Blood Transfusions and Blood Substitutes: Some Considerations - Essay Example

Blood substitutes would be highly useful for Jehovah’s Witnesses; soldiers in combat areas and people in disaster and trauma zones or in highly remote areas (where portability of human blood and the challenges of cross-typing are issued); for use with people whose hyperactive immune system may initiate a dangerous allergic reaction or people whose hypoactive immune systems may not be able to cope with the infection potential; and for people in high HIV or hepatitis risk areas where uncontaminated blood is more difficult to obtain. It would also be useful for those people who, though not members of a religion forbidding human blood transfusions, still have spiritual concerns about the possible foreign consciousness complications of taking someone else’s blood into their own body. 

Life is in the blood, so it is ethical issues are raised about casually taking another person’s life into your body. It can have spiritual ramifications and not only medical ones. A second ethical issue of using human blood in treatment is that a medical prime directive is to not harm the patient, yet the transfusing of human blood involves a lot of potential harm, for example, the risk of infection (HIV, hepatitis, etc.), transfusion reactions, lung injury, delayed wound healing postoperatively, risk of cancer recurrence, possible mistakes in blood-typing, and the risks associated with old blood, compared to fresh blood.

A third ethical issue is that there is a shortage of human blood, so how is it determined, and by whom is it determined, who gets the transfusion and who does not?  In a similar situation, there is a severe shortage of body organs (hearts, kidneys, livers) for transplant. This shortage has resulted in an active underground trade in organs, internationally, which is responsible for the exploitation of poor people, the murder and involuntary seizure of organs, organ smuggling, and war atrocities. We do not want a similar evolution of the blood shortage problem, a similar negation of human rights, and commercial trafficking.

The primary ethical issue of using blood substitutes involves safety (vasospasm and change in blood pressure, nephrotoxicity and dysfunctional bacterial ingestion, production of antibodies, oxidation outcomes in storage, coagulation, iron overload, gastrointestinal distress, neurotoxicity, free radical generation, interference with reaction diagnosis, flu symptoms, hepatic engorgement, and temporary immune impairment, and limited shelf life can lead to complications).

The HBOCs also use animal and biotechnology sources, which might not be accepted by those with religious or spiritual objections (like Hindus, for example) or with severe allergic reaction history. Perfluorocarbons are also better for severe coronary artery disease or limb ischemia, due to their small size.

4. Why do you think there are so many issues with blood substitutes?
Blood substitutes are artificial and not natural, therefore causing a risk of rejection, unnatural outcomes on arterial and pulmonary pressure can be poison to the kidneys, can produce free radicals and oxidation, and, like human blood, can destabilize at room temperature and be difficult to store. They need to be an improvement in the use of human blood, and this is not an easy matter. It requires a lot of research and trial and error. It requires animal testing first, as doctors cannot simply put artificial blood into people experimentally, without solid evidence that there is a reasonable chance of success.

When it seems that researchers are onto a good thing (with DCLH for example), the promising results for one group of patients are offset by increased complications and mortality for another group of patients, and thus it has to be dropped from testing. It requires FDA approval to market it, also, and this is not easy, nor immediate. Blood substitutes still do not have market approval in the USA, Canada, or Europe, so it will still be a few years before they are in routine use.

5. If you were making a blood substitute, what would the main challenges be?
Safety (nontoxic, non-reactive, non-infectious, does not destabilize pressure, sufficient half-life in circulation, hypo-allergenic, does not overload the reticuloendothelial system, no oxidation and free radical generation), does not require blood type differentiation, storage life (does not easily de-stabilize), immediate availability, easy to administer, funding, animal testing, cooperative sharing of information and resources with international partners, market approval and eventual popular acceptance would be some of the major challenges.