In the early 1930s, S.S. Yudin successfully performed one of the first transfusions with blood from a dead donor1. The practice subsequently expanded, reaching Spain through Frederic Durán i Jordà and Norman Bethune — a clinician recently paid homage to in an article published in MEDICINA INTENSIVA2,3. Over the decades, however, improvements in preservation techniques and the decrease in military conflicts led to obsolescence and even rejection of this practice.

Although it cannot be affirmed that the Spanish Blood Bank is experiencing a sustainability crisis, this issue is becoming a problem in the United States4.

In Spain, the National Transplant Organization manages solid organ, tissue and hematopoietic precursor cell donations on a centralized basis. In contrast, the donation of blood products is managed by the different regions (Autonomous Communities) in the country (RD 1088/2005) in accordance with the European guidelines (2002/98/EC). According to Law 30/1979, all Spanish citizens are to be regarded as organ and tissue donors unless they have explicitly stated otherwise (presumed consent). The mentioned Law specifies that “this consideration does not apply to the therapeutic use of human blood and its products”. The donation of blood is seen as a “voluntary and altruistic act” (RD 1945/1985), with no mention at all of the situation of brain death (BD).

The question regarding the possibility of blood donation under conditions of BD does not seek to generate a conflict, on the understanding that blood donation should not be made before organ harvesting, since doing so would adversely affect the validity of the latter. However, it should be asked whether family rejection of organ donation ought to be extended to the donation of blood.

Most organ donations take place under conditions of BD. The percentage of rejections of donation is greater in BD than in non-heart beating donations. The reasons for such rejection include presumed rejection expressed in life (40.7%) and rejection on the part of the family (24%) — though other underlying factors may be distrust of the healthcare system, a lack of understanding of BD, the idea of cadaver mutilation, or the religious beliefs5. Despite some of these arguments, blood donation does not affect body integrity, and donation seems all the more reasonable if the individual involved has already donated blood in the past. In practice, blood donation would be a technically simple process in the Intensive Care Unit, where patient vascular catheters are already in place and close communication with a transfusion service is available. Likewise, the study of potential organ donors includes the tests necessary for the evaluation of blood donors.

Considering the above, we could raise several questions that may serve to open a broader debate: Could presumed consent be extended to include blood donation under conditions of BD? Would it be feasible to implement the logistics necessary to make blood donation under conditions of BD possible? Could donation be contemplated immediately after or during organ harvesting via erythrocytapheresis? Would we collect the usual 450 ± 50 ml, or could larger volumes be obtained?