We Already Know a Way to Save a Bunch of Lives. There's a Really Dumb Reason We Aren't Doing It.

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Blood runs through every human body. And yet there's still not enough of it. For one, not enough people are donating it. But it's also really hard to store, and it takes very special conditions to keep it healthy.

But there's a potential solution: an artificial version that wouldn't need to be treated quite as gently or refrigerated. The Department of Defense recently granted $46 million to the group responsible for the development of a synthetic blood called ErythroMer.

“If this synthetic blood substitute works, it could be absolutely game-changing because it can be freeze-dried, it can be reconstituted on demand, and it's universal,” journalist Nicola Twilley says. It would save many lives: As she reported for the New Yorker, 30,000 preventable deaths occur each year because people didn't get blood in time .

On a recent episode of What Next, host Mary Harris spoke to Twilley about the bleeding edge of artificial blood research and why we need more blood in the first place. This transcript has been edited and condensed for clarity.

Mary Harris: Can you give some historical context to our understanding of blood?

Nicola Twilley: It took a long time for people to figure out what it was, but even before that, everyone thought of it as special. You can see that in everything from religion: blood sacrifices to gods or Jesus Christ's sacrifice of his own blood to save humanity. It's a very important symbolic liquid. And it always has been. Virgil calls it the “purple soul.” There was this sense that if you were blood brothers, if you swore a blood oath, somehow that's more serious than anything else. Even before we had a clue that blood is essential to sustain life, there was this sense that it represented the very essence of a person.

Now that we do know about blood, it seems even more magical. It's more like an organ than a liquid. Can you explain that?

A lot of people think of blood as a bodily fluid, like sweat or urine. And it's not. It's alive. It has all these functions in keeping you alive. The most obvious one is picking up oxygen in the lungs and releasing it throughout the body. But it's also delivering nutrients. It's transporting hormones. It's getting rid of waste products. It regulates body temperature and overall fluid balance. It's monitoring organ damage and inflammation. And it's the mechanism behind how tissues can get swollen.

You tell that story in your piece about how, back in the '90s, there was an effort to test artificial blood. It got really far, and then it failed very dramatically. Can you explain what happened there?

There was a big chunk of time in the early years of the AIDS crisis when there wasn't a test for HIV, and so the entire blood supply was potentially contaminated. That really reads a fire under the artificial blood researchers. The thing that carries oxygen in blood is a molecule called hemoglobin. It's what makes blood red and very iron-rich. It picks up oxygen in the lungs, ferries it around, and releases it into the body. The researchers thought: Why don't we just isolate hemoglobin and we'll put that into people, inject it into their bloodstream, and it can carry oxygen around. Why fuss with all the rest of the blood when we can just isolate hemoglobin and get it to do the job? And several major pharmaceutical companies developed products that did this. They got to Phase 3 clinical trials, which is when you're injecting it into people who have suffered trauma. That's the final hurdle before Food and Drug Administration approval. And those trials failed. People died.

Tell me a bit about the synthetic blood, ErythroMer, and what the charmingly named co-inventor Allan Doctor is doing.

He's been working on it for more than a decade. The research got a huge boost recently when the Defense Advanced Research Projects Agency gave a $46 million grant to move this forward. He's combining ErythroMer (a synthetic red blood cell) with a synthetic platelet that's being developed at the University of Pittsburgh with freeze-dried plasma. It's a little cocktail, and it's going to be pretty close to whole blood, but magically universal and freeze-dryable. And Dr. Doctor's red blood cell particle is actually slightly more effective than a human red blood cell at releasing oxygen.

So you can get more oxygen to your cells?

Exactly. Get a little bit more bang for your buck. He is currently testing this in animals, specifically rabbits. He drains half the blood out of these rabbits, which sounds terrible, but actually, it's the most humane setup you can have. He replaces that lost half of their blood with his cocktail. It's kind of astonishing to watch, because the rabbit that has lost half its blood is not happy. It is struggling to stay alive. That's a fatal injury. If you do nothing within 10 minutes of having their blood replaced with this cocktail, they're sniffing. Their ear is twitching. They start hopping around again. It's sort of astonishing. It looks semi-miraculous.

How long does Dr. Doctor think it's going to take for him to be trying his cocktail in people?

There are a lot of hurdles to be cleared. I went and saw a pair of rabbits. But you can't do science based on one pair of rabbits. You have to do a lot of these trials. When I talked to Dr. Doctor, he's hesitant, like any good scientist, to say when, but there's no chance you could do all of that in under seven, eight years, even if you are moving really fast.

In theory, couldn't we just invest a whole lot of money in getting more people to go to the Red Cross and donate blood?

You are 100 percent correct. There are two easy things we could do that would actually solve a lot of problems.

Before I say what they are, I should back up and say, if you're on a battlefield, this synthetic nanoparticle is going to be the way to go always. You freeze-dry it and you rehydrate it on the battlefield with drinking water, and that's it. Right now, in Ukraine, blood is a real crisis because you have to keep it cold. And aerial surveillance drones can see the generator that you're using to keep it cold, and they will bomb that. So the heat signature of the infrastructure to keep blood even anywhere near the front lines is making hospitals a target. And so they're not able to have blood. So for military purposes, synthetic freeze-dried blood is the way to go.

Yes, more of us should give blood. But also, we know that even a five-minute delay in giving someone blood reduces their chances of survival. It's like CPR. You wouldn't wait to start CPR until you get to the hospital. We all know that you have to start it right away. Same with blood: You should give blood as soon as you can. Right now, in most of the US, blood is not given before the hospital because it can't be reimbursed under our current system.