Are 'bloodless' transplants the future trend for cheaper surgeries?

With the rising cost of blood transfusions, patients may have an alternative choice for transplant surgeries.

On the last day of January 2013, Dr. Scott A. Scheinin successfully performed a "bloodless" lung transplant at The Methodist Hospital in Houston — a surgery done without a blood transfusion as a safety net if the patient begins to bleed out. This surgery was one of only 11 that had been attempted at that hospital.

Sheinin is on the cutting edge of doctors who have come to believe that transfusions, typically part and parcel of transplant surgeries and many other procedures, are not in the best interest of the patient.

According to the Red Cross, an organ transplant surgery can require up to 100 units of blood.

In fact, blood transfusions occur "in over ten percent of all hospital stays that included a procedure, and was the most frequently performed procedure in 2009. The rate of blood transfusion more than doubled from 1997 to 2009," according to a government report by the Agency for Healthcare Research and Quality.

The cost of processing and transfusing blood has skyrocketed, to now upward of $1,200 for just one unit, according to the New York Times. In addition, government data shows that about one in every 400 units received is tracked to an additional medical issue for the patient. Sepsis, circulatory overload and allergic reactions are often the culprits.

These factors, and a growing body of research showing that patients who have surgery without transfusions do just fine in comparison to matched patients who have had transfusions, are leading doctors like Scheinin to the idea that transfusions may cause more risk for the patient than doing surgery without.

In this new approach, a patient's blood is salvaged during the procedure, then spun via a centrifuge to remove red blood cells. These red blood cells are cleaned with saline, then reintroduced to a patient's body during surgery.

Also, prior to surgery, a unit of blood is removed from a patient, and a unit of saline is given to replace it, keeping blood pressure steady. That unit is reintroduced to the patient's body right after the procedure.

These techniques are supported by the Jehovah's Witnesses because the blood is kept with the patient, with no donor involvement.

Though extremely rare, and still difficult to perform, bloodless transplants and surgeries are not a new concept — Johns Hopkins hospital performed the first bloodless lung transplant in 1996. The procedures have also been driven by the requests of Jehovah's Witnesses, whose religion forbids transfusions. These believers are willing to take the perceived risks of surgeries performed with a "patient blood management" approach, and sign consent waivers relieving the hospital of responsibility if the patient bleeds to death during surgery.

As economics, need and research drive this technique into more hospitals, availability and training will be more common.


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