The American Red Cross collected hundreds of thousands of blood donations after Sept. 11 knowing that the blood could not be used for victims of the terrorist attacks.
After selling some of the surplus blood to hospitals, the Red Cross has begun to destroy thousands of pints that have outlasted their shelf life. Directors of several Red Cross blood centers said their sites may discard as many as 1 of every 5 donations and the national total could easily reach tens of thousands.
The charitable outpouring offered an opportunity for the $2.5 billion-a-year organization to restock its depleted blood inventory. Although the Red Cross told the public that surplus blood would be frozen, it did not have the resources to freeze large amounts of excess blood, according to documents and interviews.
The Red Cross, which is the nation's largest blood supplier, declined to answer questions about how much extra blood was collected. Spokesmen said the Red Cross kept collecting blood because it did not want to turn away donors and hoped to create a reserve in case of more terrorist attacks. They noted that every blood donation yields some lifesaving byproduct, such as plasma.
The nonprofit Red Cross collects more than 6 million pints of blood annually and earns about $1.5 billion, or 60 percent of its revenue, by selling donated red cells, platelets and plasma to hospitals for more than $225 a unit.
The Red Cross estimated that less than 10 percent of the donations will be discarded, but some of its blood-bank directors disputed that. They said the Red Cross collected at least 250,000 and perhaps as much as 400,000 extra pints in the month after the attack.
The events surrounding Sept. 11 illustrate the tensions that exist over the management and control of the nation's fragile blood supply. It is a business much like a public utility, managed by a mix of nonprofit and for-profit companies that compete for donors and market share. Their dealings seldom attract public attention.
The Red Cross decisions in the days after Sept. 11 created a standoff with other blood groups, which opposed collecting unneeded supplies of a perishable product. Federal officials tried to negotiate a unified policy, but the Red Cross balked at a plan to encourage donors to delay their donations.
"It's inexcusable," said Arthur Caplan, a University of Pennsylvania ethicist and until recently chairman of the Advisory Committee on Blood Safety and Availability for the Health and Human Services Department. "It could be very damaging and cost them an enormous amount of goodwill."
Two months after the attacks, the Red Cross is mired in criticism stemming from its handling of the crisis. President Bernadine Healy has been forced to resign, effective the end of the year, partly because of her decisions on how to use money contributed to help the victims of the terrorist attacks.
Part of the money is being used in an attempt to create a 100,000-unit reserve of frozen blood, a program that will cost $50 million -- or 10 percent -- of the gifts Americans donated for victims of the attacks.
"As the organization supplying most of the nation's blood we believe we have an obligation to ensure enough is on hand and ready," Red Cross spokeswoman Blythe Kubina said.
Last week, Healy told Congress that the frozen reserve would be stockpiled in part for "military" use. That came as a surprise to officials operating the Armed Forces blood program, which has its own frozen reserve of 60,000 units stored in Asia and Europe. On Thursday,Kubina acknowledged that the military had not asked it to freeze blood.
42-Day Shelf Life
Soon after the Sept. 11 attacks, the country was awash in blood. Americans donated in record numbers. Nationally, blood inventories swelled from an average of three days' supply to 10 days' worth.
Charles Rouault, a physician and president of the Blood Centers of South Florida in Fort Lauderdale, was among them. By the time a second hijacked plane hit the World Trade Center, he was on his way to the donor room.
"I knew we would be overwhelmed quickly, so I wanted to get it out of the way," Rouault said. "By 5 p.m. that night it was standing room only. The wait was at least six hours. We started telling everyone: 'You're really not going to be doing anyone any good by donating today. Write your name down. Leave a business card. We will contact you again.' "
To much of the blood industry, it quickly was clear that there would be no huge demand for blood: Most of the victims were dead. Yet there were disagreements about how to handle the surge in donations. Some urged caution, but the Red Cross continued to seek donations.
In San Diego, the Red Cross urged donors to give blood at the "request of the White House," according to a press release. Two weeks after the attacks, the Red Cross in South Carolina, was still telling donors that their blood "will go to victims of the Sept. 11 terrorist attacks in New York and Washington."
"The most disturbing thing was that Red Cross refused to hold back," said the head of one large Red Cross center, who requested anonymity. "We were ordered by national [headquarters] to keep collecting. Now, at my center, we're looking at a major loss of product."
In the Washington area, home to the Red Cross and the nation's two other major blood organizations, the debate shifted from whether there would be enough blood to whether there would soon be too much. Blood has a 42-day shelf life. Having too much blood can be as challenging as having too little.
America's Blood Centers, which runs 450 centers and handles about half of the nation's blood supply, informed the Red Cross that it would tell donors that blood wasn't needed immediately and to schedule future appointments. Within a day after the attacks, "we were already getting messages from our centers to turn the spigot off," said Executive Director Jim MacPherson.
Federal officials, concerned that the public was getting mixed messages, called the blood organizations to a Sept. 14 meeting at the Health and Human Services Department to draft a statement to guide donors. They left thinking a consensus had been reached that would promote donations, but ask donors to stagger their blood giving over coming months.
But the Red Cross later balked, said Stephen D. Nightingale, executive director of Health and Human Services's blood safety and availability committee. The Red Cross's Kubina said that after the meeting, its officials decided "we were not comfortable saying we do not need donations any more."
Nightingale said it was not the responsibility of the Health and Human Services Department to tell the Red Cross what to do. "Obviously we felt if there was a consensus it would be easier for everyone involved," Nightingale said. "But we don't tell the blood banks how to operate."
Blood centers usually have no problem using surplus blood. Centers that have too much sell it to centers that have too little. In some cases, blood organizations sell as much as half the blood they collect.
After Sept. 11, that changed. With nearly all of the nation's blood centers flush with blood, the ability to sell surplus disappeared, increasing the odds that blood would go unused and have to be destroyed, authorities said.
Prices of valuable type O-negative, the universal donor type that can be transfused in any patient, fell from nearly $100 a pint to as low as $20 a pint, according to several center directors.
Ronald O. Gilcher's Oklahoma Blood Institute, a longtime blood exporter, asked individuals to slow down the donations. "We knew we wouldn't be able to export large amounts, so we scaled back," said Gilcher, a physician.
At the Community Blood Centers of South Florida, of which Rouault is president, he also pulled back requests for donations. "The blood was building up like a tidal wave on the shelves and we knew we couldn't ship them out," Rouault said.
The Red Cross, meanwhile, continued to run advertisements soliciting blood donations, Rouault said.
When the Red Cross encountered questions after the Sept. 11 attacks about how it would use surplus blood, officials had a ready answer: It would would be frozen. The plan was to create a reserve of up to 100,000 type O units, which Healy has said would be "one of our finest investments towards national preparedness in the wake of 9-11."
The facts were more complicated: While the Red Cross had the ability to freeze some quantities, it was not equipped to quickly process the huge outpouring. The Food and Drug Administration did not accept the Red Cross's plan for a major freezing program until Oct. 1, a document shows.
Experts say it takes time, manpower and equipment to gear up for a major freezing program. "You just don't decide to freeze 100,000 units of blood," said Celso Bianco, a physician and executive vice president of America's Blood Centers. "You need to have a good plan and time and money. It's very labor-intensive."
Gilcher, in Oklahoma City, said the Red Cross was "irresponsible in the message that was 'given' to the American people by saying 'donate blood and money' and implying that the American Red Cross would freeze that blood."
The Red Cross declined to disclose how much of the extra hundreds of thousands of pints collected since Sept. 11 were frozen. An inventory that one Red Cross director saw showed that about 8,000 units of blood had been frozen between Sept. 11 and mid-October, which suggests that large-scale freezing had not happened by that time.
Kubina disputed that account, saying "8,000 is wrong," but would not offer specifics. She said "some blood" collected just after Sept. 11 has been frozen, but acknowledged that most of the proposed reserve would come from donations being made now and later.
The Red Cross approached the FDA on Sept. 14 for approval of procedures for freezing and thawing a large reserve, which it proposed keeping at six sites. State-of-the-art technology enables frozen blood to be used for up to 14 days after thawing. The thawing method the Red Cross cleared with the FDA on Oct. 1 requires thawed blood to be used within 24 hours, which poses a greater challenge in moving blood from scattered stockpiles to a disaster spot.
The feasibility of a strategic blood reserve had been discussed inside the Red Cross for a year, Kubina said, and it was thought that special fundraising would have to be conducted for the project.
The events of Sept. 11 "accelerated" the plan, Kubina said. It made the need more apparent, she said. But also, with the surge in money that came into the Red Cross after the attacks, it was able to designate $50 million to fund the blood-reserve program out of the gifts sent to the Liberty Fund, the account intended to help disaster victims.
That use came under fire last week when Healy appeared before Congress to explain how the Red Cross was managing the victims fund. "I don't believe anyone who wrote a check to Sept. 11 expected it to be used for frozen blood," Rep. Peter Deutsch (D-Fla.) told her.
Fresh blood donated Sept. 11 reached the end of its shelf life Oct. 23. Blood donated Sept. 30 will hit its expiration date today. When blood becomes outdated, it is useless and must be burned. "At my center," a Red Cross director said, "we have all of this surplus blood that is only now starting to outdate. We don't have the supplies to freeze it. There's no place to ship it. What do they think is going to happen? We can't create a need for it that isn't there."