Blood

by Lawrence Hill

  SINCE KARL LANDSTEINER IDENTIFIED the main blood types in 1901, and since physicians began carrying out successful transfusions over the next years, the sharing of blood has offered opportunities to give in one of the most noble, selfless ways possible. When you give blood, you don’t even get a grateful smile or hug from the recipient of your blood. Because your blood has been broken into parts, and there are many recipients, you will never know them, and they will never know you. You know that you are helping to preserve human life, and that general knowledge is good enough. The desire to reach out and help others in need reflects the best parts of our humanity.

  Within minutes of hearing the news of the terrorist attacks in New York City and Washington on September 11, 2001, donors began lining up outside collection agencies in the United States. In Oklahoma City, for example, three hundred people were standing in line outside the Oklahoma Blood Institute by 11:30 a.m. on the day of the attacks. Nationwide, donors gave 1.5 million units of blood within two days of 9/11, creating a shortage of storage bags. The supply of blood eventually exceeded demand, and authorities asked donors to wait. After the Boston Marathon bombings in 2013, donors again turned out in such large numbers that they were asked to wait and schedule appointments to give blood later.

  Since transfusions began, millions of people around the planet have received blood that helped save their lives. I am one of them, and I will be forever grateful. Today, according to the World Health Organization, people around the world donate more than eighty million units of blood annually. (A unit is about 450 millilitres, or just less than one American pint.) But the gift of blood has been a double-edged sword. It has brought out some of our worst fears and prejudices.

  To set the politics of blood donation in context, I wish to go back to early- and mid-twentieth-century America, when racial segregation permeated virtually every corner of American life, and the mistreatment of blacks even spilled into the arena of health care. Take, for example, the Tuskegee Syphilis Study, which is now considered the most infamous biomedical research project in U.S. history. Doctors funded by the United States Health Service subjected hundreds of African-Americans to forty years of medical experiments without telling them that they had syphilis, without treating them for it, or intervening as they died and their wives contracted the disease and their children were born with congenital syphilis. The study began in 1932 and continued until 1972, when the media exposed it.

  Another realm of health care in which American blacks felt the sting of rejection and disrespect relates to who was allowed to donate blood during World War II — when blood was in big demand and when the technology finally existed to rush large quantities of it to critically injured soldiers — and who was not. I will explore these politics — now almost three-quarters of a century removed — by remembering the life, words, and death of Charles Richard Drew.

  Drew was born in Washington, D.C., in 1904, of black parents. His father was a carpet-layer and his mother a schoolteacher. He was a tall, light-skinned, athletic boy. He could have passed for white, had he been so inclined, but there was nothing about Charles Drew that sought to deny his heritage.

  The society in which Drew grew up separated blacks from whites in schools, theatres, swimming pools, department stores, sporting events, and even in federal government cafeterias in the nation’s capital. Drew attended the segregated Dunbar High School in Washington and then studied at Amherst College in Massachusetts.

  Drew left the United States to attend medical school at McGill University in Montreal from 1928 to 1933, graduating second among the 137 students in his class. He went on to do two years of internship and a residency in internal medicine in Montreal. He obtained his M.D. and master of surgery degrees but had trouble finding a job in the United States. The Mayo Clinic, where he had hoped to work, turned Drew down, as did Columbia University. Allen O. Whipple, head of surgery at Columbia, gave Drew a frank explanation for his rejection.

  Spencie Love, who wrote a biography of Drew in 1996, quotes a dean of the Howard medical school who witnessed the conversation and described it after Drew’s death. Whipple told Drew that he was of the wrong race and economic class to treat the most wealthy and privileged of American citizens: “I am certain that you could do well with the average patient. But could you, with your background, feel at ease and render competent service if one of your patients in surgery were a Morgan, an Astor, a Vanderbilt, or a Harkness? We have such patients here. In the selection of our residents we choose only from among superior students and we take into account their family and personal background.”

  Drew taught for a few years at Howard University and received an additional two years of training in surgery at Columbia at the hands of Dr. Whipple, the same man who had declined him earlier. Although blacks did not generally find openings for surgical residencies in the United States until the late 1940s and early 1950s, Drew, through a combination of persistence, personal charm, and his light skin colour, won over Dr. Whipple and gained a full training experience, including visiting hospital wards and treating patients.

  The outbreak of World War II presented Drew, who at Columbia had become a leading expert on blood storage technology, with the opportunity of a lifetime. In 1940 — before the bombing of Pearl Harbor, which drew the Americans into the war — Drew was hired as the medical director of the Blood for Britain project, which was to ship liquid plasma from the United States to British soldiers who had been wounded in France. In 1941, he served for a short time as the medical director of the first American Red Cross blood bank, overseeing a pilot project involving the use of dried plasma for the anticipated wartime needs of American soldiers.

  In November 1941, by which time Drew had returned to Washington, D.C., to lead Howard University’s surgery program, the American Red Cross announced that it would exclude blacks from donating blood. Black leaders objected so vociferously that the Red Cross modified its policy, announcing in 1942 that “the American Red Cross, in agreement with the Army and Navy, is prepared to accept blood donations from colored as well as white persons . . . In deference to the wishes of those from whom the plasma is being processed, the blood will be processed separately so that those receiving transfusions may be given blood of their own race.”

  Drew weighed in on the matter several times. In 1942, he said, “I feel that the recent ruling of the United States Army and Navy regarding the refusal of colored blood donors is an indefensible one from any point of view. As you know, there is no scientific basis for the separation of the bloods of different races except on the basis of the individual blood types or groups.” Just six years before his death, while being honoured by the NAACP for his work in blood plasma research, Drew again criticized the blood segregation policies: “It is with something of sorrow today that I cannot give any hope that the separation of the blood will be discontinued . . . One can say quite truthfully that on the battlefields nobody is very interested in where the plasma comes from when they are hurt. They get the first bottle they get their hands on. The blood is being sent from all parts of the world. It is unfortunate that such a worthwhile and scientific bit of work should have been hampered by such stupidity.” Drew also commented on how the blood segregation policy was a “source of great damage to the morale of the Negro people, both civilian and military.”

  By the time of his accidental death at the age of forty-five, Charles Drew had risen to the position of head of surgery at Howard University College of Medicine. He might have continued to rise in prominence as a blood plasma expert, surgeon, university professor, and critic of discriminatory blood donation policies had he not fallen asleep while driving on a highway in North Carolina and crashed his car in 1950. After a long day of work at the hospital in D.C., Drew had been travelling with three other doctors to a medical conference in Tuskegee, Alabama. They had planned to help train black doctors and take part in a free medical clinic. The other passengers survived the accident, but Drew was th
rown from the car and sustained fatal injuries.

  For decades after his death, rumours persisted that the prominent surgeon and pioneer in blood plasma storage and shipping had bled to death because the Alamance General Hospital in North Carolina refused to treat him. But that is not true. Drew was rushed to Alamance General and treated promptly and thoroughly, as Love says in One Blood: The Death and Resurrection of Charles R. Drew. However, his injuries were massive, and his death could not be averted.

  It’s ironic that this tragedy should befall a man who had helped to save other lives by finding efficient ways to store blood plasma so it could be safely shipped from the United States to Britain in the early days of World War II. How symmetrical, and disturbing, that the surgeon who drew upon his medical training to challenge American policy barring African-Americans from donating their blood to white patients ended up being thrown from his vehicle and dying as the blood ran from his body.

  It wasn’t only black physicians who opposed the wartime blood segregation policy. At least one white physician, who would go on to become famous in his field, shared Drew’s beliefs.

  Bernard Lown, a cardiologist, creator of the direct current defibrillator, and internationally recognized peace activist, began studies in medicine at Johns Hopkins University in Baltimore in 1942, by which time the Americans had entered World War II. Lown, who was born in Lithuania in 1921 and moved to the United States at the age of thirteen, had family members who were murdered during the Holocaust, and he believed that the Allies were fighting in World War II to create a better world. During his time at Johns Hopkins, blood destined for patients in the university hospital was segregated into two categories: “colored” and “white.” Because Lown knew that these were absurd distinctions, he took great delight in mixing up the tags on “colored” and “white” blood bags.

  Lown was kicked out of medical school after it was discovered that he had supplied “colored” blood to a white patient from Georgia who had insisted that he not be given any “nigger blood.” But colleagues raised a fuss on his behalf and Lown threatened to go public with the blood segregation policy; he was quickly reinstated.

  Describing his acts of private rebellion at the Johns Hopkins medical school in more detail on his blog, Lown writes: “Black blood had to be kept apart from white blood. This was especially galling since apartheid in blood had no scientific basis. Yet it was being practiced in one of the leading medical schools in the country, an institution that prided itself on being a pioneer in promoting science-based medicine while it distinguished donated blood with tags labelled either C (for ‘colored’) or W (for ‘white’) . . . I decided not to partake in the immoral charade. Single-handedly I sabotaged the system. I did it with a black crayon. Whenever we were running low on white blood, I would take a number of bottles of black blood and add on the tag a mirror letter C to the one already there. The result resembled the letter W. Lo and behold, the blood was now white . . . For me it was both a medical and political maturing experience. I learned that if one wishes to effect social change, one must never walk alone, and that historical transformations are largely bottom up. Over my long life I have witnessed profound advances in diminishing the racist color line that pervades our country. This spurs a sense of unquenchable optimism. It affirms the poetic words of Martin Luther King Jr., that ‘the arc of history is long but it bends toward justice.’”

  Even in the time of the Second World War, American physicians understood that the body of a sick or wounded person receiving plasma or other blood products would not distinguish between the blood of a black or a white donor. The blood exclusion decision had nothing to do with science, and everything to do with society and politics.

  WE LOVE OUR NEIGHBOUR so much that we are willing to give up our blood for a person, three streets or three thousand kilometres away, whom we will never meet or know. And yet we would much rather give, believing that we are healthy, than be put in a position of receiving. As blood transfusion science has revolutionized the ability of humans to give to each other, it has also raised our fears of each other. Could this donor make me ill? Might that blood bag be the cause of my death? We know that people who give their blood are likely to save someone’s life — maybe our own — but we also fear that the same gift that moves straight into our own veins and arteries might carry a virus or disease that could kill or cripple us. One has only to look at the various exclusionary policies to see how concerned authorities are with preserving the safety of the blood supply.

  Tainted blood, however, is an entirely different matter. In the 1980s, the tainted blood scandal that affected several countries entirely altered our collective psyche. Blood was no longer simply the pure gift that could save lives. In the minds of citizens across the world, it became a product that could kill. And kill it did. In Canada, some two thousand people acquired HIV and about thirty thousand people contracted hepatitis C after receiving tainted blood transfusions and tainted blood products to treat hemophilia. Some eight thousand people are expected to die as a result of having received bad blood in Canada over the course of a decade.

  In Factor 8, named after a clotting factor given to hemophiliacs, American documentary filmmaker Kelly Duda chronicles the blood harvesting scandal in an Arkansas prison and the blood’s subsequent sale into Canada. Some of the tainted blood products entered the blood supply in Canada and other countries after Arkansas prison inmates — some of whom had unprotected sex in prison, shared needles for drug use, and contracted AIDS — were paid between $7 and $10 for each unit of blood they donated, which they collected themselves in inmate-run blood drives. The Arkansas Department of Correction used private organizations to sell the prisoners’ blood at great profit to Connaught Laboratories in Canada, which used the imported plasma to create a blood-clotting factor later sold to the Canadian Red Cross Society.

  The tainted blood scandal led to the creation of the Horace Krever’s Commission of Inquiry on the Blood System in Canada, which reported its findings to the government of Canada in 1997. The Krever report noted that until Connaught Laboratories was informed in 1983 that the blood plasma it had been importing from the United States was tainted, the Canadian company “had not been aware of the fact that it had been processing plasma collected from prison inmates. The shipping papers accompanying the plasma had not revealed that the centre was located in a prison. They had simply referred to the source as the ‘ADC Plasma Center, Grady, Arkansas,’ without any indication that ‘ADC’ stood for ‘Arkansas Department of Correction.’”

  The Krever report recommended that new blood collection agencies be created in Canada to replace the Red Cross. As a result, Canadian Blood Services now collects blood in English Canada, and Héma-Québec collects it in Québec. The commission also recommended that the government compensate victims of the scandal. Federal and provincial governments in Canada have paid out billions of dollars of compensation, and civil litigation has been massive. Nearly $5 billion has been paid in compensation and to settle class-action lawsuits. Among its many other recommendations, the commission also said that, barring exceptional circumstances, donors of blood and plasma should not be paid, and that Canada needed far more stringent policies related to blood collection and blood safety.

  Canada was not the only country affected by the tainted blood scandal. In what was surely the most catastrophic public health scandal of the century, people in the United States, France, the U.K., Ireland, Japan, and other countries were also contaminated with tainted blood. The global scandal spread just as the AIDS epidemic began to unfold in the world. Indeed, in 1981 — by which time tainted blood was already entering the market — HIV had not yet been identified as the virus that led to AIDS.

  It took years to bring the contaminated blood supply under control, but one result was the implementation of a new rule in 1983 — in Canada and elsewhere around the same time — banning blood donations from gay men. Experts tend to agree that it was a neces
sary step at the time. AIDS was highly prevalent in the gay community, and little was known about the disease, the virus that led to it, or how to contain it. Some three decades have passed since then, and science has evolved hugely, but the politics of blood donation have barely progressed.

  In Canada, you cannot donate blood if you are a man who has had sex with another man (which classifies you as an “MSM”), unless you have been celibate for five years. This, ostensibly, is to prevent the HIV virus from entering the blood supply. However, each blood donation is tested for HIV, hepatitis C, and other viruses. There is a window of time — approximately two weeks — in which a donor might have acquired a virus, without that same virus showing up in a blood test. This is given as a reason for excluding MSM donations, even though heterosexual donors may also provide blood-carrying viruses that will not necessarily show up in tests.

  The arbitrary, subjective nature of the rules barring or impeding blood donations from males who have had sex with males becomes very clear when one looks at the divergent policies from country to country. In Israel, France, Greece, and the United States, gay men are not allowed to donate blood. Canada recently eliminated its lifelong prohibition, and ruled that gay men who have been celibate for five years will be eligible to donate. New Zealand also sticks to five years. In the U.K., Sweden, and Japan, gay men can donate blood if they have been celibate for one year.

  Gay rights activists and many others argue that the exclusionary rules are based on fear of homosexuality, rather than on science. They say that a promiscuous heterosexual who does not practise safe sex will pose a much greater risk for the transmission of HIV than a gay male who is faithful to one partner and who uses a condom.