SAFETY AND EFFICACY OF PREOPERATIVE DONATION OF BLOOD FOR AUTOLOGOUS USE BY PATIENTS WITH END-STAGE HEART OR LUNG-DISEASE WHO ARE AWAITING ORGAN-TRANSPLANTATION

Many patients are, perhaps inappropriately, denied the benefits of aut ologous blood transfusion, because they are thought to be too ill to d onate blood safely. The safety and efficacy of autologous blood donati on by selected patients with end-stage heart or lung disease who are a waiting organ transplantation were studied to determine if even these critically ill patients could be suitable candidates for autologous bl ood donation. Seventy-two adults awaiting heart or lung transplantatio n were evaluated for autologous blood donation in a hospital-based blo od collection facility. Phlebotomy was performed if the patient met th e required medical eligibility protocol, and if he or she consented to participate. Units of blood were separated into packed red cells and plasma and stored in a frozen state, Of 48 heart transplant candidates , 31 (65%) were each able to donate 1 to 8 units of blood. The median number of exposures to allogeneic components was 1 for patients who do nated and 7 for nondonors (p = 0.0141). Among patients who donated, 54 percent required allogeneic components, as compared to 88 percent of nondonors (p = 0.0968). Of 24 lung transplant candidates, 15 (63%) mad e 1 to 6 donations each. The median number of exposures to allogeneic components was 0 for donors and 2 for nondonors (p = 0.1 871), but onl y 45 percent of donors required allogeneic components, as compared to 100 percent of nondonors (p = 0.0418). No serious complications during or following phlebotomy were observed. It is concluded that autologou s blood donation by patients with end-stage heart or lung disease may be safe. However, to delineate fully which patients can participate, a dditional studies of safety are required, including more objective mea surements of postdonation hemodynamics in these and other ''high-risk' ' patients. But, because avoidance of exposure to allogeneic component s or significant reduction in total exposures has been possible for ma ny patients, it is imperative that further studies of safety and effec tiveness be undertaken. The outcome of this current study suggests tha t the benefits of preoperative autologous blood donation can be extend ed safely to many patients previously considered too sick to participa te.