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HIV and the Blood Supply: An Analysis of Crisis Decisionmaking
presence of an antigenic component of the virus. Prior to 1970, the incidence of post-transfusion hepatitis was 8-17 percent among transfusion recipients (Seeff 1988). During the period from 1970-1972, all blood and plasma collection agencies implemented the test for the presence of hepatitis B virus. Subsequently, hepatitis cases continued to appear in approximately 5-18 percent of transfusion recipients (OTA 1985), strong evidence that viruses in the blood supply other than hepatitis B caused hepatitis (non-A, non-B hepatitis).
In the late 1970s and early 1980s, blood donor pools included many groups at high risk for AIDS. The homosexual population volunteered to donate blood frequently during this time frame in efforts to help develop a hepatitis B vaccine and to gain a social acceptance (Evatt, Curran, McAuley, Perkins interviews). In addition to homosexuals, other populations who were at a high risk for infectious diseases, such as prison inmates and persons in other institutional settings (e.g., mental hospitals), served as blood or plasma donors (McAuley, Perkins, Rodell, Shanbrom interviews). People in these groups constituted a large proportion of the paid donors in the United States. Thus, both the paid and volunteer donor pool included many individuals from the high-risk populations.
Early Donor Screening Practices
Efforts to have "safe" donors started in the early 1950s. The aim was to eliminate persons who carried the two known blood-borne infectious agents, those causing syphilis and hepatitis. Blood bank personnel obtained every donor's medical history and deferred any donors who had a history of hepatitis. Blood from volunteer donors was known to be safer than blood from paid commercial donors (Allen, et al. 1959; Eckert 1986). In July 1973, the Secretary of Health, Education and Welfare called for a transition to an all-volunteer blood donation system (for whole blood) as part of a national blood policy. In November 1975, the FDA required that all blood units collected be labeled as from either a paid or a volunteer donor (U.S. Comptroller General 1975). At this time (and currently), paid donors were the principal source of plasma for fractionation into blood products such as AHF concentrates.
In 1982 the American Association of Blood Banks (AABB) standards required that each donor meet the following criteria: the donor had to appear in good health, the skin at the venipuncture site had to be lesion-free, the donor should not have received blood or blood components (known to be a possible source of hepatitis) in the preceding six months, and the donor's arms had to pass inspection for repeated sites of venipuncture prior to donation. In addition,