I spent this morning donating a bag of platelets down at my local Red Cross donation center.  Indeed, an irascible and churlish old fool like me occasionally does things other folks would consider charitable. 

But this isn’t to pat myself on the back.  I gave because much was freely given for my son when he recently had to endure his second bone marrow transplant.  Two blood drives were held in his honor, one by his high school and one by our church.  A total of about 200 pints were donated.  He didn’t need all that blood (thankfully), but probably used about half as much as was donated.  Some days he got two and three infusions of platelets, and for about six weeks, he got about a bag a day of red blood because he was bleeding out about a bag a day through his bladder.  A bone marrow transplant ain’t for sissies, especially not the second one.

I’ve decided that I’m gonna do all I can to pay it backward.   At about 5 bags of platelets and five bags of whole blood per year, I’ll need about twenty years to give it all back.  If I can keep on the schedule, I’ll be about sixty-seven when the debt is repaid.

Both of the blood drives in honor of my son got their impetus from an incident in the first part of December last year.   The chemo that had destroyed his old bone marrow (and hopefully any remaining leukemia cells with it) had, of course, also destroyed his ability to make platelets.  Platelets are one of the three primary blood components (red blood that carries oxygen, and white cells that fight disease are the others), and are absolutely necessary for coagulating the blood such that it stops bleeding. 

On the morning of December 6th, my son’s combined blood count showed only 8,000 platelets.  The normal level for platelets is about 200,000.  Anything below 10,000 is considered critical for anyone with active bleeding.  A teenager will go through about 30,000 platelets in a day’s time, which is the roughly the amount infused with one bag. 

The lab sample was taken at 4:00 am.  By the time I arrived in my son’s room at about 6:00 pm, it looked like a slasher movie’s protagonist had visited.  There was blood everywhere.  His nose had begun bleeding at about noon that day, and without platelets–he’d surely used all that he had by then–there was no way to stop it.  Yet he still hadn’t gotten any platelets.  The doctor on call said there was a platelet shortage holding things up.

I was furious.  There is no excuse for not having secured a steady supply of platelets if you are a doing a bone marrow transplant.  Absolutely none.  If you think you won’t have enough platelets, then you shouldn’t do the transplant.  But even if you thought there was a good supply and found out otherwise later, and you have a bleeding kid that has effectively no platelets, you should be telling the world of your predicament so that it can be quickly resolved.  The doctor just sort of shrugged his shoulders and ignored it.

I immediately set out to secure the kid some platelets, and so set up an account for his benefit at the Red Cross, telling everyone on CaringBridge (the website that allows people to keep up w/ a patient’s condition) to donate if they could.  I told the doctor he would not have as an excuse anymore that he couldn’t find any platelets.  Gracious donors emerged from everywhere.  Platelets were never again an issue.

Platelets are a part of what’s donated when a person gives a pint or so of whole blood.  But very little of a pint of whole blood is platelets, maybe a teaspoon.  The Red Cross separates whole blood after donation into the red, platelet and plasma (white cells, etc.) components, and can add the platelets of several donations together to get a full bag.  But the better way to get platelets is to use apheresis during the donation, so that only platelets are harvested and the red blood is returned to the donor.  Since the body generally makes far more platelets than it ordinarily needs, and replaces them continually (platelets only last five days), platelet donations can be made much more frequently than donations of whole blood.  But it takes longer to donate–about two hours total for platelets, but only about half an hour for whole blood.   And it is far more uncomfortable, as the donor must sit with a needle in each arm, which are held immobile for the duration of the procedure.  Don’t try to give platelets if you have a runny nose or allergies.  You can’t wipe your nose or cover your mouth when you sneeze.

But there’s a lesson in economics here.  Most healthy people are walking around with a huge excess of platelets to meet their needs.  Why don’t they willingly donate the product of their healthy blood factories (the bone marrow) to those whose factories might be only sputtering along, or as in my  son’s case, had quit altogether?  It’s not out of selfishness.   It is because of the cost, in time and pain and discomfort.  What would happen if those platelets that are very valuable to some people but are excess to others could be purchased by those that need them from those that have an excess?  Using an intermediary like the Red Cross,  assuming that a market-clearing price could be resolved, there would never be a shortage of platelets, or any other blood products.  For some people the joy of altruism is enough, and it might even offend them if they were offered money for their donation.  But there obviously aren’t quite enough people motivated by altruism to ensure a steady, shortage-free supply. 

It fails me to see where there is a moral dilemma here.  With regenerating bodily products, such as the blood products of the bone marrow, the potential supply is effectively unlimited.  Why shouldn’t people be compensated?  When I was in college, my blood was of the type that made its plasma valuable, so I was able to make beer money by donating plasma once or twice a week.  What’s different about that and about donating whole blood or platelets? 

But it goes further.  Why should people who agree to donate marrow and stem cells for bone marrow transplants not be compensated for their trouble?   Donating marrow and stem cells is a damn sight more rigorous than giving platelets, requiring the donor to undergo a battery of tests and endure painful shots even before the marrow is harvested, which is itself hardly a pain-free procedure.   Bone marrow and stem cell donations save people’s lives.  More could be saved if there were a means of facilitating the transaction such that donors have more than just altruism behind their willingness to donate.   I’d have gladly paid whatever I could to the young lady that graciously agreed to donate her marrow last year so my son could have a new chance at life.   That she was willing to donate, at great cost and without monetary compensation, speaks volumes about the inner beauty of her soul.  But would it have been wrong for her to have been able to at least get some compensation for her trouble?  I would imagine her soul to be still just as beautiful. 

Allowing compensation for marrow donors might also alleviate a chronic shortage of minority donors.  It is a simple numbers game that minorities have fewer chances of finding a matching marrow donor than do whites of Northern European descent.  If more would be enticed to register for donation by the chance they might be compensated for a donation, so much the better.  Blood diseases amongst minorities, particularly sickle-cell anemia, might become less deadly.

The economics lesson is one of pricing.  Shortages accrue when prices are below cost.  The only price paid to a donor right now is the joy of altruism.  For a good many people, the subjective evaluation is that the cost of donating exceeds the joy of altruism.  There is a corollary free rider problem.  Nobody checks to see whether a person has donated blood or platelets before they get an infusion at surgery.  The selfish incentive is to allow others that are highly motivated by the internal joy of giving to do so for them.  But shortages could be easily eliminated if prices could be allowed to rise to make blood product donation attractive even to those without an altruistic bone in their bodies.

But.  If you are driven by altruism alone to donate blood, platelets or even marrow, God bless you.  You help save the lives of people who you don’t even know and that is a wondrous and splendid thing–a non-selfish aspect of human behavior to which I challenge evolutionary biologists to find an explanation.   I don’t consider what I’m doing altruistic.  I’m just repaying a debt.  I would do it regardless of whether I was compensated for my time and trouble, because it was similarly done for me.  For those that have no such debt to pay, yet donate anyway–Kudos.   I hope it wouldn’t impair your altruistic joy if we saw the way clear to allow compensation to you and others.  What you do is in many ways priceless.  Allowing some reasonable compensation for time and trouble would not dilute the gesture, but might enhance the numbers that could benefit from the products of healthy bone marrows.

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