I’m so sorry to hear about your friend and the seriousness of his late stage MDS. Sadly, this disease can progress to a more aggressive form of leukemia which may be difficult to treat. A bone marrow transplant remains the only potential cure for MDS or AML. But unfortunately, a transplant may not be suitable for every individual with MDS because of the rigors of the pre-transplant chemo, medications and the transplant itself. This can be due to the age of an individual or more often it’s due to co-morbidities which may cause complications for the patient.
This is a very sad and difficult time for your friend and his loved ones. Sometimes all the modern medicine in the world can’t change the course of a disease. Blood cancers can be formidable foes. I’ll certainly add him to my prayers and hope that he will remain comfortable and at peace.
Is he currently in a hospital or involved in hospice?

I am receiving injections of Luspatercept every 3 weeks. This has gotten my hgb over 10 consistently. Maybe ask if he is a candidate for that drug.