Should You Have the Right to Choose Your Blood Donor?
A blog companion to Wise Traditions episode 597 with pharmacist Liz James
Published companion piece. Source interview: Weston A. Price Foundation, Wise Traditions, episode 597, September 21, 2026.
(See Video at bottom of blog post)
Most people never think about a blood transfusion until the day someone they love needs one. At that moment, the usual instruction is simple: trust the supply, sign the form, and do not ask where the unit came from.
Pharmacist and patient advocate Liz James thinks that is the wrong default, at least outside an emergency. In Wise Traditions episode 597, she tells host Kendall Nelson why she left a six-figure pharmacy career, why she founded the nonprofit cooperative Blessed By His Blood, and why Idaho became the first state to write a patient’s right to directed donor blood into law.
This post is a companion to that conversation, not a transcript. Claims James makes about the blood industry are labeled as hers. The Idaho law is public record.
The pharmacist who walked away
James spent more than 30 years in retail and specialty pharmacy. Her turn toward a more traditional view of health started, she says, with a broken wrist and two customers who told her to drink raw milk. She later found Ron Schmid’s The Untold Story of Milk and the Weston A. Price Foundation.
She stayed in pharmacy for years after that, trying to give patients more information than a standard counseling script. She describes insurance-driven Medication Therapy Management calls that pushed extra drugs, including statin calls to people with diabetes, and says she used those calls to tell patients they could refuse and should look up the risks.
In September 2020 she decided she could not give or receive the COVID-19 shots as a matter of conscience. She says that on September 9, driving home from work, she concluded she had to leave. She gave notice that Friday, with her husband’s support, and walked away from a salary above $100,000.
Blessed By His Blood came later. James says the directive she heard was to “preserve the blood.” The organization, a faith-based nonprofit cooperative, matches patients with directed or known donors and helps families navigate hospitals and blood centers.
Official site: https://blessedbyhisblood.com
Her own history is part of the argument. During pharmacy school, in the HIV era, she had surgery and her mother and brother donated for her. Directed donation, she says, was then a normal question a surgeon asked.
What “directed donor blood” actually means
There are three different things people often lump together:
Volunteer allogeneic blood. The standard supply. Anonymous donors, tested, stored, and issued by type and medical need.
Directed donation. A specific person donates for a specific patient. The unit is still collected by a blood establishment and still has to meet federal collection rules.
Autologous donation. The patient donates their own blood ahead of a planned procedure.
Directed donation is not a backyard transfusion. Federal blood-establishment rules still apply. Idaho’s 2026 law is explicit on that point.
James’s practical claim is narrower than “anyone can demand any unit.” She argues that in non-emergency, non-urgent cases, a patient who has a compatible known donor should not be told the option does not exist. She says families are increasingly told it is unavailable, unnecessary, or too hard to arrange, even when there is time to plan.
Why some patients want a choice
James raises several concerns. They are arguments, not settled consensus.
Storage. Banked red cells change over days in the refrigerator. Transfusion medicine calls this the storage lesion: shifts in cell shape, metabolism, and some function. How much that matters clinically is still debated, and emergency medicine depends on stored blood. James treats it as a reason to prefer fresher, planned donation when time allows.
What else is in the unit. Donors are screened and blood is tested for major infectious markers. James argues screening does not capture every medication, exposure, or health state a recipient might care about, and that a known donor is one way to narrow that uncertainty. Mainstream blood services argue the tested volunteer supply is the safety system that ended the transfusion disasters of earlier decades.
COVID-19 vaccination status. A large share of Blessed By His Blood’s matching, James has said in other interviews, is for people who do not want blood from donors who received mRNA COVID-19 shots. Whether vaccination status changes transfusion risk is disputed. Blood collectors in the United States do not label units by COVID-19 vaccination status. Readers should treat this as a preference some patients hold, not as an established clinical finding from this episode.
Money. James says the blood industry generates about $32 billion a year, and that U.S. blood exports rank as the country’s ninth-largest goods export, ahead of gold and coal. That export ranking has been reported for plasma-derived products, not bags of whole blood. The Economist and Econlib have cited figures around $37 billion and a ninth-place goods-export rank, driven largely by paid plasma used to make medicines. Plasma is a different market from hospital red-cell transfusion. The scale is real. The leap from “plasma is a major export” to “hospitals block directed red-cell donation because of that export business” is James’s interpretation, not a finding in the Idaho statute.
Idaho went first
House Bill 528 added Idaho Code 39-3704, Directed Blood Product Transfusion. It was signed March 16, 2026, became Session Law Chapter 26, and took effect July 1, 2026. Representative Chris Bruce carried it. James testified in support and says she began working with him in 2024. She also says similar bills are being discussed in other states, including Texas.
The operative rule is plain. Except in listed cases, a provider or facility may not prohibit a patient from supplying, through a blood establishment that follows federal collection rules, the patient’s own blood or a directed donor’s blood product for a transfusion related to that patient’s care.
“Blood product” includes whole blood, plasma, derivatives, platelets, and clotting agents.
The ban does not apply if:
the donation or transfusion would harm the donor or the patient
there is not enough time to arrange it before a procedure
the procedure is emergency care
Providers acting inside their license are immune from liability for injury or death from using that patient-supplied product, unless gross negligence regarding the product or the transfusion contributed. The section also says it does not conflict with federal law on collection, donation, sale, or use of blood products.
That is a right-to-access statute, not a safety rollback. It does not let a hospital skip federal collection standards, and it does not cover a crashing patient in the emergency department.
What James tells families to do before they need it
The episode’s most usable point is timing. Directed donation fails most often because nobody asked until the morning of surgery.
If this matters to a household, the work happens before a procedure is booked:
Know blood types for the people most likely to donate for one another.
Ask the surgeon and the hospital blood bank, in writing, whether directed or autologous donation is available for this procedure.
Ask which blood establishment they will accept units from, and how many days of lead time they require.
If the answer is no, ask whether that is a clinical judgment, a logistics limit, or a policy. Those are different objections.
In Idaho, after July 1, 2026, point to 39-3704 if the refusal is a blanket prohibition rather than harm, time, or emergency.
Outside Idaho, the option may still exist under federal rules even without a state statute. It may also be refused. James’s group exists to help families navigate that.
Two cautions - directed donation does not remove infectious-disease testing, and a relative is not automatically a safer donor. For some patients, related donors raise separate risks, including transfusion-associated graft-versus-host disease in certain settings. That is a question for the treating physician and the blood bank.
A clean way to frame the argument
The interesting fight is not “is the blood supply evil.” It is whether non-emergency patients may choose a known, properly collected donor when a hospital would rather issue from inventory.
James says yes. Idaho now says a facility may not forbid it, with narrow exceptions. Other states are still arguing. Hospitals and blood centers will say inventory, timing, and tested anonymous supply are what keep transfusion safe.
Both can be true at once: the anonymous system is what makes emergency transfusion possible, and a planned surgery is not an emergency.
Sources
Wise Traditions episode 597, “Should You Have the Right to Choose Your Blood Donor? With Liz James,” Weston A. Price Foundation, September 21, 2026. https://www.westonaprice.org/podcast/should-you-have-the-right-to-choose-your-blood-donor-with-liz-james/
Blessed By His Blood: https://blessedbyhisblood.com
Idaho House Bill 528, now Idaho Code 39-3704. Signed March 16, 2026. Effective July 1, 2026. Bill text: https://legislature.idaho.gov/wp-content/uploads/sessioninfo/2026/legislation/H0528.pdf
LegiScan status for ID H0528: passed, Session Law Chapter 26. https://legiscan.com/ID/bill/H0528/2026
Plasma export context: “America’s 9th Largest Export,” Econlib, September 9, 2024, discussing Economist reporting on U.S. blood-product exports. https://www.econlib.org/americas-9th-largest-export/
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