Comment by killjoywashere | Hacker News Reader

Comment by killjoywashere | Hacker News Reader

As the medical director of a blood bank and donor center that produces plasma, please do not taint the public's perception of the blood supply with misuses like this. We have a hard enough time ensuring sufficient donors without calling into question our disposition of their generous donations. We do not condone this sort of use. If you think this is abstract, I am about to send an email to my surgical colleagues because we'll be out of the most precious donation tonight at midnight: platelets. You tighten the donor pool at all, and you will make platelet donations exponentially harder.

I can't overemphasize the risk this misuse of blood products represents to healthcare systems around the world. This is an anti-vax movement waiting to happen: "Billionaires looking for a fountain of youth get blood transfusions from young bucks? WTF?" blends easily into "Why should I donate blood if they're just going to sell it to billionaires?" This would be catastrophic for trauma resuscitation, surgeries of all kinds, and a variety of medical patients.

There should be severe penalties for soliciting service like this. Imagine if solid organ transplants were handled in the same way: "Young man, as a new intern, I'll give you a percentage of my Facebook stock in exchange for a kidney..."

The next problem: it will only take one high-profile transfusion reaction to crater the public trust. If the biology nerds in the audience want to distract you with fancy talk about the low risk of certain molecular things happening because "it's just plasma", skip it. Simple, mechanical transfusion-associated circulatory overload is plenty enough to kill an old guy with stiff arteries and hypertension.

And the worst part is the lack of science being used to drive a supply chain decision that's highly science-dependent. This is so ethically corrupt I don't even know where to begin. The FDA's statement pales in comparison to what I'm sure the inspectors are actually feeling right now.

Please, if you know someone soliciting this kind of transfusion (recipient or physician), encourage them to read the FDA statement.

> Imagine if solid organ transplants were handled in the same way: "Young man, as a new intern, I'll give you a percentage of my Facebook stock in exchange for a kidney..."

This is already true in Iran. Here's the first paragraph of the Wikipedia entry.

The practice of selling one's kidney for profit in Iran is legal and regulated by the government. In any given year, it is estimated that 1400 Iranians sell one of their kidneys to a recipient who was previously unknown to them.[1] Iran currently is the only country in the world that allows the sale of one's kidney for compensation (typically a payment); consequently, the country does not have either a waiting list or a shortage of available organs

Your success criteria both reference the recipient. Often things can work out well for the wealthy and poorly for even those who "voluntarily" opt in.

Oh, yeah, donating a kidney halves the donor's long-term glomerular filtration capacity. They're sacrificing years of life for that decision.

Is it really this much? Anything you can point to? I had a friend who worked for. A non profit related to kidneys and she said the risks were minimal besides the surgery, and I always found that hard to believe.

You have two sieves and can sift 10 pounds of sand a minute. I take away one of your sieves. How long will it take you to sift those 10 pounds of sand?

This analogy doesn't really explain how much having only one kidney effects life expectancy.

Weird though because that's only one organ and most of the others don't compare with spares.

But if there's a scale about how replaceable an organ is then kidneys are far closer to blood or plasma than other organs.

Couldn't you fix this with paid, professional (but not full time), healthy blood donors? Compensation to donors would be a trivial cost of any operation performed with the blood, right?

Is this -- at risk of going there -- just another case where the effective solution is too disgust-evoking to try?

Edit: I agree that free donors will dry up under a system of compensation, but that's equally true of e.g. going to "all lumber must be donated" -> pay market prices to tree farms.

Paying for blood is not new. It has been shown to increase the infectious disease risk in the blood supply.

Yes, for the general population. Hence why I was careful to say "professional, healthy". Can you address that version of the proposal?

Say, limiting it to people who are well-screened and known to be healthy and not have risky lifestyles.

I assume this isn't a case of "oh we tried something like this ages ago and failed so we can't do anything like it again".

I mean, you are shoving needles into otherwise healthy people's arms. I've not googled the claims of the MD here, but as a first pass, you should expect that infections should increase every time you open up the brachial artery. Sterilization isn't every perfect, people can be Typhoid Marys, mistakes happen when putting in and taking out needles, etc. Just trying to play vampire all willy-nilly is not a good plan for longevity.

Seriously? I've never heard of blood extraction as presenting a risk to the extractee.

Any medical procedure has risks. I mean, you are breaking skin and jabbing a sharp metal rod into someone's arm. Like, you should expect there to be at least some risk.

https://www.mayoclinic.org/tests-procedures/blood-donation/a...

https://www.healthline.com/health/disadvantages-blood-donati...

Yes. But I don't see any obvious reason why it should be so large that, even doing it every day, that adds up to notable risk.

That depends very heavily on the numbers, and I've never heard any public health professional even suggest that the risk rises to the level of "you need a good reason to justify doing it at all". Whenever I hear of a downside to having blood drawn, it's always in the context of "oh you might get results with false positives" or unnecessary physical cost. Never "zomg you could get infected if you keep it up". If anything, I've heard that it's healthy to have blood drawn regularly.

Heck, even the (healthline) link you gave -- which specifically exists to enumerate downsides, says nothing about infection, just very acute stuff and the physical costs I mentioned above.

Everything has risk; that doesn't mean everything has risk that is significant; that question depends crucially on the numbers involved, and all heuristics show this isn't a significant one. (Seems roughly on the level of "staying safe by taking 4 rather than 20 flights a year.")

In any case, it still seems irrelevant to the use-case in question, with regards to "evil Peter Thiel is compromising the blood supply".

- Thiel finds and screens a healthy person who likely wasn't already donating blood.

- Thiel pays out the nose for proper extraction protocols.

- Thiel's candidate's blood doesn't enter the blood supply.

How does that translate into someone not getting a blood transfusion because of lacking supplies? How does that translate into more infections?

>If anything, I've heard that it's healthy to have blood drawn regularly.

Look, unless you have Thrombophlebitis or other such diseases, I would advise you to find new places to hear things. Having regular blood draws as a normal healthy person is obviously crazy.

> But I don't see any obvious reason why it should be so large that, even doing it every day, that adds up to notable risk.

> ... I've never heard any public health professional even suggest that the risk rises to the level of "you need a good reason to justify doing it at all".

Literally, this whole comment chain is about how the FDA is specifically saying that the risks outweigh the benefits.

If Peter has a 'thing' for blood and wants to play vampire to naively stave off death for a few more weeks and someone else wants to try to take advantage of his insanely large ego, that's fine with me. Y'all do your own kinda crazy. All I'm saying is that blood draws and infusions have obvious health risks and I agree with the FDA in that the risks outweigh the benefits.

>Look, unless you have Thrombophlebitis or other such diseases, I would advise you to find new places to hear things. Having regular blood draws as a normal healthy person is obviously crazy.

Here's a non-shady site justifying giving blood every two months and significant health benefits from doing so:

https://www.brmsonline.com/blog/wellness/healthcare/2018/ben...

>Literally, this whole comment chain is about how the FDA is specifically saying that the risks outweigh the benefits.

Yes, saying risks outweigh the benefits with respect to the recipient, and because the benefits are currently very speculative. Not because having blood drawn is a super risky endeavor.

Virtually every objection levied in this demonstrably non-responsive.

Given the lack of blood donors, what is your personal stance on paying people to donate blood to blood banks? (to be used strictly for "trauma resuscitation, surgeries of all kinds, and a variety of medical patients", not for voodoo science anti-aging treatments)

Wondering this as well. I used to donate blood, but why do it for free when technically speaking hospitals generate revenue off my blood? How hard would it be really to incentivize me to show up and compensate me for my time, after all, the doctors, nurses, etc who are handling our blood wouldn't do it for free so why should I?

This always rubbed me the wrong way. Remember back in the day Red Cross doing this and this was before Haiti scandal.

Could be a decent business to pay x amount for people to donate blood and sell it to hospital. People would be incentivised to donate blood, hospital would get more off it and given they are already paying for it.

It significantly increases the risk of blood borne pathogens.

Paying for blood significantly increases the risk of blood borne pathogens.

> Paying for blood significantly increases the risk of blood borne pathogens.

Because the money incentivizes those who shouldn't donate to donate (and attempt to bypass any controls that prevent them from donating)?

I've also felt annoyed about the dishonesty of the blood donation market but that makes actually "some" sense. then again they should just register donors and extensively check them plus paying. then everybody wins.

Running extensive checks before each donation would dramatically increase the cost, I would think.

You don't do it on each donation, you screen specific people and then disproportionately use them.

> then again they should just register donors and extensively check them plus paying. then everybody wins.

That probably won't work. You want donors to voluntarily disqualify themselves when they become ineligible (like if they've started taking a prohibited mediation), and they're going to be less likely to do that if they're coming in to get paid. You can't monitor their lives 100% and I doubt it's practical to run screening tests for every problem.

To use a software analogy: it's defense in depth strategy. Their polices screen for honesty, and then they do technical screening as a further check. Neither's perfect, but together they're probably more effective than either alone.

That seems like an easily solvable problem. "We've tried the most security-hole ridden version of the idea ... and we're all out of ideas!"

It significantly increases the risk of blood borne pathogens

Thanks for posting this - these are facets of the story I'd never have known otherwise

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