Why is it important to donate blood? What is transplantation, which many people still consider a taboo topic? Who gets a new kidney or heart first? How to tell the bereaved family that their beloved relative is brain dead, so they should allow his organs to be removed as soon as possible and save more of his fellow human beings? These were the issues discussed by a member of the Budapest Medical Students’ Association (BOE) at the Corvinus University in late November.
“Blood donation is essential for the maintenance of health care, and modern medicine cannot function without it, so we are actually at the mercy of blood donors’ altruism”, said Márton Falus, a fifth-year medical student, member of the BOE, who gave a lecture at the university at the invitation of the Young Autonomous Economists’ Association (FAKT). He said that although there are experiments at Harvard to produce human blood, the method currently used costs such an astronomical amount of money that donating blood is the only option for now. He then briefly recalled what we learned in high school biology class about blood groups and the components of blood. He talked about red blood cells, white blood cells and platelets (thrombocytes). He explained that the vast majority of blood donated by donors is used for surgery, with the rest being used for various medical treatments. Blood shortages can mean that operations are cancelled, so it is important that as many people as possible donate blood.
Does everyone know their blood type?
AB negative is the rarest blood type, and although all blood types can be used, of course no one can receive blood with a foreign antigen. Inadequate blood can even kill a patient who needs a blood transfusion for one reason or another. One of the most serious mistakes a doctor can make is not checking a patient’s blood type before a transfusion, he said. The speaker was pleased to see that almost everyone raised their hand to answer the question: who knows their blood type? As it is known, blood groups were discovered by Austrian physician, physiologist and immunologist Karl Landsteiner in 1901, and he was awarded the Nobel Prize in 1930. Falus pointed out that it is also necessary to get as many people to donate blood as possible, because blood components such as platelets can only be stored for 5 days, whereas plasma can be frozen. Plasma is the liquid component that makes up about 55 percent of our blood. The protein in plasma is the raw material for life-saving medicines, which are needed by thousands of patients.
The next question was who can donate blood. Only people aged between 18 and 65 who weigh over 50 kg can donate blood. Women can donate four times a year and men five times. Taking certain medicines can exclude you from donating blood, the list of which can be found on the National Blood Service website. Falus immediately added that a common misconception is that people who take contraceptives cannot donate blood. The amount of blood in the human body is about five litres, of which 500 ml is drawn when donating blood. A healthy person (a medical check-up is a precondition for donating blood) can easily cope with this, but of course you should drink plenty of fluids before and after, and you should also eat well, but not too much fatty food. You don’t get paid for donating blood, but you do get a food voucher – which is not really why anyone does it, of course, but to help the sick.
Disqualifying reasons for donating blood may include low haemoglobin levels (anaemia), acute bleeding inside the body, iron deficiency and B12 deficiency. “Today, many people lead a vegan lifestyle, so they have to get their iron from alternative sources, as the average person usually does from meat. If you don’t take iron supplements, you will recover more slowly from any illness, for example. In the case of a meat-free diet, instead of browsing the internet, it is best to ask a dietician how to supplement iron,” suggested Márton Falus to the students.
Kidney transplantation is the most common
According to Falus, transplantation is still a taboo topic, yet it is one of the greatest achievements of modern medicine. Today 12,000 people in Hungary are living with transplanted organs, and they have every chance to live a full life, so much so that there are even long-distance runners, living in other countries. And among the donors, there is also an ultramarathoner – running 230 km with one kidney is no mean feat.
He then described the types of transplantation. There is the so called autograft, which means that the patient’s own organ is transplanted: for example, in the case of a blockage of a blood vessel, a piece of the saphenous vein (the varicose vein running down the inside of the thigh) is cut off and transplanted where it is needed. Allotransplantation refers to human-to-human transplantation, while xenotransplantation refers to transplantation from another species (animal source). Pigs are used for this purpose because they are genetically very similar to humans. In the long term, the real solution may well be to regenerate our own organs, but that is still a long way away.
In Hungary, the most common is kidney transplantation. Of course the immune system must match between the two people, otherwise the transplanted organ will be rejected. The kidney is a paired organ, so a living donor is conceivable here, as it is possible to live with one kidney (and even in liver transplantation, a living donor is possible, as the liver has the ability to grow back if a piece of it is removed) A living donor must be genetically related and have a close emotional connection to the person to whom he or she is donating. The ethical regulations are very strict, and no one can sell their own organs for money – but we know that in poor countries, unfortunately, organ trafficking is thriving.
A particularly difficult medical communication task
Of course, we have a shortage of transplantable organs, and the fact that an organ can be kept in a bloodless state for only a few hours reduces the chances, so there is often not enough time to get a transplantable liver from, say, Germany to our country. Many people are waiting for a transplant on the transplant list, most of them for kidneys. As Falus explains, preference on that list is given to those who “benefit the most” from the particular organ, so the sad truth is that those over 65 years old who are waiting for a transplant have little chance. But of course, in the case of a match, it also depends on the condition of the person and how long they have been waiting for the new organ. It makes a big difference that 9 years after joining the EU, Hungary became a member of Eurotransplant, founded in 1967 (there are 7 other member countries), so we have a much wider choice of organs.
In Hungary, the principle of presumed consent applies, so if a person does not declare during his lifetime that he does not wish to donate his organs to another person after death, he is deemed to have consented to the donation of his organs to a person in need. This is what the law says, but as Falus explained, in practice, after the brain death of a patient in hospital, it has to be independently determined by three different doctors none of whom can be the patient’s treating doctor. The proper information of relatives is just as important. As he pointed out, this is a particularly difficult medical communication problem, as the bereaved family needs to be convinced that the organs of their loved one can save up to five people. Hospitals are entrusting this task to highly experienced specialists – and the decision has to be made quickly, because there is a short time before a transplant is even possible.
Then there came questions from the students, which revealed that many of them have already donated blood.