Cultivating the next generation of life-saving blood products – and blood donors

Since 1964, the New York Blood Center has been one of the largest blood centers in the U.S., providing blood and stem-cell products and related services to hospitals and patients. The center, which provides about 80% of blood to New York City hospitals, also conducts research in the fields of hematology, blood banking and transfusion medicine and cellular therapies. It is also a training center for blood-related professionals. The center, known officially as New York Blood Center Enterprises, says it serves more than 75 million people and more than 400 hospitals, research organizations and other entities in nearly 45 countries. 

Since 2009, the center's president and CEO has been Christopher Hillyer, a prominent hematologist who spent 20 years as a professor at Emory University in Atlanta before coming to NYBC. (He was ranked among professionals in City & State's 2024 Power Health 100 list.) Hillyer, who says that meeting a leukemia patient when he was at the University of Rochester medical school inspired him to go into bloodwork, talked for an hour on earlier this month with New York Nonprofit Media about helming NYBC in its 60th year, the never-ending challenge of getting enough blood donations to meet the need, and particularly how the center is working to get glued-to-their-phones millennials and Gen Zers to donate blood as readily as previous generations have.

This interview has been edited for length and clarity. 

Dr. Hillyer, thank you for talking today. If we were seated together at a dinner party and I asked you to tell me more about NYBC and your role there, what would you say?

I'd start by saying that when I got here 14 years ago, we were just in southern New York and northern New Jersey, and now we've expanded into 20 states and have taken on other small community blood centers to help supply New York and better deal with blood-related emergencies. I'd add that NYBC is one of the oldest and largest community and comprehensive blood centers, meaning that it collects blood for transfusions, without which you can't have trauma surgery, cancer therapy, maternal and fetal medicine, pediatric medicine – all the things hospitals need. 

The majority of what we use from the blood we collect is red blood cells and platelets, but we also collect and process cord blood, which is stem cells, for which we have a special bank, and we also do cell and gene therapy and have a specialized program for people with clotting problems. 

We also have a large free-standing research institute and also a ventures fund, which is how we invest in growing the next world of blood products and services. We have a lot of smart people working on problems that, if solved, would help advance blood products and care, such as if we could make a universal blood cell, as opposed to different types of blood, like A or O. We created one of the first hepatitis B vaccines in America. We did the pioneering work for COVID testing during the recent epidemic. We have a big sickle cell program. We're very excited about a biomarker to predict how well people are doing with sickle cell and how they'd respond to treatment. We have a big program in babesia, which is a parasite that infects red blood cells and is in ticks. Think of it as Lyme, but it goes into red blood cells like malaria does. It's a huge issue for blood centers in the northeast because of the prevalence of ticks and Lyme in this region.

What is one of your lines of research that is close to prime time?

Probably our IPSC master bank, which stands for inducible pleurypotent stem cells (master cells capable of maturing into any human cell they choose to become.) Our core blood bank is so big that we have these cells that can be made into IPSCs that can then match up to 70% of the population. We're working on cells that can be turned into retinal cells for macular degeneration.

So this is about creating all-purpose cells?

Exactly. We could provide cells all over the world, to be used for repair and regeneration of tissue. So it's pretty cool. Our core blood bank has served over 42 countries. 

Yes, very cool. So in January, NYBC put out an emergency plea for blood donors due to short supply. Can you talk about the blood supply? I think there is a general sense that it's gone down dramatically since COVID because fewer people were leaving the house to donate.

We predicted pretty early on into COVID that it was going to hit New York hard, which it did, rapidly. So right away NYC was shut down and we could no longer collect blood, because nobody was going out. Normally, we collect at places of worship, workplaces, schools and universities. So during COVID we had real difficulty collecting blood. There was a 90% decrease in donations, but hospitals still needed blood. We were lucky because we could collect regular blood from our facilities in the midwest. So, people who recover from any infectious disease, if you take their plasma, it has therapeutic antibodies against that disease. So we started collecting plasma from people we were pretty certain had recovered from COVID and hence should have antibodies. And that so-called convalescent plasma saved tens of thousands of lives during the early epidemic.

That's amazing, but what about the blood supply right now?

I'd say we have an urgency right now but not an emergency. Since COVID, we've recovered about 90% of our collection rate pre-COVID. But we're still not at pre-COVID levels because people aren't working in offices the way they once did. So that has made us change how we collect. Instead of sending our teams to schools and offices, we've increased our number of brick-and-mortar collection sites. And we're getting back to our mobile blood drives.

Do you come to people who want to donate but can't or won't go to one of your sites?

We've contemplated a model like that for decades, but we have a low margin of profit and most years we actually lose money, and it's expensive to send a team out to collect from one person. That's why we don't do it. 

I'm curious about research into people's attitudes and motivations around donating blood. I would think that in our current era, there's a lot of misinformation out there about donating blood, like you are being unknowingly injected with something or your blood is being used for some nefarious purpose.

The biggest misinformation is that many people think they are not eligible to donate blood when in fact they are. Two-thirds of people in the U.S. are eligible, but only 3% donate. In New York, if we could just get that up to 5%, we'd have all the blood hospitals need. But people think that because they're on high blood pressure medication or that they have diabetes, they can't donate, and that's incorrect. Almost everyone can give blood.

Who can't give blood?

People with active cancer and debilitating heart disease. Cancer because if cancer cells could be circulating in the blood and if they were transfused, that could pass on the cancer. With debilitating heart disease, there's the worry that lowering the person's blood volume could put them at risk.

What about people with chronic infections like hepatitis or HIV? Recently, the FDA changed its longstanding policy against gay men donating blood. Now anyone can donate unless they say they've had anal sex in the last three months. Obviously people diagnosed HIV-positive can't donate, and people on the HIV prevention regimen called PrEP can't donate until they've been off the regimen for three months, because the regimen might obscure a new HIV infection. But why is the sexual behavior, which is self-reported, still a disqualifier when all the donated blood is tested anyway for HIV and other pathogens with highly sensitive screening? 

The FDA's rationale is that standard HIV testing won't pick up a brand-new infection.

So there's a tiny chance that, despite screening, newly HIV-infected blood could get in the supply, and that's what the sex behavior questions are trying to eliminate?

Correct, but the chances we're talking about are one in 5 to 10 million. 

Okay. Can you give us a brief trajectory of your career and how you became head of NYBC?

In my third year of med school, I met a leukemia patient, which got me excited about hematology (the study of blood and blood-forming tissues) and oncology (the study of cancer). So I went to Boston and studied that. We were doing HIV therapy and cell therapy, which got me interested in blood banks and making cells that could potentially cure people. So, I went to Emory and spent 20 years as a professor there. Then 14 years ago, the NYBC asked if I would come lead them. My young son had special needs which meant that he might never be able to drive, so I thought New York would be perfect for someone who could never do that.

Oh, wow. What happened with your son?

He's 21 now and actually was able to get a license. But when he was five weeks old, he and I fell down the stairs and he had a skull fracture and bled into the part of his brain that receives stimulus from the eye. We couldn't test at that young age what he could see, but it looked like he would have defective vision and never be able to drive. But over 15 years, his brain cells regenerated without intervention – brain cells are fairly plastic in the first 20 to 30 years of life. But his recovery was still shocking. There aren't many cases like his. I published his picture on the cover of a medical journal.

Wow, that is a remarkable story. So what part of your job do you like the most?

Like many of the people at NYBC, I totally believe in our mission and in helping people. We give blood to people in need and we get to do good stuff. You can't dislike the NYBC – it does nothing but good. It's also wonderful to work with highly loyal, dedicated, motivated people. We have tremendous diversity in our employee base. 

Reading up on you, it seemed that you were involved in some private medical ventures. Are you still?

Way back at Emory, I started a company based on a number of patents I had, but NYBC Ventures [which invests in research companies] is wholly owned by NYBC.

What would you say is something about your leadership you need to work on?

I don't get out to see all our staff as much as I want. We have centers from Providence across to Minneapolis, down to Kansas City, across to Delaware and back up to the northeast. And even when I travel, I can't see everybody in a certain city because we have teams out in the field. We're a 24-7, 365 days-a-year operation. We never close. We were working during 9/11, Hurricane Sandy, COVID. I'd like to interact more with our phenomenal employees.

But that's more of a structural limitation. I mean personally. Like some nonprofit leaders have told me they're not good at delegating, they micromanage, or they push people too hard.

I probably ask everyone to do too much too fast. 

Has anyone ever pushed back on you?

Several times over the last decade we've had to stop and take a breath. I'd have to say, "Let's prioritize and take three months to accomplish what we've set out to." Everything can't be Priority #1. 

Walk me through a typical day for you.

We moved out of the Upper West Side a while ago to Mamaroneck so my son could go to a special-ed school there. So I usually wake up around 5:30 a.m., have coffee and look at three papers – The New York Times, The Washington Post and The Wall Street Journal. Then I start sending emails so we can get the day going. I look at our blood situation for the day.

What does that mean?

Blood has four main components – whole blood, red blood, plasma and platelets. Those are all products with a shelf life – a month for red blood cells, a week for platelets. So we have to see if we have enough of all of those. We have data and dashboards up the wazoo everywhere.

So then I get into the city and mostly I spend the day in meetings with different executives. For example, we're building a new master campus in Rye and we're working on rebuilding our longtime location in Manhattan to become a life sciences biohub. We also have meetings about how to figure out how to motivate people 15-25 years of age to donate blood, to reach them. They're used to life on TikTok time.

That's interesting. How much does that generation donate blood compared to older generations, and what's the psychology behind it?

The Silent Generation after WWII, they would line up and do what they were told, so people gave blood. And that generation is now aged out – people 75 years and older can only give blood with a doctor's permission. Then the Boomers were a big enough generation that even just 3% of them giving blood was enough. But now we have millennials down to Gen Z, what I call the true iPhone generation. An 18-year-old perfectly able to give blood – they're looking at their phone every two seconds. We want to be relevant to them and to reach them.

How do you do that when you have to somehow motivate or entice them to leave the house, whereas so many other kinds of things they can just do from their phone or laptop?

We've started offering the use of mixed-reality goggles to young donors so they can watch serene scenes and be entertained but still see the procedure. We piloted this at our Brooklyn donation site.

Does research show that young people are as willing and motivated to give blood as older generations? We've read all the ways they are less willing to do things, such as be married to their job. 

You've asked the toughest question, because it's almost impossible to measure motivation in social science. How do we make sure they know there's a need and that their donations can save lives? I think they're just as altruistic but they need information in a mode they're used to. They're not going to read a book or a magazine.

You have to find ways of getting them to leave the house and come to you.

Absolutely. COVID has made everyone a little bit agoraphobic. One thing we do is send texts to donors saying, for example, "Your blood just saved a life at New York Presbyterian." Historically, our industry would robo-call people. But who answers their phone anymore for an unknown number? You have to reach young people in a different way and it has to be quick.

Okay. So what is your evening like?

I usually leave the office around 5 p.m. and I'm home for dinner with my family by 6:30 p.m., then I almost always check emails. And then I read actual books. I just reread Atlas Shrugged—it's probably my favorite book. Now I'm reading War and Peace as well as a biography of John James Audubon. I also read a lot of Churchill and WWII-related stuff because I'm devastated by our current wars and I want to know why we're still having wars.

What's your vision for NYBC for the next three to five years?

Like I said, I want to grow our blood program with younger donors. I also want to move our stem-cell program, cell therapy and gene therapy programs forward. We have special labs that can help companies bring products to light, and to save patient lives.

Great. And what's up for you after this call?

Meetings upon meetings upon meetings!