Blood Substitute.

May 27, 2004 5:22 PM

Loyola University has received approval to investigate PolyHeme®'s use as a blood substitute for critically injured and bleeding trauma patients at accident scenes. Blood has a very short shelf life, requires refrigeration, and matching types takes too much time too carry blood in ambulances. The blood substitute has a long shelf life and is compatible with all blood types. It's designed to furnish oxygen which will "prevent organ damage in the brain, heart, lungs, liver and kidneys," until a transfusion can be done at the hospital. - pretty damn cool. I hope it works. [cross-posted on my site]
posted by giantkicks (34 comments total)

It's a backwards approach to consent. Instead of those who wishing to opt out wearing a wristband or calling a toll-free number, it should be the other way around. That way it is known that those who receive the substitute are aware of its existence.
posted by Feisty at 5:56 PM on May 27, 2004

Actually (and slightly off-topic), I've always believed that organ donation should be opt out. Unless you can state a religious or other objection, they should be using the stuff you don't need for people who do. This would affect the blood supply but it might help shorten the waiting lists for transplantation.
posted by Octaviuz at 12:22 AM on May 28, 2004

Feisty:That way it is known that those who receive the substitute are aware of its existence.

Okay, fine. What about the other hundreds of procedures we have no clue about or ones that have been deemed safe enough by the FDA and medical community? Not to trivialize this, but it seems that in medicine there's a lot the patient doesn't know or will ever know. I don't think this trial is backhanded or overly secretive. Especially when you consider it could be the difference between full recovery and permanent brain damage.

Think of all the prescriptions you've filled, all the things you've been injected with, etc. Granted, this is a trial, but its a human trial and has been tested elsewhere and in the end if we can't have trials like this where will progress come from?

Its a tough call because these are trauma patients; not exactly the type that has time to sign a contract. This kind of thing is a power of the government, it can grant hospitals power to do this. Is this inherently wrong? Should the FDA just jump the gun and say, "this stuff is safe, just use it?" Is it practical to have this "libertarian" view of full disclosure over stuff most medical students couldn't understand? It seems that the complexity of modern medicine means we as health consumers are kind of in a weak position.

Its an interesting practical and philosophical question and I think many would err on the side of the greater good, especially when its their loved ones on the line. Imagine having to raise a brain-damaged child for the rest of your days because you opted into low-tech in fear of the future or progress.

Christian scientists, the Amish, Jehovah's witnesses prefer to take the low-tech chance. I sure as fuck don't and I'm sure many others would agree.

(im also sick of spell checkers pretending that fuck isn't a word)
posted by skallas at 1:36 AM on May 28, 2004

Yes, I understood that intention was for the injured to be made aware of the blood substitute and asked if they wanted it.

I disagree on the opt out of organ transplant position. It's my body, and my investment of energy and money into my body's organs. Screw/fuck being politically correct. I choose to not donate my organs because I cannot control who will receive them. There are far too many people who's lives/lifestyles I don't respect for me to chance that someone I do not respect would receive my organs.
posted by giantkicks at 1:49 AM on May 28, 2004

Is a lifestyle permanent? Do we believe in personal change as being authentic? Is a bum always a bum?

Hypothetical: Opt-out donors are made law. Some reckless asshole does something stupid and inherets your liver. Reckless asshole not so reckless anymore, learns life lesson, changes ways. This certainly isn't unheard of. Hell, the current US president went from coke head drunk to sober fundie nut. (I cant tell which is worse, but thats besides the point)

Not to mention the lifestyle argument is pretty weak when you consider the gamut of diseases and waiting lists that go one for years because someone had the misfortune to get a crappy mix of DNA or a nasty virus.

I could easily see the lifestyle argument in a society which can already treat its "blameless" ill, but that society seems fictional at best.

I think its a very interesting idea. It seems such a waste to toss all those fine organs into the earth. In the end, we're probably better off raising awareness and pushing the issue so that people take being a donor seriously. As Americans we don't like being told what to do, but a little coaxing can go a long way.

I'm one and I dont even think about nor do I care who gets my organs. Its a non-issue as I will be dead.
posted by skallas at 2:04 AM on May 28, 2004

Screw/fuck being politically correct.
It has nothing to do with being politically correct. Donating your organs is simple human decency, in my book (those with genuine religious objections are rightfully excluded). In any case, who are you to judge whether someone else deserves to live? Apart from a few obvious cases that tend to be deemed unsuitable for transplants anyway, the judgement over whether someone deserves a chance at life is subjective at best.

Back on-topic, I think this is a great idea and is no different in principle to using saline to maintain blood volume. I don't know of anyone who has decided to opt out of being given saline via an IV.
posted by dg at 2:22 AM on May 28, 2004

I choose to not donate my organs because I cannot control who will receive them.

You do realize that under an opt-out system, you could always, you know, opt out?
posted by DevilsAdvocate at 2:56 AM on May 28, 2004

I hope this trial pans out.

I think that unless your religion forbids donation, we should all be much more educated and encouraged about the enormous need to donate. I wouldn't go so far as "opt out" tho--I don't want to see harvesting departments in every hospital/emergency room.
posted by amberglow at 5:41 AM on May 28, 2004

You do realize that under an opt-out system, you could always, you know, opt out?

exactly - the problem is the number of ambivalent people who generally think it's a good idea, but don't like the idea of "signing their organs away" or even feel paranoid that if they're listed as an organ donor, doctors won't bother to save them, since their organs could save 5 other people... etc. You need two witnesses to sign on your state ID to be an organ donor, and I had enough trouble finding people willing to witness for that reason (okay, it wasn't that much trouble, but two people were very uncomfortable and initially refused to do it; one of them came around after some argument - but remember, this is just to witness!)
posted by mdn at 6:38 AM on May 28, 2004

I think many would err on the side of the greater good, especially when its their loved ones on the line. Imagine having to raise a brain-damaged child for the rest of your days because you opted into low-tech in fear of the future or progress.

skallas, I admire your cheerful assumption that "progress" always works, but I'm afraid I don't share it. Imagine having to raise a brain-damaged child for the rest of your days because you opted for "progress" out of scorn for traditional procedures.

People should be allowed to control what's done to their bodies while they're alive and after they're dead. And if you think everyone should bow before "the greater good," you haven't learned anything from the history of the twentieth century.
posted by languagehat at 7:01 AM on May 28, 2004

Christian scientists, the Amish, Jehovah's witnesses prefer to take the low-tech chance.

Don't know where you're getting this 'Jehovah's Witnesses take the low tech approach' angle because they have many options to blood transfusions, including saline, dextran, Haemaccel, Ringer's solution, Hetastarch and now, potentially, Polyheme.
posted by Tacodog at 7:10 AM on May 28, 2004

I have to say, I am a huge proponent of organ donation, and feel everyone should donate organs.

But not my eyes.

It's not logical, lord knows I won't be using them, but it just freaks me out that they might take my eyes.

I try to be intellectual about it, but... ((shudder)). Am I alone in this?
posted by John Kenneth Fisher at 7:50 AM on May 28, 2004

There are far too many people who's lives/lifestyles I don't respect for me to chance that someone I do not respect would receive my organs.

By the time you're an organ donor, you won't care about the lifestyles of the people who receive them.
posted by kindall at 8:30 AM on May 28, 2004

Feisty, maybe I'm reading the article wrong, but it looks like the opt-in nature of the use of Polyheme is because it's still being studied and hasn't been approved. Will this change if the drug is approved? I assume so.
posted by Tacodog at 8:41 AM on May 28, 2004

giantkicks,

It's my understanding of organ donation, and I could be mistaken, that simple need does not always mean that someone will get an organ. Surgical teams screen potential recipients for all kinds of factors, from tissue/blood compatibility to viability and mental concerns as well. Someone who's ruined his liver through drink (and can potentially ruin his next) is going to be a lot farther down on the transplant list than someone who needs a liver because of an accident. Doctor's do weigh other factors aside from need.

I know someone personally who was going to donate part of her liver to a friend in need and 2 days before the surgery her son mysteriously collapsed in school and was hospitalized for 2 weeks. Not only was the surgery not performed but the doctor's decided that emotionally she was too fragile to be a living donor (her son's incident having brought to surface a whole slew of life/death issues for the family that they were previously screened for).
posted by archimago at 8:54 AM on May 28, 2004

PolyHeme is being tested all over the US (I believe it may have something to do with whether or not the hospital is a "Level 1" trauma center). Do a Google search for PolyHeme...
posted by internal at 10:12 AM on May 28, 2004

But not my eyes.

It's not logical, lord knows I won't be using them, but it just freaks me out that they might take my eyes.

John, did you watch too many Tales of the Unexpected as a kid, perhaps?

I searched for the particular episode your comment reminded me of, but couldn't find it (unless it's this one - but that still doesn't sound like what I remember). Now I'll be humming that themesong all day...
posted by widdershins at 10:37 AM on May 28, 2004

If you need the MP3, let me know.
posted by jonson at 10:43 AM on May 28, 2004

Hey jonson, do you know if TotU is available on DVD in the US? Reading the episode synopses got me all inspired but googling hasn't found anything yet.
posted by widdershins at 10:55 AM on May 28, 2004

I am fairly convinced that it is not. No sucess on Netflix, certainly, nor Amazon. Although I did find an old Don Johnson movie with the same title, but I don't think that's it.
posted by jonson at 11:07 AM on May 28, 2004

Tacodog:Don't know where you're getting this 'Jehovah's Witnesses take the low tech approach

The alternatives are nowhere as good as real blood. Here's a nice news piece on one of them dying for his beliefs.

You can google for more, especially the ones involving kids.
posted by skallas at 12:50 PM on May 28, 2004

Are you kidding? Heck, they're welcome to rummage around in my carcass and do whatever they need to do to save someone else. (As long as I'm not using them, that is...) I never understood why people are buried intact.

As for caring about who needs them, who cares? They can eat my liver with fava beans and a nice Chianti, if that's what it takes to keep somebody alive and I'm already dead. The only thing I care about is that they don't do something with my innards that'd horrify my wife.
posted by FormlessOne at 12:56 PM on May 28, 2004

Think of all the prescriptions you've filled, all the things you've been injected with, etc. It is precisely my experience with what was given to me as a child that causes me concern. As it is, properly prescribed drugs account for over 100,000 deaths a year, I wonder how many more people are injured but still living. The slippery slope argument may not be very popular, but changing the drug testing field in this manner is bad news.

"Some Jehovah's Witnesses have accepted PolyHeme, a chemically modified hemoglobin which is not whole blood, but is derived from it. L.C. Cotton indicates that members must decide for themselves whether to accept this product. He said: 'When blood is fractionated beyond those primary components and other blood derivatives, we feel that it is an individual decision. If an individual's conscience will allow him to accept the product, then that would be up to that individual. That is between himself and his God...The understanding is that each person stands before God and is judged according to his own conscience. The other Witnesses would not criticize any decisions he makes.'"
posted by Feisty at 1:25 PM on May 28, 2004

Interesting that the immediate focus of this thread was on the consent process rather than the polyheme. My own university briefly considered applying for this grant too, and we started looking at the procedures you go through to get what is basically a community wide waiver of informed consent. It is not an easy process, and if done right, would take considerable time and effort. The proposal was dropped here, but for reasons other than the difficulty of the consent process. It is an interesting study, and the potential benefit is fantastic. That said, Loyola and the other participants are taking a huge risk based on how this trial is designed.
posted by MetalDog at 1:29 PM on May 28, 2004

Loyola and the other participants are taking a huge risk

But imagine the possible reward, if they manage to save someone's life with this stuff. The PR from that alone could make the whole enterprise worthwhile.

Aside, to those who say they won't donate to people who've made poor lifestyle choices: it is a poor idea to overload outlets with a bunch of daisy-chained power strips, as well. Does that mean we shouldn't try to save someone whose house catches fire as a result? Would you walk past a burning person and say, "well I'm not risking my neck because that idiot managed to set himself on fire"? That's not ethics, its cowardice. Its your decision, and your entitled to it, but call it what it is.

Aside aside: the DSM IV lists alchoholism and drug addiction as a disease, just like renal failure and jaundice are listed in other manuals. Saying you won't donate to addicts is therefore making a value judgement about the relative merits of various diseases, an idea I personally find distasteful. "Oh sure, kidney failure sucks, but its not that bad. If he had heart failure, then I'd donate." Bah. A fatal disease is a fatal disease. Sure, addiction sometimes relapses, but then again cancer often does, as well.
posted by ChasFile at 3:11 PM on May 28, 2004

Also, Wired mag piece on Hemopure, another blood substitute.
posted by Hackworth at 6:59 PM on May 28, 2004

So far no analogy has swayed me to reconsider donating my organs. That a committee of surgeons takes many things into consideration is commendable, but I am fairly certain that the committee would not follow the donors wishes. If some technically moronic person was burning, probably I'd try to find a way to stop the fire in a manner that wouldn't cause litigation (sarcasm. -if you need it pointed out). George Bush changing his ways doesn't encourage me to donate organs. No way you can seriously believe that not donating my organs is akin to deciding someone should die. My judgement is that I think there aren't many people I've met who I'd be comfortable with my organs being inside. Sorry if I don't feel the urge to prolong the lives of everyone just because we're all two legged creatures with organs. If I could donate to friends and family or have them make the decision, fine. I don't believe we are inert; that once I'm dead there's only flesh. I don't consider myself to be particularly spiritual, but I do believe that our body is impregnated with our energy. It's really creepy to think of my organs, with remnants of my energy, in a stranger that doesn't let people merge in traffic, that is unconcerned with the environment, that doesn't tip, that supports the war in Iraq, that listens to country music, that looks at me and thinks I'm weird...there's a bazillion reasons why I do not want someone else deciding who's life my organs should prolong. -alcoholism and drug addiction never entered my mind.
posted by giantkicks at 8:06 PM on May 28, 2004

It's really creepy to think of my organs, with remnants of my energy, in a stranger that doesn't let people merge in traffic, that is unconcerned with the environment, that doesn't tip, that supports the war in Iraq, that listens to country music, that looks at me and thinks I'm weird...there's a bazillion reasons why I do not want someone else deciding who's life my organs should prolong. -alcoholism and drug addiction never entered my mind.

I'm with you all the way on the, um, creepiness aspect, there, giantkicks (and nice post to the front page, by the way), but there are some things that trump our ideological revulsion.

At death, your organs become even more the "property" (there's really no such thing) of the all that you are part and parcel of...that mysterious and yet obvious singularity we uncomfortably sense (and try so desperately to ignore) in life. Illusion dies hard, but death has a way of ending all illusion.

Hell, this particular liberal would donate his bleeding-heart to the likes of John Fuckin' Ashcroft or Ann Suckin' Coulter as quickly as they could cut it from my lifeless thorax....no doubt a vast improvement for either recipient.

Although frankly, the critical transplant issue for the right wing in this country is obviously testicular, rather than cardiac.

But I wander from the topic. All life is sacred, be it sloth, toad, worm, or conservative wingnut. Be an organ donor.
posted by fold_and_mutilate at 9:50 PM on May 28, 2004

The problem with raising our organs to the sacredness of our soul is that it lowers that very soul to the base level of our organs. Put it another way, whatever wonder lasts after we die, if it's represented in our organs, then all that remains rots and becomes food for worms.
posted by effugas at 11:32 PM on May 28, 2004

There are far too many people who's lives/lifestyles I don't respect for me to chance that someone I do not respect would receive my organs.

I feel the same way about dehydrated people I meet in the desert. (in all seriousness though, the hell is wrong with you?)
posted by mcsweetie at 6:01 AM on May 29, 2004

This reminds me of an old All in the Family ep where Archie Bunker got black blood and was totally freaked out by it.
posted by amberglow at 8:04 AM on May 29, 2004

All life is sacred, be it sloth, toad, worm, or conservative wingnut. Be an organ donor.

nicely put.

The problem with raising our organs to the sacredness of our soul is that it lowers that very soul to the base level of our organs. Put it another way, whatever wonder lasts after we die, if it's represented in our organs, then all that remains rots and becomes food for worms.

Or allows others to continue living... even if you're buried, you help the worms and grass to grow - nature keeps on. There's no need to think of our personal finitude as indicative of meaninglessness. You're just part of something bigger. So, get over yourself!

It's really creepy to think of my organs, with remnants of my energy, in a stranger that doesn't let people merge in traffic, that is unconcerned with the environment, that doesn't tip, that supports the war in Iraq, that listens to country music, that looks at me and thinks I'm weird...

yeah, this is totally archie bunker territory. We're all human beings. Even people who like country music. And anyway, you'll be dead. Maybe your organs will save the life of someone who tips well, is committed to saving the environment, and is a connessieur of indie rock. Would you rather she died? Even the country music lovin' truck driver you dislike may have a positive impact on members of the community you hold in higher esteem. Or maybe this "energy" you imagine inhabits your organs will have a positive impact on the receiver of the organ.

At some point, you gotta let go, though. I think death is a pretty good time for that.
posted by mdn at 9:14 AM on May 29, 2004

connoisseur.

man, I really don't like misspelling things.
posted by mdn at 9:17 AM on May 29, 2004

"But imagine the possible reward, if they manage to save someone's life with this stuff. The PR from that alone could make the whole enterprise worthwhile."

I agree the potential benefit is huge. But, the study design is flawed, and the flaw has been pointed out by academic types, in medical publications. The study sponsor is ignoring this. Specifically, look at the part of the article describing how long the polyheme will be administered. 12 hours after admittance to the hospital. There are guaranteed to be people who will die when on this study, no matter how great this blood substitute is. Now, when at the hospital, they will not be receiving standard level of care (real blood) even though it will be available. Loyola, and every other participating research institution have just set themselves up as cash cows for any moderately competent ambulance chasing attorney.
posted by MetalDog at 3:26 PM on May 29, 2004