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What concerns Shander most is how blood has become a convenient tool for his fellow anesthesiologists, and how it is sometimes used cavalierly when it need not be given at all. According to some estimates, 25% of U.S. transfusions are unnecessary. There are also indications that patients cannot tolerate levels of hemoglobin as high as previously thought and that young people especially have a built-in reserve of blood. These findings, Shander believes, support the need for a more sparing use of blood products. As one of the directors of the Englewood institute, he is convinced that withholding blood is a viable and preferable choice for most patients. It not only benefits many patients but also forces surgeons to pay closer attention to technique and tests their willingness to depart from tradition.
While most surgeons are willing to adopt minimally invasive, or noninvasive, procedures to control bleeding during an operation--such as laparoscopy, which requires tiny incisions, or ultrasound to destroy kidney stones--they usually stop short of transfusionless surgery. Some medical fundamentalists view it as a false promise with its own risks, but even doctors who acknowledge its value caution that it is not the panacea some physicians think it is. Certain situations--liver transplants, for example, and instances of trauma--will always require transfusions. Says Dr. Steven Gould, a surgeon at the University of Illinois at Chicago who advocates reduced surgical use of donated blood: "Some operations require four to six units, and when you get to that level, it's hard to imagine not getting any blood. We will never have a completely bloodless society for surgical patients."
Still, even as the practice seemingly thumbs its nose at mainstream medicine's historic reliance on transfusion (more than 14 million units were used in the U.S. last year alone), an increasing number of physicians are taking a harder look at bloodless medicine. According to the Jehovah's Witnesses, more than 75,000 doctors already practice bloodless surgery in the U.S. Also, more and more patients are clamoring for safer and more effective options than transfusions, either because of religious conviction or fear of contracting disease.
Medical technology has tried to answer the call. It has come up with a panoply of methods and machinery, some of them known for decades but refined and repackaged to fit today's needs and concerns. While bloodless techniques vary from hospital to hospital, they invariably begin with medicinal and nutritional approaches to increase a patient's blood count before surgery. Efforts are made to guard against unnecessary blood loss from tests, and standard blood drawings are either reduced or eliminated altogether. And since an intensive-care patient during an average stay must part with close to a liter of blood for testing--much of it unused and thrown out--microanalyzers have been developed to scrutinize tinier quantities of blood.