Following two days of contentious debate in the Iowa Senate, the chamber’s calendar for Wednesday, February 21 appeared to be stacked with non-controversial bills.

Then State Senator Jeff Edler rose to offer Senate File 2369, an “act relating to autologous and directed blood donations.”

The blood donation bill may not be as impactful as other legislation Senate Republicans approved last week: proposals to undermine Iowa’s state auditor, reduce Medicaid eligibility for pregnant Iowans, make state funded crisis pregnancy centers less accountable, enable discrimination if grounded in religious beliefs, and repeal the gender balance requirement for state boards and commissions.

Yet Senate File 2369 is important—not only because of its potential impact on the blood supply, but for what it reveals about legislative culture in the eighth year of Iowa’s Republican trifecta.

FORCING BLOOD BLANKS TO “COMPLY WITH AN INDIVIDUAL’S REQUEST”

It’s unclear who inspired Edler to press for new rules on blood donations. During the floor debate, he said the concept came from “a constituent who worked in the blood industry for over 26 years.” The senator did not respond to Bleeding Heartland’s inquiry about the kind of position that constituent held, and whether Edler (who chairs the Senate Health and Human Services Committee) had consulted with any other subject matter experts.

The original bill would have required blood banks and hospitals to “comply with a physician’s order” for autologous or directed blood donations. Autologous refers to donations a patient makes for their own use, in advance of a scheduled medical procedure. A directed donation comes from someone the patient selects (usually a relative or friend), and is set aside for transfusion to that patient. The bill also would have allowed blood banks to charge a “reasonable” fee “to cover the administrative costs” of facilitating that kind of donation.

The Iowa Medical Society, American Red Cross central Iowa chapter, and major blood banks (ImpactLife and Life Serve Blood Center) registered against the proposal; no group lobbied for it.

When the Health and Human Services Committee took up the bill on February 14, Edler proposed a major rewrite. Instead of making autologous or directed blood donations available when ordered by a physician, the revised bill would force blood banks and hospitals to “comply with an individual’s request, based on a physician’s order for a medical procedure that may require a blood transfusion.” It no longer allows blood banks to charge a fee for the increased costs associated with directed blood donations.

Democratic State Senator Sarah Trone Garriott, the ranking member on Health and Human Services, warned colleagues that the amendment “makes this bill so much worse,” by allowing a patient to choose that option for any reason. The only grounds for refusing the request would be if a blood bank or hospital determined a directed blood donation “would result in an imminent risk to the individual’s life.” She walked through some of the bill’s potential costs and the medical problems it could create.

Nevertheless, Republicans advanced the amended bill from committee in a party-line vote. Again, blood banks and the Iowa Medical Society registered against the bill (renumbered Senate File 2369); no one registered in favor.

“THERE ARE ACTUAL RISKS IN FACILITATING THESE BLOOD DONATIONS”

In his opening remarks on the Senate floor, Edler summarized the bill’s contents but did not explain its rationale.

Trone Garriott spoke next, sharing points she learned after “I listened to our blood banks.”

The bill would be costly. It takes 48 hours to process blood donations, Trone Garriott noted, and many other resources to manage the blood supply and keep it safe.

There are also safety concerns. Some people may feel pressure to donate blood for a friend or relative, and may not be honest during the screening process about behaviors they don’t want loved ones to know about. For instance, donors may lie about their history of IV drug use or other behaviors, Trone Garriott explained. “Blood banks have found that when somebody is pressured to give donations, they are more likely to end up in screening having blood that cannot be transfused because of risks that are found in the screening.”

In addition, a blood donation from a close relative increases the risk of graft vs. host disease, a condition where donated cells attack the cells of the recipient. For that reason, family members who have previously donated blood might be ineligible to donate bone marrow or a kidney, if the patient needs a transplant later in life.

“So there are actual risks in facilitating these blood donations when they are not medically necessary,” Trone Garriott said. She added that Iowa’s blood supply is already under stress: “Blood banks do not have the resources available to manage, store, test, administer private blood supplies for anyone who feels like it.”

Trone Garriott urged colleagues “to listen to the folks who do this work.” Our understanding of the medical risks have changed over the last 20 to 30 years. “And there are real medical reasons, real important reasons why this will be harmful to health care in Iowa.”

“A BILL BASED IN IGNORANCE”

Democratic State Senator Bill Dotzler is one of the longest-serving current members of the chamber, and in recent years has lamented the majority party’s disregard for basic norms, like putting dollar amounts in budget bills, or answering substantive questions during Senate floor debate.

Senate File 2369 struck a nerve with Dotzler, who earned an undergraduate degree in biology. He began his remarks by declaring the legislation “a bill based in ignorance. It’s here because people believe that vaccinations in an individual’s blood will be carried over to them and somehow affect their health. It’s ridiculous.”

After taking a few minutes to explain how the immune system and vaccinations work, Dotzler zeroed in on a bigger problem: “There are too many bills in this chamber who are well meaning, but don’t know what they’re doing.”

This bill could actually hurt people by diminishing Iowa’s blood supply, Dotzler said. Or, someone losing blood might wait for a donation from someone they know, instead of getting a transfusion when they need it.

Dotzler said he didn’t understand why the Iowa Senate majority “continues to put bills in front of us with no clue about what’s really going on. No basic science.” He recalled Senate colleagues who were against wearing masks during the COVID-19 pandemic.

Lowering his voice, he added, “It’s unbelievable that we have so many bills up here where somebody gets some kind of an idea, and it goes through, and it never really gets worked out and have a true understanding of the effect.” He thanked Trone Garriott for flagging the medical community’s concerns.

Dotzler wrapped up by telling Senate Republicans, “And I know you’re going to pass it, so I pray to God that somebody over in the other chamber is going to understand how goofy this is. And dangerous.”

Democratic State Senator Janice Weiner then delivered one of the shortest Senate floor speeches I’ve seen: “Colleagues, blood banks have no way to test for vaccines in the blood.”

DEFENDING “A BASIC RIGHT OF A PATIENT”

Edler set out to give “the rest of the story” in his closing remarks on the bill.

He asserted that Iowans had just been told “their right to know who their donor is is ignorance.” He said he sponsored the bill because of a constituent “who worked in the blood industry for over 26 years. So we have expertise bringing forward concerns, in the industry.” He also insisted the bill “has nothing to do with vaccines.”

“For time’s sake,” the floor manager did not address any of the specific practical and medical issues Trone Garriott had highlighted. Instead, he spoke in general terms: “It’s becoming increasingly difficult for patients to receive a known donor blood donation,” which Edler described as “a basic right of a patient to provide their own blood or have a specific donor.”

Edler noted that autologous and directed blood donation is legal; the Food and Drug Administration does not prohibit the practice. He said medical professionals would still be involved, and the process of donating and screening would be the same.

He summed up by saying the bill would give Iowans “the right to choose on what they want to have done for their blood transfusion, if it doesn’t pose an imminent medical risk.”

How would a blood bank or hospital ever prove a directed donation posed an immediate threat to a patient’s life? The risks would play out over a longer time horizon: graft vs. host disease, or possibly ruling out a close relative as a future blood marrow donor.

Doctors should be able to order a directed blood donation, when there is a genuine medical need. But Senate File 2369 doesn’t just protect valid reasons for that procedure. Under Edler’s bill, someone could refuse to use the normal blood supply for any reason, including wanting to avoid blood donated by a vaccinated person, or blood from someone of another race or ethnicity.

I would describe patients who demand directed blood donations as uninformed, rather than ignorant. I can see how it would feel safer to get a transfusion from someone you know. But if I were that patient and a doctor explained the downsides, I would accept their reasoning.

Legislators aren’t supposed to cater to constituents’ irrational concerns. They should weigh evidence and listen to those who know the most about the topic at hand (in this case physicians and blood banks).

But as Dotzler pointed out, Iowa’s governing majority runs a lot of bills not grounded in facts. All 30 Senate Republicans who were present on February 21 voted for Senate File 2369.

I don’t know whether they were humoring a colleague with strong feelings about this legislation, or are committed to getting the bill to Governor Kim Reynolds’ desk.

As for Dotzler’s prayer that “somebody over in the other chamber is going to understand how goofy this is,” early signs are not encouraging. Edler’s bill was assigned to an Iowa House Health and Human Services subcommittee within hours of clearing the Senate. A subcommittee hearing is scheduled for February 27.

P.S.—I could have written a whole post about the hypocrisy of defending patients’ “basic right” to choose their own blood donors after Edler and all but one of his Republican colleagues voted last July to deny any bodily autonomy to Iowans facing an unintended pregnancy.

FEBRUARY 27 UPDATE: After hearing testimony from Edler (the only speaker in favor) and more than a half-dozen medical or blood bank professionals who opposed the bill, the Iowa House subcommittee voted 3-0 not to advance this bill. The subcommittee members were Republicans Steven Bradley and Tom Moore and Democrat Austin Baeth.

Top photo: State Senator Jeff Edler delivers closing remarks on a bill changing rules for blood donations on February 21. Screenshot from official video.