Nov. 4, 2009 (The Yomiuri Shimbun) -- An increasing number of major hospitals are switching away from domestically produced blood products to those from overseas, giving rise to fears over the safety and reliability of medical treatments that involve blood preparations.
The switch to products made using blood collected in foreign countries has come about because domestically donated blood is much more expensive than that from abroad.
The move to using blood products produced overseas runs counter to what has been standard practice in this nation and risks a repeat of past tragedies caused by products containing tainted blood sold by individuals overseas.
The government should take urgent steps to ensure problems linked to contaminated blood products are never repeated. ===
Tainted blood fears
Blood products are broadly divided into two categories: those to be used for blood transfusions and products produced with blood plasma components for other uses.
Blood consists of various components, such as red blood cells, white blood cells, platelets and plasma, which perform different functions.
Certain components are used in some operations and during transfusions to prevent side effects.
Blood plasma is the liquid component of blood, in which the red blood cells, white blood cells and platelets, all consisting of proteins, are suspended.
A number of plasma protein components--such as albumin, immune globulin and blood-clotting factors--are separated for the treatment of patients requiring one or more of these components.
In the past, a large number of patients given contaminated blood products were infected with serious diseases, including AIDS in the late 1970s to early '80s, which caused the deaths of more than 600 people, and the infection of more than 10,000 people as a result of blood products used during roughly the same period with the hepatitis C virus.
HIV infection linked to blood products was found to have been caused by the use of plasma protein products produced using contaminated blood exported from the United States and other countries. ===
Blood imports surging
A key type of blood product, containing albumin, is used for the treatment of burns and shock, and has been marketed in Japan by four Japanese companies, including the Japanese Red Cross Society, and two foreign-based firms.
Up until a few years ago, about 40 percent of albumin-based products used across the country were reportedly produced using blood sold by individuals overseas. The figure has been further increasing in the past couple of years, according to experts.
Tokyo's Mitsui Memorial Hospital in Chiyoda Ward, a key treatment center, stopped using domestically produced albumin products at the beginning of October, switching entirely to foreign-made ones.
The shift to imported albumin products also has taken place at other major hospitals, including the Japanese Red Cross Medical Center and many university hospitals, such as Showa University, Kinki University, Hyogo College of Medicine and Shiga University of Medical Science. Among them also are member hospitals of the government-run National Hospital Organization such as Iwakuni Clinical Center in Yamaguchi Prefecture, Sendai Medical Center in Miyagi Prefecture and Aichi Cancer Center in Okazaki, Aichi Prefecture.
Domestically produced albumin products are made from blood collected from donors by the Japanese Red Cross. Enough blood is collected to meet the nation's needs for albumin product production, but blood plasma domestically produced from donated blood is not utilized effectively.
The increased use of foreign-made blood products has come about simply because they are much cheaper.
A Japanese Red Cross-produced 50-milliliter syringe pack containing 25 percent solution of albumin, for instance, costs 8,039 yen, while the same product made by major U.S. pharmaceutical company Baxter International Inc. (NYSE:BAX) costs more than 30 percent less at just 5,619 yen.
In addition, Baxter and other foreign firms have further slashed prices against the backdrop of the rising yen.
A major factor behind the shift by large hospitals to low-priced blood products from abroad is the current medical fee system called the lump-sum billing formula.
Under the formula, medical treatment fees are set at predetermined levels based on each patients' medical problem, irrespective of the amount of medicine and technical services required for their treatment.
Unlike the conventional system under which medical bills were calculated in accordance with the amount of medicines and services provided, the new system has seen hospitals try to cut medicine costs to avoid budget blowouts.
Lower costs are understandably attractive to hospitals, especially as many have been struggling financially.
Some hospitals are said to be eyeing an improvement of several millions of yen a year on their bottom line as a result of switching to foreign-made blood products.
Why do domestically produced blood products made using blood donated for free sell for a higher price than those made from blood sold by individuals overseas?
Shigeyuki Aoki, director general of the government-authorized Donated Blood Supply Foundation, said, "In contrast with Japan's blood-donation system, in which people are called on to donate blood voluntarily at donation buses and in donation rooms, blood in the United States is collected from people who sell their blood in large volumes, volumes of more than 700 milliliters of plasma per person at a time.
"Plasma products in the United States are mass-produced at factories, each of which has a blood-processing capability more than 10 times that of the Japanese Red Cross." ===
Self-sufficiency the goal
All blood products carry a risk of infection due to unknown disease-causing agents.
In light of this risk, Toranomon Hospital in Minato Ward, Tokyo, recently conducted a survey of its patients whose operations were drawing near, asking if they would prefer to be told which countries the blood to be used for their transfusions had come from.
Ninety-six percent said they wanted to know and 87 percent said they would prefer domestically donated blood be used.
In response to the survey results, the hospital has kept on using only domestically derived blood products.
Michio Matsuzaki, the doctor at the hospital in charge of medical safety, noted: "Japan's medical world has experienced grave and irrevocable tragedies caused by tainted blood products. We shouldn't treat blood products the same way we treat other medicines."
The World Health Organization and the European Union have drawn up proposals for every one of the world's nations that, if acted on, would ensure self-sufficiency of blood product supplies though blood donations from their own populations.
There can be no doubt that neither blood nor organs, should be treated as a commodity to be bought and sold.
In order to prevent blood product-caused tragedies from reoccurring, the government should quickly establish a system that allows complete self-sufficiency of blood products. To achieve this goal, the government should adopt such measures as a review of the government-set list of medicine prices, a ban on medicine price-cutting practices, and take steps to encourage more effective use of blood products.
These efforts are imperative if the government is to effectively acknowledge the good intentions of this nation's blood donors.
