(Amy Moreland, Jeanne Segrest, 1988)
An important facet of the engineering process involves finding out what needs people or organizations have that can be supplied by engineering. In this particular study, interest in engineering and our specific problem solving techniques was generated by simply calling and offering our service. As the project unfolded so did new problems and the resulting project became very interesting in that the areas of scrutiny were not limited to a small area of Operations Research / Engineering Management. The realm of this project includes but is - certainly not limited to forecasting, computer simulation, marketing and OBA. The real excitement in the project, however, was the chance to work on a ``real life" situation that has significance to many people, and also to experience actual data gathering, method selecting and decision making.
What is Apheresis donation? Basically and simply, apheresis donation involves taking certain components of the blood from the donor. In this project the components of concern were the platelets. Platelets can be transfused to patients with disorders such as leukemia, cancer or aplastic anemia.
The process is relatively simple. The donor is given an anticoagulant to facilitate blood flow through the apheresis machines and the donor is then connected to the machine that draws off the blood, centrifuges off the desired component (platelets) and returns the remaining blood components to the donor. While this process is carried out, the donor can watch television, read a book or take a nap for the two to three hours necessary for the apheresis donation. This type of donation can ideally be performed as much as once per month.
The machines used are one of two types. The first is an IBM machine that draws off platelets that can be stored for only twenty-four hours before the platelets become outdated. The other machines process an apheresis donation that can be store! up to five days without becoming outdated. This particular machine allows an inventory to be built up at Wadley, and hospitals in need of platelets can order from this inventory. Wadley presently has three machines of each type.
Wadley currently has a policy for preferred apheresis donors, although they do not limit themselves to these particular donors. Ideally, the target ``donor market" would be middle class, white males between the ages of 30 and 50 years old. They prefer a person with a stable social and family life, one who is well-informed in current affairs, one who maybe has been touched by cancer in some way and who knows his contribution will help a particular patient.
Benefits and Problems of Apheresis Donation. One major benefit of apheresis donation is that one apheresis donation is equivalent to six to eight whole blood donations. To explain, if apheresis donation is not used, the same effect can be achieved using whole blood but the platelets must be centrifuged from whole blood units and pooled together to get the same amount of platelets as one apheresis donation. The remaining components of blood from the whole blood units are wasted.
Another advantage is that use of apheresis products gives a lower incidence of sensitization for the patient. By using a tissue typing system known as Human Leukocyte Antigen (HLA) matching, Wadley can achieve as nearly a perfect match as possible donor-to-patient match. The result is that patients have fewer incidences of immunologic response (rejection of platelet transfusion.) Also by providing a large number of platelets from a single donor as opposed to a pooled donation from many different donors, the immunologic response is somewhat diminished. The greatest advantage of apheresis donation is that its use increases long term survival of the patient. Apheresis products can be used as a therapeutic modality. Transfusion of donated platelets into diseased patients can help alleviate symptoms of their diseases and improve the recovery process. Similarly cancer patients who have undergone chemotherapy have a markedly reduced capability to produce their own blood cells so apheresis provides the cells they need.
Problems. The initial limitations to apheresis donation are those such as age (must be 18-65 years old), weight (over 110 pounds), and health (generally good, i.e. no colds, flu, etc.) If the donor is female she cannot donate if she is in cycle. Also it must be at least one month since the last apheresis donation (except in special cases), and at least 56 days since the last whole blood donation. Additionally, a donor is not allowed to have taken aspirin five days prior and up until donation as aspirin makes platelets ``inactive."
Another potential problem is with the anticoagulant given to donors. The anticoagulant must be given to donors so that the blood flows freely through the machines. However, some people have adverse reactions to the anticoagulant. Also, an FDA rule allows the anticoagulant to be used for only three hours, so if the donor fails to fill his bag in three hours, he must be disconnected from the machine.
The distance to the Blood Center at Wadley also deters many donors. The fixed site is on Harry Hines in Dallas which is not very accessible to many other of Dallas, Fort Worth and their suburbs. Wadley's Harry Hines location simply is not convenient for those donors who are their target apheresis donors.
Finally, the biggest problem with the apheresis program is the time that must be committed by the donor. Since there are no mobile apheresis stations, the donors must travel to Harry Hines, probably having to take off work. The process itself takes two to three hours to complete, so the average donor takes three to four hours out of his day. Many donors -and employers are less than enthusiastic about this much time taken from the work day.
Problem Description. Upon our first meeting with the client management, they described their goal for the number of apheresis donors per week, and they asked us to examine ways to utilize the present donor pool to meet the desired demand. Our first task was to look at the initial information given us and determine what the actual problems are. For the scope of this project we outlined four problems to scrutinize with particular emphasis on the first two.