Blood from cadavars

[tardieu]

My blood bank days are dimming. However, I still remember naively asking during one of my BB-TM rotations about using cadaver blood for transfusion. The response I got was something like "Would YOU want to get transfused with blood from a dead person?!". Then everyone chuckled and it never went any further.

Til this weekend, when a non-medical person asked me about it, and I had that awkward feeling that this is something I should know about, but don't.

Google yielded little, pubmed even less.

So, anyone else out there who is closer to the BB-TM world, I'd appreciate your input:

What's the deal with using blood from cadavers for transfusion? Does anyone do it? Why doesn't everyone?

Thanks.

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[loveoforganic]

Blood cells have their hemoglobin decompose to the bilins, don't they? If the exhuasted blood cells aren't constantly being filtered off and replaced, you're just going to have a suspension of cellular contents and bilins I think?

 

[icpshootyz]

What's your time frame for collecting the blood? Immediately following the last breath/heartbeat, or later? How will you collect the blood, since blood from donors usually passively collects due to the pressure in the venous system to force it out of the body. Wouldn't happen in a cadaver. Active collection, ie pheresis, would hardly be economically very viable. If you wait any length of time after death the blood is slowly clotting as factors degrade. Also, as the RBC's use up their glucose stores they will begin to die. So I think there's a ton of reasons why cadaver blood collection is both improbable and likely impossible.

 

[tardieu]

What's your time frame for collecting the blood? Immediately following the last breath/heartbeat, or later? How will you collect the blood, since blood from donors usually passively collects due to the pressure in the venous system to force it out of the body. Wouldn't happen in a cadaver. Active collection, ie pheresis, would hardly be economically very viable. If you wait any length of time after death the blood is slowly clotting as factors degrade. Also, as the RBC's use up their glucose stores they will begin to die. So I think there's a ton of reasons why cadaver blood collection is both improbable and likely impossible.

The assumption is that the blood will be collected in a timely manner, just like other organs for transplant have to be.

So, for arguments sake, let's say beating heart donor. You're there with a cell saver or some other type of thing at the same time they are taking the heart, kidneys, lungs, what ever else.

 

[Giemsa]

Transfusion from cadavers saw very little utilization, despite (or maybe because of) the grotesquerie. Basically it was limited to some 30,000 transfusions at one centre in Russia (PMID: 13836924).

From Mollison 7th ed. "Suitable donors [in the above mentioned Tarasov report] are victims of sudden cardiac arrest (MI, hypertensive heart disease, electric shock); victims of accidents involving tissue injuries are not suitable. In subjects who have died suddenly, blood obtained by venesection flows out in the liquid state; it clots after 20-30 minutes, but 30-90 minutes later it becomes liquid again. This fibrinolysis is seen only in the blood of healthy persons after sudden death. Two to four litres of blood are obtained from the jugular veins of the cadaver within 6-8 hours of death and nothing whatever is added. The blood is said to be suitable for transfusion after storage at 4oC for a period not exceeding 25 days, but if it behaves like defibrinated blood from living subjects, 5 d would seen to be a more reasonable upper limit for the storage period."

The American experience: PMID: 14130939 (yes, that Dr. Kevorkian)

Obviously, I've never seen this done. The technique didn't survive much beyond the 60's. The most recent edition of Mollison's pooh-poohs it with a three-sentence entry on page 14, saying "Administration of cadaver blood seems to be of prime interest to journalists and reporters" and "reports of widespread use and benefits have attained mythical proportions".

It just didn't work that well. It was complicated, cumbersome and the supply was unpredictable (forget making these donors appointments!) It's one thing in 1960's Russia to extract blood from the dead in great quantities, but no doubt this would require the next of kin's consent in North America - I would expect most people to say no. And that doesn't even begin to cover the recipient's response to this proposal.

The one advantage at the time - that you could do a full autopsy on the "donor" and see if they had any obvious internal evidence of illness - read hepatitis - has been to great degree been supplanted by modern infectious disease testing.

 

[green mantis]

I doubt the FDA would look favorably on it. The donor (being dead) wouldn't be able to respond to the questionnaire. There are things that it screens out that we don't necessarily test for.


----- Antony

 

[Freak]

I doubt the FDA would look favorably on it. The donor (being dead) wouldn't be able to respond to the questionnaire. There are things that it screens out that we don't necessarily test for.


----- Antony

Yea, the whole being in Britan since the 80's and such (mad cows fear).

 

[KCShaw]

Right. That's how I remember that sort of issue. Basically, a lot of risk vs. reward. Blood is collected and transfused a LOT, and is generally much more readily available than a heart. And, blood transfusion has been blamed for a number of batches of various infections, not least being HIV back in the day -- thus some pretty strict controls (like, oh, not paying donors for their blood) and screening measures. So while The System will take a heart from someone since they're very difficult to obtain, it won't take blood without going through the accepted series of screening requirements.

Cadavers would pose a lot of technical hurdles and a demoralizing lack of consistent material from cadaver to cadaver. But a beating-heart/brain-dead donor I think would certainly have the "capability," depending on meds, etc., though I suppose there may be stress-related alterations that could affect a potential recipient..

 

[The right Path]

Beating heart donors are maintained on a sh*tload of drugs (pressors, lasix, levothyroxine, insulin, desmopressin, vecuronium, methylprednisolone, etc.) as a rule. Though honestly I don't know for certain, it seems reasonable that this would preclude collecting their blood for donation.

 

[green mantis]

There's already a stigma about receiving blood. How would a recipient feel if they knew the blood would be coming from a cadaver? Also, there have been concerns about the use of "fresh" blood vs "old" blood? Where would cadaver blood fall into this scheme?

I don't think any of the drugs mentioned or a combination thereof would defer a live donor.


----- Antony

 

[The right Path]

There's already a stigma about receiving blood. How would a recipient feel if they knew the blood would be coming from a cadaver? Also, there have been concerns about the use of "fresh" blood vs "old" blood? Where would cadaver blood fall into this scheme?

I don't think any of the drugs mentioned or a combination thereof would defer a live donor.


----- Antony

Are you sure? I would think that being on a vec gtt for instance might make a person's blood unacceptable for donation, but for some reason I don't think they typically screen for that particular drug during blood drives. 😉

I truly don't know what concentrations of which drugs remain in processed blood products and what is considered acceptable. I'm pretty sure that if a person takes ASA q d they can donate for packed cells and plasma, but not platelets. Where are those blood bank guys when you need 'em?

But then again, as someone already mentioned the inability to ask those screening questions of a beating heart donor or cadaver would preclude standard safety measures so that makes on board drugs a non issue. Just a theoretical curiosity.