Germany is running out of blood

The young man was in poor health when he was admitted to the University Hospital Hamburg-Eppendorf (UKE): His liver values ​​were miserable, and that wasn't the only problem. He had the rare blood group 0 RhD negative, only about six out of 100 people share this characteristic. On the one hand, this blood is particularly in demand in blood donation services, since every patient can tolerate it as a transfusion. On the other hand, 0 RhD negative individuals can only get 0 RhD negative blood themselves.

During the liver transplant, his doctors needed more than 40 blood bags of this type and soon reached their limits: the clinic itself only has 50 to 70 of these rare canned goods in its storerooms. It soon became clear that many more canned goods would not be justifiable, otherwise the clinic would be left empty handed for other emergencies. The practitioners used a last medical joker: Even 0 RhD negative people can tolerate 0 positive canned food once - but then never again. The procedure was successful and the 38-year-old was initially released.

Five weeks later, the patient was admitted to the UKE again – the new liver was not working properly and bleeding kept occurring. The second operation was very difficult, in the meantime the patient even had to be resuscitated. Within one day, 70 blood units of the rare blood group 0 RhD negative were needed again - and this time the practitioners could no longer draw a joker.

The clinic pulled out all the stops to get more "universal donated blood". The doctors asked other large hospitals in the city and spoke to colleagues across the country. Ambulances from all over Germany made their way to Hamburg, the only cargo: 0 RhD negative blood bags.

"Even if this case turned out well in the end, it shows how quickly our system can be shaken by just one patient," says Sven Peine, head of transfusion medicine at the UKE and master of the blood supplies. Peine has been worried about the supply for a long time. Around 40,000 blood donations are needed every year in the Hamburg-Eppendorf University Hospital alone. But the willingness of the citizens to donate is decreasing, recently it has dropped dramatically, by ten to 20 percent. Germany is running out of blood.

The consequences for doctors and clinics are devastating: cancer and heart patients are put on hold, operations on the spine or knees are canceled again after many have had to be postponed several times since the beginning of the pandemic, with serious health consequences for those affected. Women who lose a lot of blood during childbirth are in distress.

Statistically, every second German is dependent on a blood donation or on medicines made from blood at least once in their life. Experts from the German Red Cross, which organizes around 75 percent of blood donations in Germany, speak of a "critical situation" and clinics of a "threatening situation". All over the city, people are thinking about how the willingness to donate could be stimulated again.

You shouldn't be able to earn money with blood donations, that's what the Transfusion Act regulates. There it says: "The donor can be granted an expense allowance, which should be based on the immediate effort depending on the type of donation." At the German Red Cross you get bread rolls, a chat with the volunteers at reception, with a bit of luck a bar of chocolate.

If the DRK blood donation service then resells the blood preparations, it receives remuneration from the clinics, which, according to the DRK, covers the costs incurred. Effort and costs vary depending on the preparation. A unit of erythrocyte concentrate costs between 95 and 130 euros, depending on the quantity purchased, blood group and other characteristics, among other things.

Anyone who donates as an individual to private providers or clinics such as the UKE receives compensation for the effort of usually 20 to 30 euros, not payment in their own right. But none of this seems to motivate enough volunteers anymore. In addition, the high number of corona infections is also disrupting operations on this topic: anyone who is positive or has recently been is not allowed to donate blood.

There shouldn't be this bottleneck: around two thirds of all adults could be considered blood donors. In fact, only about two percent do so. Men can donate blood up to six times a year, women around four times. If, from today, suddenly no one were to donate any more, meaning the blood bags remained empty, then the clinics could only hold out for a maximum of three days with the supply, calculates institute director Peine. It used to be three to seven days. "I expect that the situation with blood donations will deteriorate dramatically over the next 15 years - today's donors will then become tomorrow's patients."

In a rust-red, two-story building just outside Hamburg, there has been a lack of willingness to donate for some time. All blood donations are collected and processed centrally at the Institute for Transfusion Medicine of the DRK Blood Donation Service North-East in Lütjensee, just outside Hamburg. While a few years ago around 550 blood bags were delivered per day, the current figure is around 450.

Blood products are subject to the Medicines Act, so the production and testing of blood donations is expensive. After the blood donation appointments, which are mostly in the afternoon, the full bags are delivered by one of the five mobile blood donation teams stationed here at around 9 p.m. and, as prescribed, processed within the next 18 to 20 hours.

"The aim is to produce an erythrocyte concentrate and a plasma from each donation," explains the head of production, Bettina Lizardo. In addition, a blood platelet concentrate can be produced from the so-called buffy coat – the layer of leukocytes and thrombocytes that develops after centrifugation.

The institute supplies clinics, medical care centers and practices in Hamburg and Schleswig-Holstein. Sales is staffed around the clock. In a storage room cooled to four degrees, the erythrocyte concentrates are sorted according to blood groups and can be kept for up to 42 days. On this day with "A RhD neg." there are only two lonely bags. "That's far too little," says Lizardo. "If there are complications during vascular surgery in a patient with this blood group, two units are far from enough."

Six out of a hundred people have blood group A Rhesus factor negative. In the spring, many more shelves were empty because there were so few blood donations. The need for blood can sometimes be so urgent that a clinic sends a helicopter or the police to Lütjensee to pick up suitable blood preparations. Long-term donors with particularly well-tolerated or rare blood groups call Lizardo and her colleagues directly and ask for an immediate donation.

At the DRK in Hamburg and Schleswig-Holstein, the donors are already 46 years old on average. The blood donors who come to the UKE are significantly younger, which is also evident in the waiting room in building 050 on the clinic grounds. Students stand in line next to young professionals. You see very few seniors.

A young man is sitting in the waiting area, he has just said goodbye to his girlfriend to donate blood. He usually comes six times a year, during the pandemic he felt "struck" and had been "renegade". That should now change again.

"I take half an hour and can save lives with it," says the 29-year-old, who works for Deutsche Bahn. "For me, that means donating blood." Money, he thinks, shouldn't be an argument. He grew up in the village and his mother regularly donated blood. In his circle of relatives there have been a few cases over the years in which people have needed donor blood from others – that motivates him to donate himself.

A typical donor, you could say. Sven Peine, director of the institute, found that personal contact and motivation are the most important things, ie friends or acquaintances who convince their loved ones of the matter. Peine hopes that the sense of community will be awakened more when it comes to donating blood.

Perhaps this is possible through social multipliers, people who can shake up and inspire others. “It could be an idea to approach people who have benefited from the blood donation themselves even more.” These could then advertise the blood donation like influencers in the area. Because one thing is clear: it takes more effort if blood donation is to have a future.

Here you can donate blood in Hamburg: The Hamburger UKE provides information on its website about opening times and locations

https://www.blutsgeschwister.net

The German Red Cross, the largest provider, provides useful information about blood donation here https://www.blutspende-nordost.de

Blood donation service Hamburg (Asklepios): https://www.blutspendehamburg.de

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