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ADRP Advisory Board Member Amanda Hess discusses advances in transfusion medicine, challenges blood centers face, and how clinicians can boost blood donation.

The need for blood donations in the US remains significant. According to the Association for Blood Donor Professionals (ADRP), over 15 million units of red blood cells, platelets, and plasma were transfused in 2024. However, only 3% of Americans currently donate blood, with most donors over 50 years old and trending upwards as the number of younger donors increasingly declines.

In recognition of National Blood Donor Month, Physician’s Weekly (PW) spoke with Amanda Hess, ADRP Advisory Board Secretary and Vice President of ImpactLife, to discuss how clinicians can encourage blood donation, the latest advancements in transfusion medicine, and the challenges blood centers will face in the coming years.

PW: What can clinicians do to promote blood donation?

Hess: Clinicians have a tremendous influence on our volunteer donor base. As influencers in their communities, they can help connect the dots and explain the need for volunteer blood donors to support transfusion medicine for patients undergoing life-threatening conditions such as cancer, organ transplants and surgeries, emergency and trauma care, hereditary blood disorders, and more.

Every two seconds in this country, someone needs a blood transfusion. We have patients who need blood in advance, so it’s ready in the operating room. Organ transplants or heart surgery are often not possible without blood transfusion. And, of course, emergency and trauma situations—unexpected situations that happen daily. That’s where we must have a stable and sustainable blood supply from routine voluntary blood donors who give every 56 days as often as they’re eligible.

Patients receiving care involving transfusions and those patients’ family members often want to know how they can help others facing those situations. Donating blood can make them feel like they’re making a difference. Clinicians can tell them, “Your loved one is going through this care, and there is something that you can do: become a volunteer blood donor. You may not know which patient is getting your blood but know it’s a patient in need, just like your loved one.” The value of that can’t be underestimated.

Clinicians nationwide are encouraged to direct people to donatingblood.org, a website ADRP developed specifically to educate the public about donating blood. The website is incredibly useful and includes a locator tool to help prospective donors find a donation location near them. It would be incredible if more clinicians shared it with their patients and their patients’ families.

What are the most common public misconceptions about blood donation?

The biggest misconception about blood donation is that blood will be available when it is needed without more donors choosing to give and give more often. About 60% of the adult population is eligible to give blood, but only about 3-5% take time to give. Of those, about 70% only donate once or twice a year. I often hear, “I’ll donate if it’s needed,” but the reality is that it would be too late. Blood used in emergencies must come from donors who gave days and weeks before transfusion. Constant replenishment is our biggest ongoing concern because blood products have short shelf lives. Red blood cells must be transfused within 42 days, platelets must be used within 7 days, and plasma can be frozen for up to a year but must be used within a week once thawed. Our supply of life-saving blood must come from people who give routinely.

Many potential donors have misconceptions regarding their eligibility to donate. For example, we conduct hemoglobin testing as part of our pre-donation screening. If a potential donor’s levels are too low, they must wait before they can try again. Many people think this is a diagnostic test for anemia, but it’s not, and hemoglobin results can fluctuate daily, so those individuals are eligible to attempt donation days later. Additionally, many people who have medical conditions such as diabetes or who are on certain medications such as antihypertensives think they can’t give, but most are eligible. Clinicians can help promote blood donation by answering patient questions about eligibility. They can also direct patients to local blood center websites. Most blood centers offer eligibility information on their websites and have staff members available seven days a week who can answer eligibility questions.

Lastly, although our industry has worked hard to ensure the quality and safety of blood and donor products, the donor’s safety, and the donation process, some people still have misconceptions about the safety of blood donation. Potential donors may need reassurance from their clinicians that blood donation and transfusion are very safe.

What are the most common perceived barriers to donation cited by potential donors?

Lack of time and fear of needles. To combat that, clinicians can explain that blood donation is a quick, simple procedure. Many blood centers now allow donors to complete their medical history questionnaire in the comfort of their home or workplace before arrival, saving them time. A  donor typically spends an hour with us, but only about 15 minutes or less is spent on the donation. We often hear from first-time donors that donation was far easier and quicker than they’d ever imagined and that the feeling that they directly helped save a life—or multiple patients’ lives—far outweighed the time they spent or that fear of that needle.

Have there been any exciting, recent medical advances in blood transfusion?

It’s always exciting in this field! Clinical researchers have started using blood products donated through our nation’s blood centers to develop new cures and treatments through cellular therapies, so blood centers are starting to focus on collecting white cells. Traditionally, a donor would give a unit of whole blood that would then be manufactured into red blood cells, platelets, plasma, and sometimes cryoprecipitate, a product used in heart surgeries. We’d typically leukocyte-reduce those, removing the white cells. We now have a donation procedure for a product we refer to as a leukopak—a unit of white cells we can deliver to a researcher. We’re also now using leukoreduction system (LRS) chambers—cones that capture biological cellular materials historically not used for transfusion but that have recently become important for research—so we can provide those materials to researchers.

The pre-hospital transfusion movement is also recent. Many clinicians might be surprised to learn that transfusable blood products are unavailable on most ground and air emergency medical vehicles in the US. Now, medical directors of major trauma centers and blood centers across America are leading a movement to provide EMS teams with blood products to allow them to perform transfusions in the vehicle when moments matter. It makes so much sense. Our blood center now provides 18 or more EMS providers with blood products—components or whole blood—available on their vehicles.

That’s also a little different. For many years, transfusions were based on separate components—red cells, platelets, and plasma—but now blood centers leave some blood products in whole form. Low-titer whole blood (LTOWB) is being transfused in trauma situations in the hospital and on EMS vehicles.

In addition to LTOWB, biologic manufacturers are developing novel transfusable products to address product storage and shelf life challenges. For example, Velico Medical is developing a spray dried plasma product that can be reconstituted with water and used in EMS settings in the future.

What are the biggest challenges blood donation centers face in 2025?

The biggest challenge will be finding enough volunteer blood donors to meet the traditional needs for transfusion medicine while increasing donations for improvements in patient care, such as pre-hospital transfusion, and research and development of new cellular therapies.

The next generation of donors will ensure a sustainable blood supply. We’re concerned about not having that next generation to replace our aging donor population. Our typical donor age is over 50 years old, and as our routine donor population ages, they may become ineligible. During the COVID-19 pandemic, donations among individuals under the age of 20 dropped dramatically, and we haven’t seen improvement. We missed out on engaging an entire generation of high school students in blood donation by being unable to host onsite blood drives for several years.

Another concern is having an adequately diverse donor base to match the diversity of our patient population. The number of patients with extended phenotypes who need transfusions is increasing. Patients with hereditary blood disorders, such as sickle cell disease, often require multiple transfusions over many years. To avoid a transfusion reaction in many of these patients, we must locate matching rare blood types or extended phenotypes, which typically come from a volunteer donor with a hereditary background similar to that of the patient.

One of the biggest challenges we’re facing now, and we’ll probably continue to face in the future, is the lack of elasticity and surge capacity of the blood supply. Improving that starts with engaging volunteer blood donors. US donations typically drop during summer months and the weeks of winter and summer holidays—New Year’s week donations are typically 20% to 25% less than average weekly donations—but transfusions occur every day. Some of the clinicians at our hospitals call summer “trauma season.” It’s particularly challenging when we see a simultaneous surge in demand and a drop in donations.

Is there anything else you’d like to add?

There is no substitute for blood. It must come from people. It must come from volunteer blood donors. Life-saving treatments would not be possible without it.

For additional blood donation and transfusion information and resources, visit the National Blood Donor Month website here.