Q: Which tissue transplant is the most common and has an enviable history of success?

A: Type-specific blood transfusions.

The student closed her eyes against the sting of the needle and, when it came, was neither disappointed nor surprised at the minor discomfort. The lancet in her finger to obtain her hematocrit had almost been worse but this would last longer.

The technician placed a soft rubber ball in Ann's hand and demonstrated the proper squeeze to keep the blood flowing without pushing the catheter from the vein in her elbow. The scrub-clad woman then turned her attention to the student on the next lounge chair. Ann watched curiously as the tubing was severed and blood directly from her friend's arm was drained into several plastic vials.

"What's that for?" Carmen asked, looking a little queasy at the procedure. She sighed as the needle slid from her skin, applied pressure to the wound, and raised her arm when instructed.

"Samples for the lab to test for AIDS, hepatitis, CMV, and West Nile." The phlebotomist lifted the pint from the rocking device, removed labels from the bag, and placed them, the unit and the sheaf of paperwork on a counter top. She proceeded to squeegee the tubing, forcing the blood back into the primary bag and letting it refill. With an ease suggesting practice, she pinched the tubing in a sealer, creating inch long segments that she folded into a rubber band.

Ann noticed that the donor bag had several smaller bags dangling from a different length of tubing. "What are the other bags for?"

The worker glanced at the rocker beneath Ann's lounger, poured a Styrofoam cup of orange juice and placed a couple Oreos on a napkin. "Your friend's blood... and yours, too, will be split into parts. We call them components. We'll spin the bag, squeeze off the plasma and freeze it. Then we'll separate the platelets, which are good for helping people stop bleeding, and put them on a rocker until they get transfused. Finally, what's left, the packed cells, will be put in the fridge."

She bandaged Carmen's arm and said with a smile, "It looks fine but no bowling, weight-lifting or javelin throwing today. Okay?" She adjusted the back of the lounger so Carmen was upright and gave her the cup of juice and the cookies. "Feel okay?" Carmen nodded and started in on the snack.

"Can you tell me what kind of blood I have?" Ann asked, wondering if her bag was almost full. Her elbow ached and she felt a little funny.

"Red." The technician squatted to fuss with the rocker. "You're doing real good. More than half way. The secretary will send you a donor card when all the testing is done."

"Good. I'll need that to get the credit." The sociology teacher had given them a choice between donating blood, tutoring a help session for an underclassman, or working a meal in a soup kitchen. At the time, donating seemed the easiest choice.

She, too, sighed with relief when the needle was removed. By that time, someone else had taken Carmen's place and another was waiting to take hers. The teacher had stressed how important volunteerism was to a free society. Though the procedure hadn't been as easy as she'd hoped, it also hadn't been as bad as she feared. She'd complied... But there was no way she'd do that again.

Experiments with blood transfusions have been documented for several hundred years but the procedure became much safer after 1901 when Karl Landsteiner discovered human blood groups and described a method to match donor and recipient. The Austrian was awarded the Nobel Prize in Medicine in 1930 for his groundbreaking work in immunology. Since then more than twenty other genetically determined blood groups have been found, but Landsteiner's ABO and, later, his Rh typing remain the most important.

A person's blood type is determined by testing for the presence or absence of certain proteins called antigens, which are part of the cell surface, and antibodies, which float in the serum between. These are the A or B antigens, and anti-A or anti-B antibodies. AB people have both antigens and neither antibody, and O types have neither antigen and both antibodies. Most people are Rh positive, while the rest are Rh negative. This means that there are eight primary blood groups: A+, A-, B+, B-, AB+, AB-, O+, and O-. In transfusions, blood bank technologists prefer to give exact matches, though O type packed red blood cells can be given to any recipient in an emergency as long as the Rh type is the same.

Most blood transfusions are of packed cells. The plasma is separated and given to patients needing fluid replacement for which saline and dextrose solutions are insufficient. Burn victims and patients undergoing long surgeries, like organ transplants or open-heart procedures, benefit from the proteins, salts, and additional clotting factors in FFP (fresh frozen plasma).

Platelets, which aid in clotting, are ruined by refrigeration and have a short shelf life. Leukemia and chemotherapy patients are the usual recipients.

In recent years, new technology has made it possible to collect the blood lost during surgeries and, after filtering, return it to the patient. Since a person's own blood is the safest, salvaging makes sense. Autologous donations, where the patient banks units of his own blood prior to elective surgeries, also eliminate the possibility of transfusion reactions or incompatibilities.

Except for these special circumstances, the complete blood supply in the USA is donated by volunteers who, for a cup of juice, a couple cookies, and maybe a pizza coupon, spend an hour at a blood bank collection center or some public blood drive event.

Forty percent of all Americans are deferred from donor eligibility by medical history, current circumstance, recent travel itineraries, or life-style choices. Of the qualified sixty percent only a fraction have ever donated blood and even fewer donate regularly. In addition, many of these hardy souls are growing older, becoming infirm and ineligible, and are not being replaced by our younger citizens. The blood supply rarely exceeds demand and, with increasing frequency, sometimes falls far short of safe margins.

Blood alternatives are far from perfected and even the more successful compounds have fallen far below the expectations of developers. Research continues in chemical substitutes and interspecies transfusions but, for now, human recipients require human donors.

About 37,000 units of blood are used daily in this country. Nearly five million Americans will need to be transfused this year. During shortages, hospitals make hard decisions about how to assign the limited supply to the needs at hand. Elective surgeries that occasionally require a transfusion are postponed and when scheduled, in many cases, units of blood will be crossmatched to several patients where the likelihood of transfusion is low but not nonexistent.

This frees units for patients in which there is no choice but to transfuse or in which without transfusion the person will not survive. Cooperation between facilities has, so far, prevented the situation where doctors must decide to withhold transfusion for one patient so that another can benefit. But that day is coming.

Most of us will never need a transfusion. But wouldn't it be nice to know that, if we - or loved ones - do require blood, the nearest hospital will have a safe supply of the right kind?

With the holiday season upon us make time to reflect on the spirit of giving. What better gift than renewed hope for a family praying for the young victim of a car accident, a chemotherapy patient with the soul of a survivor, or an innocent child with leukemia who wants to be home for Christmas?

Since most blood donated locally stays within the community, it is our neighbor and not some faceless stranger who benefits from this selfless act of giving.

One hour. Twice a year. Minor discomfort. Major impact. Donation is a quiet way to change your world for the better. Heroism made easy.

You can be too busy or too afraid. You can make a vague promise to look into it after the next deadline or upcoming family occasion. You can forget because until it happens close to home the blood shortage will not affect you. Or you can be a volunteer and give the gift that nothing else can replace.

What type are you?

General Requirements:

Age: 17 (16 yo with consent of parent)
Weight: at least 110 lbs
Diet: A meal within four hours of donation
Health: General good health. No cold symptoms. No tattoos or piercings within one year.
Travel: No travel to certain destinations within various periods of time. This rules out malaria, mad-cow disease, and certain other acquired disorders.
Identification: Picture ID preferred.
Medications: Consult your local center.

References

Various articles, The American Red Cross

Blood Typing, Nobel e-museum

What are Blood Transfusions?, Genetic Science Learning Center

FAQ's, American Association of Blood Banks

Donating Blood, NetDoctor

Blood Transfusion, Discovery.com

Lisa Binkley works within the medical industry and is the popular author of this health series in the Kudzu Monthly. She also serves as the fiction editor of this ezine, edits for the online sci-fi magazine Distant Worlds, and maintains her own site for her fanciful sci-if work called Jolie Howard Fiction.

As Lisa phrases it, "Woman, wife, worker, writer. We all wear many faces and fill our niches as best we can."