Aura's Den

PSA: The Gift of Life — Blood, Marrow, and Organ Donations

Let's start with a TL;DR: If you are at all able, you should be giving blood, registered to give marrow, and registered as an organ donor. These are absolutely vital acts that save lives. Seriously, go register tomorrow and try to give blood within the next few weeks. Now then...

Disclaimer: I'm based in the US. While some of what I say here is broadly applicable, not all of it is. While I may try to properly broaden the focus of this article in the future, for now, it's largely based off my knowledge of this stuff in the states combined with things I know here and there about elsewhere. If you do decide to start donating these things, do read up a bit on the particulars of where you live.

Donating

You may be familiar with blood donation. It's that thing where the medical vampires stick a needle in you and take some of your blood. There are a few types. The thing I'd imagine most people think of when it comes to blood donation, the thing I just described, is whole blood. You bleed into a bag for a bit then go on with your day. There are a few other types, however, involving the use of an apheresis machine, a machine that separates your blood into its component parts and takes just one of them. Double reds uses the machine to take an extra load of red blood cells. This is personally the form I give in, as I happened to be type O- (which makes my red blood cells particularly useful) and it's not quite as hard on the body as whole blood. You can also give platelets or plasma. In the US, you can get paid for plasma, though the other types tend to be volunteer only.

As a sidenote, since I mentioned blood type, blood type is really complicated. The basic one's you'll probably know about are ABO and Rh, specifically Rh D. These are what are referenced by the most common form of "blood type". If I say I'm O- ("O negative") (which I am, incidentally), that means my ABO type is O and I'm Rh D negative. But, there's actually a lot more. For instance, there are actually around 50(!) Rh antigens, the most important of which are D, C ("big C"), c ("little c"), E ("big E"), and e ("little e"). There's also other antigen systems like Kell, Duffy, and Kidd, among many others. These all refer to the antigens on the red blood cells. However, we also have to worry about antibodies in serum. The only antibodies that are naturally occuring are the ABO antibodies, where you'll have antibodies to any antigens you don't have. So, while O is the "universal" donor for red cells (er, uh, kinda), AB is actually the universal donor for plasma, because they won't have any antibodies to other blood types. If you're not type O and you take my plasma, though, you'll end up having a hemolytic transfusion reaction. The other antigen systems are only important in plasma if you've either had a transfusion before or you've been pregnant before, as you only develop antibodies to things you've been exposed to before. So, yeah. There you go. Fun notes on blood type. What does this mean for you? Well, if you're type O or have either had a transfusion before or been pregnant before, it's a bit more worthwhile for you to donate red cells, while if you're type AB and haven't had a transfusion or been pregnant, you might consider giving plasma or platelets. Everyone else, give what you feel like, I guess.

You might also be reasonably familiar with organ donation. Put yourself in a registry and, when you die, any viable organs will be removed from your body for immediate transplantation. Since organs are in low supply, especially since we can't just take them from anyone unlike blood, transplant waitlists can be quite long. Allowing your organs to be transplanted after your death can make a massive difference in someone's life.

Bone marrow donation, or, technically speaking, hæmatopoietic stem cell donation, is donating cells used by the body to make new blood cells. Unlike blood, you can't just donate whenever, but, unlike organs, you can donate while you're alive. For these, you and your HLA typing are added to a registry and, if you're a match for someone, you'll be asked to have HSCs extracted. The old way of doing it involves anæsthesia, either general or local, then having marrow extracted from your pelvis with a large needle. A newer way, peripheral HSC donation, is similar to other blood donations that involve only part of the blood. You get hooked up to an apheresis machine and it pulls out just white blood cells. Generally, these procedures will be at no cost to you, though it will vary by locale and/or workplace whether you will be given paid time off.

What to expect

Organ donation is the easiest of the three. Simply ask to be put on your nation's organ donor registry. In some nations, you may be added by default! From there, nothing happens until you die. When you die, they will confirm that you are absolutely dead then, once confirmed, they will remove your organs and store them in a cold location for transport to a compatible recipient. Easy peasy.

Now, if you're really intent on donating organs, you can donate a kidney. You only need one kidney to live, so you can safely give one to someone else. Generally, this is only used for compatible relatives or friends, but I guess you can give one to a stranger. But, that's not something I'm going to go into here.

Blood donation is relatively simple. You can either give at a blood drive (say, at your school or workplace) or you can give at a donation center. They'll ask you some questions to determine your eligibility, take some physical stats (blood pressure/pulse, temperature, they'll prick your finger and get some blood to determine your hæmoglobin levels), then, if you're eligible, they'll take you out to donate.

For whole blood, they'll tourniquet your arm, stick a needle into a vein in your arm, and drain blood directly into a bag. Generally, they take 450 mL, but they may take less or slightly more. During the donation, you'll be asked to squeeze the fist of the arm the needle is in, generally while holding a stress ball or roll of gauze. The biggest risk in whole blood donation is in the fact your body is losing 450 mL of blood: hypovolemia. You may begin to feel lightheaded or like you're going to pass out. If you do, let one of the phlebotomists know. They can help. And believe me, they care.

A personal anecdote here: The first time I gave blood, I nearly passed out. I ended up with what might have been all the phlebotomists on the donation bus trying to keep me from actually going unconscious. So when I say "believe me, they care," I speak from experience. As a bit of assurance, though, do know that subsequent donations tend to be easier. The first time you don't really know what to expect and it can hit kinda hard, but there after, it'll generally be easier.

For apheresis donations, they will connect you to the machine instead of the blood bag. From there, the machine will operate in cycles of drawing and returning. During draw cycles, you'll be asked to squeeze your fist to help keep the pressure the machine expects. The machine will take blood and begin centrifuging it to separate parts. It will remove the part being taken then prepare the rest to be returned. During return cycles, the remaining parts will be pumped back into your body along with saline to help maintain blood volume. You will be asked to stop squeezing during this time. Note that the saline will generally be room temperature, so you may find yourself getting cold during this. Let a phlebotomist know as they will probably have blankets around for this eventuality. (Yep, that's also a thing I know from experience.) You may also feel pressure in your arm during the return phase. This is normal.

Now's also a good time to mention that apheresis donations are a lot easier than whole blood. If you consistently have trouble with whole blood, you may consider just donating one part. Even double reds is far easier, as they ensure you have high enough hæmoglobin levels for it to be safe. This effect will be especially pronounced if you happen to be smaller, as 450 mL of blood will cause greater hypovolemia if you have less blood to begin with. Taking just part of the blood while leaving sufficient hæmoglobin and replacing blood volume will be much less hard on your body compared to take taking all that blood and not replacing it with anything.

This said, if you do give whole blood and especially if you do red cell apheresis, be very careful about your iron intake. Trust me, if you're not, you may end up anemic. Keep up your iron intake, take a supplement if you need to, and don't be afraid to wait longer between donations. Better that you give blood less often than end up getting all anemic from giving too much.

For marrow donations, you'll start by signing up in a registry. The registry will perform HLA typing, typically though a cheek swab, in order to determine who you'll actually be a match for. There may not be any matches immediately. If/when a match is found, you will be contacted. Time is of the essence at this point, so return the contact ASAP! They'll ask some questions and run some lab tests to further verify the match and your general eligibility. Once confirmed, you'll undergo one of two harvesting procedures depending on what the patient's doctor feels would be best for the patient. Note that both procedures will generally be done at the registry's expense, not yours, though, as mentioned, you may or may not receive paid time off during your donation depending on where you live and where you work. Check local PTO laws and your company's PTO policy for more details, or ask your company's HR department.

In a traditional donation, you'll be admitted to the hospital for collection. You'll be put under anæsthesia (either general or local), and they'll stab a needle deep into your pelvis to collect liquid marrow. You may experience some pain afterwards (I mean, they did practically drill a hole into your pelvis) and it could take up to a month to recover, though you shouldn't be in the hospital for more than a day. The biggest risk is pretty much infection, though that shouldn't be an issue assuming the physician doing the collection knows what they're doing.

For peripheral cell donation, the procedure is similar to RBC, plasma, or platelet blood donations. They'll connect you to an apheresis machine and it will pull out the appropriate type of cells. However, every day for roughly the week prior, you'll receive an injection of a drug like filgrastim to increase the count of stem cells in your blood. Risks from this are mostly drug related, either side effects of the colony stimulating factor used or allergic reactions to the CSF or the anticoagulant used by the apheresis machine. But, in general, the worst side effect for most people will be bone, joint, and muscle pain.

Eligibility

I won't go into all the eligibility requirements for all these procedures, but I do want to address a few that folx who'd be reading my blog might find of note.

To start, HRT is not disqualifying. The only drug that has any deferral period that is use in any form of HRT is finasteride, and it's deferral period is generally one month. If you're properly on finasteride as part of an actual feminizing HRT regime, you'll probably be on some other anti-androgen that will continue working during that month. Talk to your doctor/endocrinologist, but you'll probably be fine to full-out discontinue it, if only for a month before a blood donation. No components of FtM HRT require deferral.

Requirements vary from place to place on deferral for "men who have sex with men". Many countries have begun to do away with these deferral periods altogether. Others do away with them for those in a stable, monogamous relationship. In the US, the requirement I'm aware of is a deferral period of three months, though this may just be Carter Blood Care's deferral period and it may vary for other organisations. In general, check with the organisation you plan to donate with.

You did NOT hear this from me, but you can probably get away with lying on that last point. I would only encourage this if you are in a situation where you can say with certainty you're clean in regards to STDs, but you probably can. Namely, I'd take that "stable, monogamous relationship" thing with a bit of an extension. I mean, lots of the folx I know are polyamorous. As long as the graph of your polycule and who y'all have sex with is pretty much closed (e.g. you and your two boyfriends only have sex with each other) and everyone in that graph has tested negative for STDs, you're probably fine to lie on the eligibility questions. They ask that question to judge risk for things like HIV/AIDS infection, but in a scenario like that, we know you're not a risk in that regards. Like, don't just go lying on these questions, but this is a case where the "professionals" involved haven't yet caught up to us yet. Just make sure you know you're not a risk. Incidentally, conversely, if you do suspect you might be a risk, I'd encourage you to get tested prior to attempting to donate blood, regardless of the gender of you or the folx you've had sex with. They do screen for that stuff, but it's better to get an STD test done first instead of sitting through an entire donation just to have it get thrown out.

Here is probably a good place to say that when it comes to these sorts of """requirements""", I don't blame your for just saying "Fuck it" and not donating blood. The fact that I have to say "Well, maybe you can consider lying" in the first place is a fucking outrage. In the US, of course, this is the only """requirement""" like this I know of. Other segments of the LGBT community aren't restricted. But that fact that this specific part is is still asinine, and if you're somewhere where other parts are also restricted from giving blood, I especially won't hold it against you if you decide they don't deserve your blood. Blood supplies are vital, but the fact that any of us can't give just because we are who we are is ridiculous, and it needs to change.

Anyways, on the subject of HIV/AIDS, you cannot give if you are currently on PrEP. There is a deferral period. The reasoning may seem a bit weird if you're familiar with the phrase "Undetectable = Untransmittable", but it's because, technically, that's not entirely true. It is true that if the HIV viral load in your body is so low it's undetectable that you can't transmit it sexually. However, it's still possible to transmit by transfusion. Unfortunately, PrEP can cause a false negative, where these is HIV in your blood but it's not possible to detect it. It won't hurt you since you're on PrEP, but it can hurt someone it's transfused into. By making you wait three months after your last oral dose of PrEP (or 2 years after your last injection), it allows us to make sure that you've not actually got HIV in you. So, yes, if you're on PrEP, please be honest about that fact.

Finally, if you've recently gotten a tattoo or piercing, you are required to wait out a deferral period before you can donate. Do be aware of that.

Concerns

Let me just try to quell some common concerns here, whilst I'm going on about these things.

Needles. I get it. Needles are scary. You think I wasn't terrified of needles when I started giving blood? I damn well was! And the folx involved with blood/marrow donation get it. Tell them you're afraid of needles. We will do everything possible to help with that, from helping you calm down to making sure you don't ever have to see that needle. We get it, and we do get training in how to handle phobia of needles.

Passing out. Been there, done that, as mentioned above. Let them know if you start to feel funny. They'll do their best to keep you from passing out. If you do happen to pass out, do know that it's not a painful experience. And, of course, the risk of passing out is much less if you give red blood cells only, plasma, or platelets. So, if you're particularly concerned about that, maybe try one of those rather than whole blood.

Needles, part 2. Veins can be hard to find. If you've had issues with phlebotomists finding veins before, let them know. If you have an arm preference, let them know. And don't be afraid to set limits. They shouldn't be blindly poking around in your arm in the first place, so if they start, don't be afraid to tell them to stop. (Note that we do have some ability to reposition inside the arm, but it involves feeling for where a vein went, reanchoring, and only then moving. It's a careful process, and, importantly, it shouldn't hurt. It's still okay to ask us to stop, but do know that there's a difference between blindly probing and intentionally repositioning.)

Organ donations and what is death. A common concern with becoming an organ donor is that is somehow incentivises doctors to not save you. Listen, not saving you would only serve to damage the organs they'd be taking. If anything, being an organ donor is all the more incentive to save you since the steps to save you and the steps to keep your organs usable are pretty much the same. And, as I mentioned above, they check, double check, and triple check to make sure you are actually dead, so they won't be taking any organs before you die.

Conclusion

In conclusion, please, please, please, if you are at all able, go give blood, and register to be a marrow and organ donor. Doing so could absolutely save a life.

I'm not gonna take comments here, but if you have any questions or concerns, please do let me know, or get in touch if you think there's anything I should add. I will absolutely update this with any new information.

Keywords: PSA