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HIV and the Blood Supply: An Analysis of Crisis Decisionmaking
1983, each of the companies … had in place donor education and questioning programs specifically requesting members of high-risk groups to identify themselves and refrain from donating plasma" (FDA, BPAC 1983a). One explanation for the plasma fractionators' aggressive approach to donor screening may have been the profit motive that drives one company to distinguish itself from its competitors. Executives at Alpha Therapeutics and other companies may have acted upon their belief, or strong suspicion, that AIDS was caused by a blood-borne infectious agent, and as a result implemented screening policies to protect both their company from product liability and the recipients of their products from harm. In addition, Alpha's insistence on the exclusion of high-risk donors in late 1982 may have led other companies, which did not want their products to appear less safe than Alpha's, to implement donor screening policies in 1983.
Some nonprofit blood centers initiated projects directed towards excluding donors or removing infected blood from the available supply. For example, by February 1983, the Greater New York Blood Program was providing donors with information about AIDS, high-risk groups, and the possibility of transmitting AIDS through blood. They asked donors either not to give blood or to give it for research purposes if they identified themselves as a member of a high-risk group (self-deferral). Medical screening resulted in the deferral of an additional 2 percent of donors, and a confidential questionnaire resulted in self-deferral by 1.4 percent of the donors (Pindyck, et al. 1985). The prevalence of anti-HBc in the group who indicated their blood was for research only was approximately 12 percent, compared to 6 percent among those donations marked for transfusion. These gains were weighted against the estimated cost of the anti-HBc test ($3.00 per test) and the cost of discarding a unit and replacing a donor (FDA, BPAC 1983c; Pindyck, et al. 1985). As a result, the New York program relied on "confidential unit exclusion" as a safety measure, rather than implementation of a routine anti-HBc surrogate test. (Confidential unit exclusion involves use of a bar code sticker to label a unit "do not transfuse" or "not for transfusion.'' See Afterward below.)
Although blood banks did not implement direct questioning of donors about their sexual preferences at the same time plasma collectors did, they did comply with the FDA's recommendations issued on March 4, 1983. These recommendations included the following steps: to expand medical screening of donors, to provide written educational materials to donors about those groups at increased risk of AIDS and the necessity of refraining from donation if identified as a member of the high-risk groups, as well as allowing for individual methods (e.g., confidential unit exclusion) for confidential self-deferral (OTA 1985).
Some people viewed direct questioning about sexual behavior and drug use as a violation of an individual's right to privacy. Public health officials countered by saying that the individuals' rights were less important than the