Tomáš Kohoutek from the BioLife donation centre: 'I am glad that the rules of donation have changed. The key is the donor's risk and sexual behaviour, not orientation."
What is the history of blood donation and also plasma donation?
As far as the history of blood donation is concerned, it is more or less the last hundred years. The first plasma donations in a private donation centre took place exactly sixty years ago in Vienna, in the centre that is the forerunner of our company.
I have experience with blood donations, but not with plasma. How is it different?
There are several aspects. But I would start with the preparation for donation, which I consider the most important. Before you donate plasma, you need to drink enough - 3-4 litres the day before and at least a litre on the day of the donation before the donation itself. It is also important to eat. Nothing completely fatty, but rather focus on protein intake. With blood, eating before the collection is not strictly necessary.
The collection is then very different. It's done with a device called a separator. This takes a target amount of blood in several cycles, from which the blood plasma itself is separated. The plasma is collected either in a container or in bags. The blood cells are then returned to the body. This cycle is therefore repeated until the desired amount, determined by the weight of the donor, is collected. The collection takes 30-60 minutes depending on the condition of the veins, the preparation and the amount required. It is therefore considerably longer than blood donation.
For blood donation, an average of 4 donations per year is recommended. Are there different rules for plasma?
Yes, they certainly do. After whole blood donation, it takes the body two to three months to rebuild all the missing blood cells, which are not lost when the donor donates plasma by plasmapheresis and are returned to the donor after plasma separation. In addition, the collected plasma is re-synthesised within 48 hours. It is therefore not so demanding on the organism. If the donor is well prepared for the donation, the body can handle it even faster. This is evidenced by the fact that you can go to donate blood 48 hours after donating plasma, but plasma is not donated until a month after donating blood. We have a number of donors who donate both, and this measure ensures that it is not such a burden on their body.
"I am glad that the rules on donation have changed. The key is the donor's risk and sexual behaviour, not orientation."Photo: BioLife ČR
In the case of blood donation, I can easily imagine the use, but what is the use of plasma?
There are two most common uses for blood plasma. Either as freshly frozen plasma, which is used in acute conditions, for example, in dealing with severe trauma due to car accidents, difficult births, complicated operations... The second option is to process plasma by fractionation, where it is used to make medicines. This is the case, for example, in our BioLife plasma centres.
There are various untruths surrounding plasma donations that can make it difficult to recruit new donors. What are these myths?
There are many. When I give a presentation, for example to students, or when donors ask me questions before donation, I'm happy when they bring up a myth because they are then very surprised when I explain how it works. Most often I hear that blood plasma is used primarily in the cosmetic industry, which is nonsense. If you imagine how much work goes into one plasma collection and how many different machines are needed, those creams would cost millions! Yes, blood plasma can be used for cosmetic treatments where a very small portion is taken directly in the beauty salon. In no way is plasma donated in a medical facility, including plasma centers. This is intended solely for medical purposes.
It has stuck in my mind that the blood that goes back into the body is cold. Is that true?
It can feel colder! In order to get the blood back into the body after the plasma is separated from it, sodium citrate is added to it. This acts as an anticoagulant, which means it prevents the blood from clotting. This procedure is important because during plasmapheresis, the blood is outside the body and must remain fluid in order to be properly processed and returned to the circulation. And this particular solution is not 37 degrees like the body, it is usually room temperature, so yes, you may feel the blood is colder, but it will not compromise the body in any way. But temperature perception is very subjective. Some people perceive the difference more, others less.
There is also a common perception that many donors are motivated mainly by financial reward and that they are donors from groups that we might consider less suitable. Is there any control over the suitability of the donors and the quality of the plasma collected?
Motivations for donors vary, of course. A recent survey shows that 69% of Czechs have the ambition to donate. From my experience of daily contact with donors, I can say that many donors go for non-contributory donations or combine it. There are donors who use donations to support charity events, but there are of course donors who use the compensation for the preparation and the donation itself to finance their everyday needs.
Of course, donor eligibility checks are ongoing. Donors first complete a questionnaire, then are examined by a doctor. However, we also focus on social history and have mechanisms to identify unsuitable donors.
You mentioned that there are various conditions that donors have to fulfil. What are the basic ones?
The important thing is that the donor is well prepared and also physically and mentally fit. Then there are various diseases, for example, bleeding disorders or cancer diagnoses, epilepsy, which are not compatible with donation at all. However, there are diseases that do not exclude donors under certain conditions, such as high blood pressure or elevated cholesterol levels. However, the questionnaire also looks at the risk behaviour of the donor.
Let's stay with the risky donors. Although sexual orientation was not officially supposed to be a reason for not being able to donate, until 30 June this year, gay men, or men who have sex with men, were among the risk donors. But the legislation has changed. So how is it different?
First of all, we should mention the historical circumstances. For a long time, there were significant prejudices and, at the same time, less expertise and experience on how to control donated blood or plasma. However, this is no longer the case. It used to be perceived as equally risky if a man had sex with a prostitute or with another man. This is no longer the case. The decree seeks to straighten out and correct the situation, to take more account of the riskiness of the donor, of risky sexual behaviour, regardless of who has what orientation. I think the doctor shouldn't be interested in sexual orientation, but just in the risk assessment of the donor. And that's what the new decree is trying to do. I'm glad it's happening.
It is also worth noting that changes in the health sector always take a very long time, and each change affects a whole range of processes that have to change over time.
There has been a straightening of the rules thanks to the decree, but practical matters have also had to be adjusted. Does this mean, for example, that the material taken in is subject to more sensitive tests?
Yes and no. The new methods have led to blood and plasma being tested with more tests that target infectious diseases such as HIV or hepatitis B and C, but there is no direct link.
In our field, we are concerned about two key groups and their safety: blood plasma donors and patients. The technological possibilities are truly extraordinary and the process is accompanied by multiple control mechanisms. Therefore, we can focus more on what is essential and what remains an injustice of the past.
