Reducing Waste in Hematology Starts With the New Generation of Researchers and Clinicians

Waste in research and clinical care is contributing to the climate crisis that threatens health and well-being worldwide, but the current generation of hematologists and researchers are poised to change the status quo, according to speakers at a YoungEHA session at the 2024 European Hematology Association (EHA) Congress.

Sustainability is reflected in the EHA’s efforts in hosting the Congress, from recycled badge lanyards to complimentary public transit passes all the way down to the eco-friendly carpet used at the venue in Madrid, Spain, so it’s no surprise that the agenda featured this session targeted toward YoungEHA members, who constitute early-career researchers and clinicians. As the speakers mentioned, these attendees new to the field have the greatest opportunity to rethink potentially wasteful practices because they are not yet entrenched in the status quo of “how it’s always been done.”

Marta Rodríguez Martínez, PhD, sustainability officer at the European Molecular Biology Laboratory in Heidelberg, Germany, set the stage for the discussion with the sobering facts around climate change: The global surface temperature is increasing due to human activities and will have serious ramifications on infrastructure, water, food, biodiversity, ecosystems, and health and well-being. But there are feasible and impactful solutions, including limiting carbon emissions and improving the resiliency and efficiency of water and power use, so there is still time to stop these destructive trends and ensure a livable planet for future generations, she said.

In particular, “researchers have a social and ethical responsibility because we have the knowledge to understand the data…and communicate,” she said. Research is a resource-intensive undertaking, in terms of both the carbon footprint generated by operations, data storage, and travel and the waste generated by chemicals, biologic materials, and plastics. To illustrate this last point, she mentioned that a laboratory uses 10 times more energy than any other office space, with ultra-low temperature freezers and chemical fume hoods drawing several times more energy than the average household.

Indeed, research is estimated to generate between 0.25% and 2% of global plastic waste,¹ with major culprits including pipettes and plates, tips and their packaging, tubes, gloves, and syringe barrels. With that in mind, Rodríguez Martínez asked the audience to plan their science and data management with resource sustainability in mind. There may be opportunities to replace single-use plastics with glass, for instance.

At EMBL, the sustainability strategy is bottom-up and top-down, encompassing funders and suppliers in addition to scientists and staff, and it works by creating a culture of sustainability though guides and resources, recycling opportunities, lab energy audits, and more. To keep waste on the forefront of everyone’s mind, the lab grounds feature an art installation called “4 Weeks of Pipetting”—a large sculpture made of half a ton of pipetting boxes. Their efforts have paid off, with 3070 tons of CO₂ saved and a 30% reduction in residual waste achieved since 2019.

According to the next speaker, Mhairi Copland, PhD, professor at University of Glasgow in Scotland, opportunities to reduce waste begin even further upstream, when researchers are crafting their study hypothesis and design. As much as 85% of health research can be considered wasteful due to poor design, not publishing the results, or not adding to what is already known, so researchers must consider whether their questions are relevant and their methods are appropriate.

Justifiable research questions must include meaningful involvement of end users and those affected by the research, and engagement of patients and the public can involve open talks, blog posts, and outreach events. The status quo, with many studies claiming to be the first to address a question while failing to use systematic reviews to inform trial design, is exacerbated by academia’s tendency to reward quantity over quality and novelty over reliability, Copland noted. It’s also important to consider carbon reduction in study design; as one cautionary tale, research has estimated that the CASPS trial of cedirinib generated 72 tons of CO₂, largely due to clinical trial unit emissions and staff travel across the study sites in the United Kingdom, Spain, and Australia.²

What the audience can do starts with asking the right questions, striving toward efficient design, and involving methodologists from study inception. “We also need to remember diversity in trial participation so the results of our trial are generalizable to as many people in the population as possible,” Copland said.

Lastly, Jaap Jan Zwaginga, professor at the University of Leiden in the Netherlands, took the podium to discuss the proper use of blood products. Clinicians have an obligation to do so, not just because these products are costly, but also to recognize and respect that these products come from altruistic donors. Key steps in reducing waste in the blood product pipeline include reducing transport times, communicating inventories, and managing stores such that the oldest units are used first. These problems are magnified in rural areas, with data showing that the percentage of discarded platelet units surpassed 50% in remote areas of Australia in 2022-2023.³

Even in urban clinic settings, Zwaginga said, overuse of blood and plasma is a persistent problem, but one that can be combatted with evidence-based guidelines. For instance, the Leiden University Medical Center hematology ward changed its guidelines so the default transfusion amount was 1 unit rather than 2, and they’ve seen erythrocyte use decline by 24% with positive feedback on patient quality of life.

To effect change, leaders in clinical settings must analyze their sources of waste and start with the low-hanging fruit, paying particular attention to the waste that occurs at transition points in the process. By finding and learning from best practice, Zwaginga exhorted the audience, “maybe you can be pioneers and champions to generate some change in blood use in your hematology departments.”

In a panel discussion, session cochair Katherine Bridge, PhD, a researcher at the University of York in the United Kingdom, asked the speakers how the next generation of leaders in hematology can affect the systems and culture that can seem too deeply embedded to change. Rodríguez Martínez suggested to the audience of early-career scientists to use their fresh outlook to their advantage: “Get together with your peers and know that you have something to change and something to say.… You do have more power than you think.”

References

1. Urbina MA, Watts AJ, Reardon EE. Labs should cut plastic waste too. Nature. 2015;528(7583):479. doi:10.1038/528479c

2. Griffiths J, Fox L, Williamson PR; Low Carbon Clinical Trials Group. Quantifying the carbon footprint of clinical trials: guidance development and case studies. BMJ Open. 2024;14(1):e075755. doi:10.1136/bmjopen-2023-075755

3. Blood product wastage. Australia National Blood Authority. Accessed June 14, 2024. https://www.blood.gov.au/blood-products/blood-product-management/blood-product-wastage