Chapter 2226 - Blood Supply

With the establishment of gas-powered cold storage, refrigerated blood and a crude cold chain of ice boxes and blocks had been set up in the Council of Elders' core territories. Both blood stations could now perform blood collection, refrigeration, cross-matching, and routine transfusions. The fermentation industry had long been able to produce sufficient quantities of citric acid—what the medical staff called "citrate"—which, combined with refrigeration, allowed donated blood to be stored for nearly a month.

Since the Council's industrial system had no refrigerants, inventing a refrigerator was still a distant goal. Gas-powered cold storage was not mobile, so the system relied on ice boxes and blocks transported by vehicle or boat—covering only a limited radius. This crude blood-supply system gave wounded soldiers only about a fifty percent survival rate.

Beyond cold-chain and transport issues, another major constraint was the scarcity of donors.

In the seventeenth century, the concept of drawing and transfusing human blood was not merely shocking—it was horrifying, tantamount to "sorcery." Even in Lingao, an "old liberated area," blood donations came mainly from naturalized populations—especially military and school units, where new ideas had been most thoroughly instilled and organization and discipline were strictest. Even in factories and government offices, the mention of organized blood drives provoked grumbling. Though no one dared openly refuse, many were deeply reluctant. The periodic donation system had even sparked rumors that the Council of Elders practiced dark magic.

In Guangzhou, the popular foundation was even weaker. "Voluntary" blood donation was virtually impossible. To encourage giving, Lin Motian—who was enthusiastic about establishing provincial blood stations—introduced a "donation compensation" mechanism. Predictably, this triggered another round of contention among Elders in the medical sector and some busybodies from other departments: "Blood selling!" A flashpoint indeed.

"Making the poor serve as 'blood gourds' for the rich—this is turning back the clock of history! A serious regression!"

"Under no circumstances can we allow the human tragedy of 'Chronicle of a Blood Merchant' to play out on our soil!"

"Encouraging blood selling will lead to 'syphilis villages'—a grave threat to social stability and the health of naturalized subjects..."

"Have you gone money-mad? This is literally eating blood-soaked bread!"

Liu San, too, felt something was off. He paid Lin Motian a visit to raise the issue tactfully.

"Their idea of running unpaid blood donation in seventeenth-century Guangzhou is simply naive!" Lin Motian dismissed the opposition with contempt. "Even in the old timeline, sperm banks paid 'transportation subsidies' of several thousand yuan per donation. In this era, what's wrong with a little compensation for blood donors? People here are generally malnourished. You let them donate and then refuse to give them a decent meal, a bit of travel money—is that reasonable? Besides, to promote blood donation and transfusion, people first have to understand what the technology is. Given their level of knowledge, not treating blood collection as sorcery is already giving us a lot of face. The best publicity is for large numbers of people to survive thanks to transfusions. Guangzhou isn't Lingao. With this huge population, the demand for blood is immense—but those who understand what transfusion is and are willing to donate unpaid? I can count them on one hand."

"We could encourage the military to donate," Liu San suggested. Drawing on old-timeline experience, the armed forces were a key blood source.

"Sure, and we do that. The only ones who trust us enough to know that donation isn't sorcery are probably the Fubo Army. But the army is only so many heads—can they support all of Guangzhou's blood needs? What's more, I'm not proposing to sell blood forever. Once the people of Liangguang understand what donation and transfusion mean, then we can talk about unpaid giving."

Liu San was about to say more, but Lin Motian lowered his voice. "Director Liu, you know what kind of person I am. The blood station's income is substantial, but I haven't pocketed a single silver dollar—all the earnings go to the Council's health budget. Our medical sector in Guangzhou has just two hospitals: the Provincial-Hong Kong Hospital and the Infectious Disease Hospital. Right now, they barely break even—sometimes we have to beg Director Liu for emergency funds. We can't keep asking the organization for help; 'economizing' isn't enough. We need to find ways to 'generate revenue.' The 'donation compensation' is trivial money, but the surge in blood supply it triggers is very real..."

At this, Liu San fell silent. Lin Motian was being diplomatic, but everyone knew the medical sector was essentially losing money for goodwill. Liangguang was still at war; Guangzhou's finances had Director Liu grimacing constantly. If the blood station's revenue could plug a hole in the medical budget, that was something every stakeholder was happy to see. As for ethical qualms—such discordant notes were mere ripples in an otherwise rosy picture.

"Even if there's controversy, who's going to override the Council of Elders? In this era, who besides us knows anything about medical ethics?" Lin Motian was still going strong. "Take your own achievements, Director Liu—the Runshi Tang patent medicines. Did they pass Phase 1, 2, and 3 clinical trials before going to market? Were animal tests, human trials, and toxicology studies done? When the pharmaceutical factory first produced crude sulfonamides and a whole slew of 'new drugs,' they were given straight to refugees without even animal testing. By their logic, that's utterly unacceptable—yet no one said a word back then. Now they jump out and make a fuss? Pure posturing, looking for trouble!"

Hearing "Runshi Tang," Liu San's heart stirred. He nodded, thinking: If he had the capability, Lin Motian would probably advocate legalizing organ sales. But in truth, Liu San did not have deep ethical qualms about paid blood donation. What concerned him was simply how poorly the idea played among other Elders.

Though the demand for blood products was smaller than in the old timeline, collecting blood was still no simple task. Since blood collection and transfusion could not always be technically separated, some long-obsolete transfusion procedures had to be revived. A popular method was "indirect transfusion": connecting the donor's blood vessel to the patient's via metal or rubber tubing. The more fearsome-sounding "direct transfusion" involved surgically suturing the donor's vessel directly to the recipient's—a high-risk, difficult, primitive technique that even Elder physicians found distasteful. Despite solving the problem of clotting in the tubing, its adoption remained limited.

"I would like to remind readers," Lin Motian had written in his feasibility report for front-line blood banks, "that although our technology is utterly incomparable to the old timeline, even so, we have reached roughly the level of the 1920s—perhaps even somewhat ahead."

But with the Council's current technology, replicating a blood station or bank that would be considered "appallingly substandard" by old-timeline standards was impossible at the front lines. Limiting factors were many; the most conspicuous were rubber and the cold chain. Rubber production had not ramped up, so the output of transfusion tubing was not guaranteed. The cold chain was almost nonexistent on the front lines and in semi-pacified areas, so blood-product safety could not be ensured. Though Lin Motian, out of habit, used the term "blood products," everyone knew that packed red cells, platelets, frozen plasma, and other component transfusions were completely out of reach. The Council's so-called "blood products" were almost entirely fresh whole blood.

Without reliable refrigeration, citrate-anticoagulated whole blood could only be stored for a few days—even less in the sweltering heat of Liangguang. To be safe, whole blood that had been out of the body for more than forty-eight hours was moved to a "reserve zone," kept for another twenty-four hours, and used only in emergencies—if not used by then, it was discarded. Thus, at the front, the system depended on "blood donors": extract and use immediately.

Seeing the stretcher bearers' blank looks, Chen Ruihe sighed. He called to the nurse hurrying over: "Put him in the observation room for now, but the bleeding won't stop. Alert Doctor Xie and have the OR ready for emergency surgery. And find some Type B or Type O donors!"

But before he could finish giving orders, Xie Yao had already rushed over, blood-spattered from head to toe—his white coat had changed color entirely. "Which patient is the hypovolemic shock?"

Before the words were out, Xie Yao had spotted Wang Chuyi on the stretcher. A single glance, and he sighed. "All right—observation room, shock position, hang an IV, have donors standing by. I've got another critical case still open—tell the OR to prep. If it's urgent, you start the prep—sterilize and drape. If you can handle it, go ahead."

"I really can't handle this... Let's wait for you, Doctor Xie." Chen Ruihe waved his hands hastily and sent the nurse to mobilize donors.

Before he could catch his breath, he heard another commotion.

"You again!" Chen Ruihe had just settled Wang Chuyi and turned to see the same officer who had tried to cut the line still making a scene at the triage table. His temper flared; he marched over. "What now?"

"Earlier you said wait your turn, see the County Magistrate first—fine, I waited. Now this little wench says triage by severity, wait behind this other casualty. How many have I waited behind already? Our Squadron Commander was wounded in combat—we've been in line forever and still can't get seen! So what if he's the County Magistrate? If this damned magistrate hadn't bungled things, we wouldn't have lost so many brothers dead and wounded. He deserves to die!"

The officer's voice was not loud, but his face was a mask of impatience—brows knitted, eyes glaring—as he complained.

(End of Chapter)