hero might work better if there was a little discussion of ANALOGOUS donation. Which is something I'm going to start looking into.

A Pint /this/ month for me. A pint two months from now for everyone else. That's what I'm going to shoot for in future. That might be easier for me to get behind.

Anonymous said...

I am O Neg / CMV Neg as well, of course that is neonatal/baby blood.

I also worry if in an accident that I would then become CMV positive, because I would be quickly given O-neg of the general population - but life is more important than a predominantly latent virus so I will take the chance.

The banks use our O/CMV neg blood for the a very specific need so I am happy to give.

Once someone recieves blood, I have witnessed they are eager to set up drives and encourage friends and family who have never participated to give, because suddenly they are aware of blood donation and that it saved their life.

Tamrah R

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