This week saw us celebrate World Blood Donor Day, an international celebration of the miracle of blood donation and transfusion. The theme for this year was the idea that ‘blood connects us all’. In this week’s blog Alice examines how that sentiment was quite literal in the early days of blood transfusion, and how the celebration of donors plays a central role...
When we consider what an integral role blood transfusion plays in modern medicine, it’s surprisingly to think about how new the practice is. Although interest in the idea is evident as far back as the 17th century, it wasn’t until the late 19th century that practitioners began to experiment with it in a more serious way.
There were a number of factors that made blood transfusion a fairly impossible procedure to carry out. Firstly, it wasn’t until Karl Landsteiner identified the different blood groups in 1900 that the interactions between these blood types were understood. He established that if a transfusion of an incompatible blood type is given, there can be fatal consequences as the two sets of cells attack each other. Landsteiner’s discovery minimised this risk.
|Andrew Crosbie demonstrating sterilization methods |
A second barrier to blood transfusion becoming an established procedure was the problem of finding a suitable donor. With no central register of donors this had to be done on a patient-by-patient basis, and often family members and friends were asked first. Even if a compatible donor was found, they would then have to be brought to the patient’s side – quite literally, that is, for the biggest barrier to successful transfusions was that of clotting. In modern medicine, anticoagulants are added to blood to prevent clotting and allow blood to be stored and transported, but earlier problem-solvers took a much more hands-on approach. Donor and recipient would have to lie alongside one another, with the donor’s “left arm grasping the patient’s left arm well above the elbow”, and the giving and receiving veins actually stitched together. This must have been a very distressing experience for all involved, not least impractical and dangerous, and early blood donors would probably understand more than most the sentiment behind ‘blood connects us all’…
|Donors in the Clinical Laboratory being supervised by Dr McRae (Director) and Miss Wilkinson.|
Thankfully, huge leaps forward were to be made over the years: swift transfers using syringes went some way towards progress, and wax-lined containers such as the ‘Kimpton tube’ reduced the need for donor and recipient to be in the same room together. Clotting remained very much an issue, however, and as there was still no possibility of the blood banks that we know, finding available and compatible donors was a huge problem.
Local attempts to mitigate this began with a man called J. R. Copland. In January 1930, horrified to learn that a friend’s wife had died because no blood donor could be found in time, Copland made the first moves towards establishing a register of donors who could be relied upon in times of need. Copland managed to enlist twenty-four individuals within two months but this was not nearly enough. There were still too many instances when donors could not be fetched in time, and medical staff and students of the Royal Infirmary of Edinburgh had to step in often instead.
Some of these students had already recognised the need for a register of donors and made their own attempts to address this. Also in January 1930, three of them – D.M. Blair, A. Desmond Stoker and W.I.C. Morris – proposed to establish a group of donors specifically to be called upon by the RIE, and initially managed to recruit about eighteen individuals, mostly other students. This group ran for about two years before the students graduated and moved away, resulting in dwindling numbers of donors.
|From the Minutes of the Board of Management of the RIE. |
Both A Desmond Stoker and J.R. Copland embodied a central tenant of the donor system as we have it now. Stoker was Type 0, considered a ‘universal’ donor and able to give his blood to any recipient without adverse reaction He gave ten pints of blood before being warned by other medical professionals of the potential harm he was causing himself! Similarly, in one report of his service, Copland reported that “one organiser” (most likely Copland himself) “has given fourteen pints”. Both men were of the opinion that blood donation should be an act of charity, with blood offered and received freely. When a meeting was called in June 1936 to establish a centralised Blood Transfusion Service “in order that this important work might be carried on in future”, the question was raised of whether donors should be paid for their service. This was rejected, and the idea that donations “should be the free will offering of men who love their fellow mortals” was heartily expressed.
That is not to say, however, that this gift has gone unappreciated. The letters of thanks received by the service demonstrate the gratitude and indebtedness that both recipients and their family have felt throughout the years. As the writer of this particular letter remarks, “I know that all donors give their services for the benefit of others and without thought of thanks or reward: but I cannot help thinking that the knowledge of the recovery they have helped to bring about must be a pleasure to them”.
|A letter of thanks written to a donor, in J.R. Copland's correspondence files. |
You can find out more about registering as a blood donor on the Scottish National Blood Transfusion Association website.
Masson, A. H. B. (1985). History of the Blood Transfusion Service in Edinburgh.