Chapter 04: A New View of Blood Banking
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Description
In this Chapter, Dr. Lichtiger explains the vision for blood banking that he made a reality at MD Anderson. He begins by explaining that when he decided to stay at MD Anderson, the only position available was as Acting Chief of the Blood Bank Section and, as he says, “I hated blood banking.” Nevertheless, he decided to take the job for a year (which has turned into a “Biblical year,” in his words). His first mission was to change the Bank’s mentality and determine what the “customer’s needed.” By the end of 1974, transfusion services were offered 24/7. He also determined that surgeons wanted to use whole blood during procedures when, paradoxically, they only needed specific blood components. Dr. Lichtiger describes how he “cracked that nut” and improved the therapeutic value of the blood products delivered in the process.
Next Dr. Lichtiger explains that he always took a business approach to problems and realized in the nineties that he needed to deepen his understanding of strategic planning, budgeting and information systems to fully address pressing issues in Transfusion Medicine. Dr. Lichtiger earned an M.B.A. in 1998 from the Lady of the Lake University, Houston TX. He notes that his family was in the clothing manufacturing business in Argentina. (His parents were disappointed with his choice of career, as they expected him to enter the family business.)
Dr. Lichtiger then talks about the financial challenges that MD Anderson faced in the 1970s and describes working with Dr. R. Lee Clark, Dr. Denton Cooley, Dr. Michael DeBakey, and Dr. Richard Eastwood, all of whom wanted to form an integrated Texas Medical Center Blood Bank. He shares recollections of Dr. Clark (who always said, “Don’t make small plans, your enemies will cut them down”) and describes his working relationship with this first president of MD Anderson. The initiative to create an integrated blood bank resulted in the formation of the Gulf Coast Regional Blood Center, but Dr. Lichtiger explains how MD Anderson remained separate (the only independent blood bank in the region) so that they could be flexible.
Identifier
LichtigerB_01_20120611_C04
Publication Date
6-11-2012
City
Houston, Texas
Interview Session
Benjamin Lichtiger, MD , Oral History Interview, June 11, 2012
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the InstitutionProfessional Path The Clinician Building/Transforming the Institution Multi-disciplinary Approaches Devices, Drugs, Procedures Institutional Processes The MD Anderson Brand, Reputation Discovery and Success Evolution of Career Professional Practice The Professional at Work Professional Values, Ethics, Purpose Character, Values, Beliefs, Talents Educational Path MD Anderson History Portraits Personal Background Beyond the Institution The Business of MD Anderson
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Tacey Ann Rosolowski, PhD :
Just out of curiosity, why didn’t you like blood banking at first, and then what was it about the service that changed your mind?
Benjamin Lichtiger, MD :
Well, maybe the model of the previous head of the blood bank I didn’t like.
Tacey Ann Rosolowski, PhD :
Who was the previous head?
Benjamin Lichtiger, MD :
It was Dr. David DeJohn. He passed away already, and he was a nice guy. He was a nice guy but I thought sometimes very flighty and—
Tacey Ann Rosolowski, PhD :
What were the weaknesses? What was wrong with the service?
Benjamin Lichtiger, MD :
I just didn’t see the intensity that I saw in other areas—intensity. I feel that I’m getting involved, and I give it all, and I didn’t see that. They were very superficial and so that was not something—the projection so I finally became involved with the blood bank.
Tacey Ann Rosolowski, PhD :
This was— Benjamin Lichtiger, MD 1973-1974.
Tacey Ann Rosolowski, PhD :
And you were acting chief—
Benjamin Lichtiger, MD :
In ’74 they made me assistant professor and chief of the blood bank, I think, at the time.
Tacey Ann Rosolowski, PhD :
What did you do to start changing the service?
Benjamin Lichtiger, MD :
Well, first of all I started to—at that time—I was always very interested in the business aspect of everything, and at that time I wanted to know what does—ask them why, to start talking to the clinicians. What do you want? What are we doing right? What are we not doing—what would you expect me to do? At the time Saturday and Sunday were being covered by medical students or we just did very limited testing, holidays too, so it was not—so slowly I started to push for a 24/7 service and have things available. Then one of the major—what I consider important accomplishments was in 1974 towards the end, I think, the surgeons did not want to use blood components. They wanted whole blood, the whole bag of blood, and I didn’t know how to correct that.
Tacey Ann Rosolowski, PhD :
What were the challenges?
Benjamin Lichtiger, MD :
Well, at that time, the concept of blood components was very, very new, to break down the unit into platelets, red cells and plasma. The new technology was coming in where you could skim out the platelets and give it to the patient. Take the red cells, give it to another patient. Take the plasma, give it to another patient. Their needs were different. Luckily, my wife worked here too. She was a scrub nurse. She was a scrub nurse at Michael Reese. I married her over there, and she came here and worked as a scrub nurse in the OR.
Tacey Ann Rosolowski, PhD :
What is your wife’s name?
Benjamin Lichtiger, MD :
Annamaria [Lichtiger], A-N-N-A. One word, Annamaria. And she told me many times—we used to come together to work at the time. I don’t know, she said, “Just tell them that you don’t have it.” Well, lo and behold, they called for blood, and I called them back up in the OR and said, “I’m sorry, the only thing I have is packed cells right now.” Silence. “Okay, send out whatever you have,” and that was the breaking point. From there on, we converted to packed cells.
Tacey Ann Rosolowski, PhD :
And what does that mean, the packed cells?
Benjamin Lichtiger, MD :
That means that we break a unit of blood into red cells, into platelets, into plasma. Suddenly we could expand our inventory because if we draw a unit of blood and leave it in the unit of blood, the refrigerator, the platelets become non-functional, are no good for anything, and the plasma starts losing the potency of the coagulation factor. You understand? But if you separate it immediately and you freeze it, put it at different temperatures, then you can use it for different patients. Not everybody needs red cells. Not everybody needs platelets. Not everybody needs plasma.
Tacey Ann Rosolowski, PhD :
So you’re targeting people’s needs very precisely.
Benjamin Lichtiger, MD :
Exactly, very specifically.
Tacey Ann Rosolowski, PhD :
And that must solve a storage problem too.
Benjamin Lichtiger, MD :
Exactly, so that was one of my first successes, and then in a couple of—I don’t know, maybe a year later, now the success has changed the way we are doing cross-matches.
Tacey Ann Rosolowski, PhD :
And what does that mean, cross-matching?
Benjamin Lichtiger, MD :
To take a sample of blood of the patient and mix it with the potential blood and see whether it’s compatible or not. The cross-match at that time was something that lasted three or four hours, testing and everything like that. By that time, people were recommending an abbreviated procedure. It takes just ten minutes, and we started to implement that, so that was also a big saving of time, personnel. But the hardest thing was here. We had technologies—because they were accustomed to the old system, the cross-match, but they took time and converted them. We were growing and started to open another donor room, and we started to collect platelets with the automated treatment. Donors just came in, and we put a needle here, a needle here. We collected, got the platelets out and gave back all the blood specifically, and they started to do it.
Benjamin Lichtiger, MD :
Since then we’ve expanded. Not as fast as I want, because although I’m profoundly inclined to academic activities, as my CV shows—education—I also think that the blood banking is like a business. We depend on money, generate margin and so forth and so on and you do that—because they tell me you need to go to school and get your MBA, and that’s how I ended up going and getting my MBA because to run the Department of Laboratory Medicine, which is one of the largest and diverse in the institution, a really gigantic operation, one needed to have a better understanding of strategic planning, budgeting, HR, technology, information systems, et cetera, and the MBA gave me the—opened up the perspective, the way to look at things. I really channelized all my inclination towards the business aspect of handling such a complex department.
Tacey Ann Rosolowski, PhD :
Where did your interest in business enterprise come from, do you think? Benjamin Lichtiger, MD My family was very disappointed that I went into medicine. It’s all business. My family was in business, and they expected me to continue.
Tacey Ann Rosolowski, PhD :
What was the family business?
Benjamin Lichtiger, MD :
We were in the production of uniforms for the army and then production of—eventually migrated into jeans and shirts and things like that, high production, and they expected me to continue in the business. I didn’t want the business part, but I always brought along that perspective.
Tacey Ann Rosolowski, PhD :
Sure, sure. Tell me about that change, because you said you’d been growing, growing, growing. What were the business challenges in the blood bank in the ‘70s, and then how have those evolved? How have those challenges evolved?
Benjamin Lichtiger, MD :
Well, in the ‘70s I was working very closely with Dr. Clark, the first president, and he had a vision of—together with Dr. [Denton A.] Cooley and [Dr. Michael E.] DeBakey those guys were talking to each other a lot of forming a Texas Medical Center blood center, and they asked me if I would be willing to direct it. I said okay, and I worked with him and also Dr. Richard Eastwood who at that time—he’s also passed away—at that time was the Executive Vice President for the Texas Medical Center, Inc. I really learned a lot from these people, Dr. Clark and being close to him, understanding how he thought, his vision. I mean, I had the opportunity to learn unbelievable—and also from Dr. Eastwood.
Tacey Ann Rosolowski, PhD :
What was it about Dr. Clark’s vision that was so compelling to you? What are the lessons that you learned from him?
Benjamin Lichtiger, MD :
One thing I always remember, he said, “Don’t make small plans. Make big plans because your adversaries will reduce it anyway, so if you start small you end up with nothing. Go with big plans and let your imagination propel and manage those plans.” He always told me that.
Tacey Ann Rosolowski, PhD :
What about Dr. Eastwood?
Benjamin Lichtiger, MD :
And Dr. Eastwood, he taught me the etiquette, how to work in the executive world, from greeting people—for example, today is the first time in thirty years that I’m using this on the left side because he always told me you were on the right side, because when you greet somebody, you see, you look at the right side. You’re not crossing over the—do you understand? That’s what I’m saying. I’ll never forget that.
Tacey Ann Rosolowski, PhD :
Wow, all those details.
Benjamin Lichtiger, MD :
He taught me when you go to eat with some executive—what you order, what you eat, and how people are watched. I mean, he gave me some lessons that are unforgettable—also a very creative man. I grew to like him very much—him and Dr. Clark, unbelievable. I really felt very, very terrible when Dr. Clark stepped down, but he did that as a political move to save the institution.
Tacey Ann Rosolowski, PhD :
How did that save the institution?
Benjamin Lichtiger, MD :
Well, apparently it was a move at the higher levels. They wanted to coalesce MD Anderson with some other organization—then—and so by him stepping down he forced somebody else to step down too. But I still continued to work with him even after he was emeritus, and so he used to call me. He used to come around the office, and he never forgot. He used to say, “You said you were going to do this and this and that. Did you do it?” “Yes, sir.”
Tacey Ann Rosolowski, PhD :
What were some of the projects that he—?
Benjamin Lichtiger, MD :
Well, for example the institution—certain departments used to send out samples to Methodist Hospital for HLA typing of patients, so we went to Methodist Hospital at the time and asked them if they would do the typing for us too for other patients. They said no, they were going to do it only for that department, so I went to Dr. Clark and said, “Look, we need to do this because there are other patients that need that.” He told me, “What would you need to have an HLA lab? How much money do you need?” I said—well, at that time I told him I think with $30,000-$40,000 we’ll be okay, so he gave me the money, and he said, “When will you have this thing running?” I said, “Ninety days.” Day ninety he shows up in the lab, and I say, “Dr. Clark, we’re already producing results.” Since then we grew, and today our HLA laboratory is one of the most advanced in the nation probably. It’s no longer the blood bank. It used to be a sector of the blood bank.
Tacey Ann Rosolowski, PhD :
Why did it separate?
Benjamin Lichtiger, MD :
Because it grew too much. It gets to a point where for the sake of that operation you need to let them grow on their own. I don’t believe in keeping them close because it’s like children. Let them go. Let them grow. Let them develop. They are doing very well, so I’m very proud of them. At that time also the Harris County Medical Society, when they heard that Dr. Clark was talking with Dr. Cooley and DeBakey and other leaders and also the president of that time of Hermann Hospital about forming a medical center, they formed the Institute of Hemotherapy. They went ahead and bought out the blood center that was located here—it was a commercial blood center—and formed what is today the Gulf Coast Regional Blood Center. And Dr. DeBakey and Dr. Cooley warned Dr. Clark to be careful with the pathologists. The pathologists will not support this, and sure enough, they did not, so they went all with Gulf Coast Regional Blood Center, and we remained the only independent blood bank since 1974.
Tacey Ann Rosolowski, PhD :
Why is that?
Benjamin Lichtiger, MD :
Well, because we needed—the needs of our patients are so very special that we practically have to run a boutique blood bank, because a patient with melanoma has one type of need, and the patient with leukemia has another need—the type of transfusions—and the patient with lymphoma is another one, and surgery is another one. So we tailor it, and the blood centers are like widget factories. They make one widget, and they are not nimble enough to go ahead, and our operation required the nimblest of the highest quality. We had to—so eventually we developed and we grew, developed muscle, and now the other institutions that deserted us and the project of the Institute of Hemotherapy now have their own blood banks back.
Tacey Ann Rosolowski, PhD :
Interesting. And so what—so does the Gulf Coast Regional Blood Center, does that still exist?
Benjamin Lichtiger, MD :
It still exists. It serves small hospitals in Bacliff, but it takes a medical center. I know that the hospital and the medical center have a contract with the Red Cross. They all buy from outside blood centers to supply their needs, and they have their own blood banks, which shows that maybe we should have gone ahead with the project in 1974. But Dr. Cooley and Dr. DeBakey told Dr. Clark and Dr. Eastwood that these pathologists were not going to support it. They were not employees; they were contractors, and I suspect there must have been some financial interest. We are employees, so for me one way or another it doesn’t make a difference.
Tacey Ann Rosolowski, PhD :
Right, it makes a big difference.
Benjamin Lichtiger, MD :
And so that made us flexible, toughened up, and we learned, and the institution supported us, and I am very grateful to Dr. [Charles A.] LeMaistre and Dr. [John] Mendelsohn because they supported us. The administration, within their limitations of the budget limitations, provided us with funds to exist, and I think that we are a revenue-intensive area, and I think that I might be mistaken but—(beeping)
Tacey Ann Rosolowski, PhD :
I’ll pause. (audio pauses)
Benjamin Lichtiger, MD :
—of most of the—all of the services and because of our involvement. We are available twenty-four hours, 365. There’s always a doctor. We are three. We are three doctors, two more junior. Let me answer this page. Give me one minute.
Recommended Citation
Lichtiger, Benjamin MD, PhD and Rosolowski, Tacey A. PhD, "Chapter 04: A New View of Blood Banking" (2012). Interview Chapters. 1459.
https://openworks.mdanderson.org/mchv_interviewchapters/1459
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