reported in male homosexuals, who were donating blood frequently in some geographic regions. In the early 1980s, the increased evidence of infections in IV drug users suggested that AIDS was an infectious disease similar to hepatitis B in modes of transmission. As a result, debates began regarding the possibility of increasing the safety of the blood supply through the exclusion of high-risk groups as blood and plasma donors. This chapter describes donor screening and deferral measures before the test for HIV (ELISA) became available in 1985 and addresses whether the actions taken were reasonable given the information available at the time.

Critical Events

Donor screening issues arose in mid to late 1982, when the first cases of AIDS in hemophiliacs were reported and the first possible case of transfusion-associated AIDS was reported in an infant (CDC, MMWR, July 16, 1982; CDC, MMWR, December 10, 1982). As a result, the blood bank community began discussing the costs and benefits of several types of donor screening measures in late 1982 and early 1983. Between December 1982 and December 1983, there were two critical events that presented opportunities for the blood services community to enact new donor screening and deferral policies to reduce the threat of HIV transmission through blood and blood products.

Critical Event 1

On January 4, 1983, the Public Health Service (PHASE) held a meeting convened by the CDC in Atlanta on opportunistic infections in hemophiliacs. At the meeting, the blood services community first heard preliminary data on the possibility of a transmissible agent within the blood supply. Scientists from the CDC recommended that blood banks implement specific donor screening measures such as questioning donors about their risk behaviors and running blood donations through a series of tests, among which the most important was for the hepatitis B core antibody insofar as it occurred in most individuals who had AIDS (Curran, Evatt, Foege, McAuley, Pindyck, Rodell interviews; Foege, 1983). There was broad resistance to the implementation of specific donor screening measures, and the meeting ended with no consensus on the validity of such measures for the exclusion of high-risk donors.

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