Most people don’t think about blood often. They might even take it for granted, assuming if they ever need it, it will be available. We think donating is a good thing to do but most people can’t find the time to do it as often as we’d like, or at all. Other people however think about blood all the time. A transfusion of a red cells provides days of energy for a patient going through chemotherapy. That’s the power of blood.
Rob Van Tuyle was “most people”. He started his career with EY in Palo Alto, California as an auditor. After about 10 years, he transitioned to the CFO world, working with three venture backed technology companies in the area. Then, in 2010, his personal life took an unforeseeable turn. Rob’s wife was diagnosed with a brain tumor and he was suddenly thrust into the realm of “other people”, acutely aware of the need for and value of blood. Overnight, his perspective changed. Three months later, Rob received a phone call that changed the course of his career as well.
Today Mr. Van Tuyle works for a company that is not about making money. As President of Vitalant’s Blood Division, the second largest blood collector in the United States, he leads over 5,000 employees on a mission to collect roughly 2 million units of blood annually to provide supply to over 1,000 hospitals with vastly different profiles in terms of acuity, service levels, access, and location. Whether for profit or non-profit, blood banking today is complex. Mr. Van Tuyle breaks down why for HPI.
Blood products have a shelf life.
Blood products are perishable, much like milk or produce. A red blood cell has a shelf life of 42 days, a platelet 5 days, from the date of collection. All blood products take a day and a half to be tested and processed prior to patient use.
Inventory is dependent on volunteers.
About 60% of the US population is eligible but only 3% actually donate. Seasonality impacts donation further as summer and holiday periods are historically challenging times to collect blood. Thus, a blood center typically only has about 2 days of supply on hand, making it critical for inventory teams to review stock levels daily and move product around the country to ensure adequate reserves.
There is competition for volunteers.
Vitalant doesn’t have investors or shareholders – theirs are the communities they support and the patients they serve inside the hospital. In a large, powerful industry, this is not the norm. Other organizations pay for blood product donations, specifically plasma, which has a tangible impact on supply. For context, the blood industry collects 11 million red cells annually while the plasma industry in the U.S. alone collects over 40 million liters of plasma. The opportunity to make $30 to $50 per donation has drawn the younger generation to the donor pool, notably impacting blood centers ability to collect.
Regional monopolies have shifted to national footprints.
For decades, blood centers were a virtual monopoly within their local regions. When costs increased, they were simply passed on to the hospital. Around 2010, this began to change as the supply chain influence within hospital groups drove down costs across the board as part of health system savings initiatives. Blood products were not immune to this shift and quickly needed to find a better way to collect and deliver product. Consolidation and collaboration followed suit. Mr. Van Tuyle shares an example: In January 2019, a polar vortex hit the Northeast U.S. Donors were not able to get to blood drives or collection facilities to donate. However, with a network across 29 states, Vitalant was able to move product and supply hospitals in that corridor to meet patient needs.
A national model has its own share of challenges as well. Supplying blood to urban hospitals differs drastically from supplying blood to rural hospitals. Demand surges are more oriented to larger city hospitals while product rotation and expirations are issues for rural hospitals. Vitalant continues to develop solutions to meet the needs of all customers in their network by building partnerships with state helicopter companies who can make deliveries to remote areas in a matter of hours.
The blood center is not just a supplier.
Vitalant has embraced the opportunity to be a partner of the hospital and physician, not just a supplier. They believe that Vitalant’s physicians are a critical voice in managing blood supply as they are able to provide valuable, consultative advice on transfusion medicine to hospitals. The blood center can be a huge help to hospitals in patient care and blood management, like helping hospitals set protocols on when to transfuse a patient. For example, type O blood is a universal blood type. O negative blood can be given to anybody. Only 6% of the population is O negative but represents about 11% of total blood cells transfused within hospitals. All too often, physicians’ default to an O negative blood product before doing a crossmatch to identify the blood type of a patient. Vitalant works with their hospital partners to set up practices to make sure blood is being used appropriately.
The COVID Impact
COVID brought a whole new set of challenges to the blood center, including panic. School closures, businesses working from home, and shelter in place orders all have put tremendous stress on the ability to collect blood. When the crisis hit earlier this year, thousands of blood drives were cancelled, and blood mobiles went from 6 to 2 donation stations at a time to ensure social distancing. For context, 60% of all Vitalant’s red blood cells were collected via mobiles. Mr. Van Tuyle reflected: We have disaster response plans, and a pandemic is one of the scenarios that we have in them. However, the reality and the magnitude of COVID goes beyond what any of us would have expected.
Given these immediate impacts, Vitalant took steps to increase interest in donation by (1) communicating the safety of donating blood through their rigorous cleaning plus temperature checks of all donors before entering a facility and (2) offering to test all donors for COVID-19 antibodies to identify potential COVID Convalescent Plasma donors. Mr. Van Tuyle noted that communities were very responsive to this offer. In March, Vitalant collected 110% of the collection target for that month.
Mr. Van Tuyle reflects on how quickly healthcare, and blood centers, can move when they have to. I’d love for us to embrace this new speed as we come out of this crisis. He also notes concerns around what comes next. Continued school closures and more businesses working from home will bring additional challenges in finding large groups of people willing to come together to donate.
In wrapping up our time with Mr. Van Tuyle, he again highlighted the need for the greater population to understand the value of blood products – and the precious gift they provide – through a recent experience. I like to think we’re doing a good job today, but I do think it can get better. I recently had the pleasure to meet a 4-year old girl by the name of Adelyn who suffers from DBA, a very rare blood disorder that prohibits the body from making blood. Patients who suffer from DBA require regular blood transfusions to keep them alive. Adelyn requires a blood transfusion every three weeks to stay alive. Blood donation is still a very important part of our healthcare system and getting that message out is critical. A donation today means a blood product on the shelf for someone who needs it tomorrow.