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HIV and the Blood Supply: An Analysis of Crisis Decisionmaking
directly about their sexual behavior and run blood donations through a series of surrogate tests (the use of nonspecific laboratory markers), including a test for the hepatitis B core antibody, which showed an 88 percent correlation with patients who had AIDS (Foege 1983; Evatt, Foege, Francis interviews). Some meeting participants opposed this recommendation because of the cost of the tests and other reasons (see Chapter 5). Gay activist groups objected to screening measures, claiming that they were discriminatory toward their members. Many meeting participants were not convinced by the evidence that AIDS was transmitted by blood or blood products (Bove, Curran, Evatt, Foege, Pindyck interviews).
Dennis Donohue, Director of the FDA's Division of Blood and Blood Products, stated that research on processes for inactivating viruses in blood products was under way. Oscar Ratnoff, a prominent hemophilia specialist, stated there was enough information about the danger of AHF concentrate to stop using it in favor of cryoprecipitate (Johnson 1983). Dr. Francis tried to establish a time frame for action or a minimum number of transfusion-related AIDS cases after which the FDA's Blood Products Advisory Committee would agree to take action to implement donor screening policies.
The Blood Bank Community's Statement
A week after the Atlanta meeting in January 1983, the American Association of Blood Banks, the Council of Community Blood Centers, and the American Red Cross issued a joint statement that ''direct or indirect questions about a donor's sexual preference are inappropriate." The statement recommended questions to detect possible AIDS exposure (i.e., a donor health history), but did not recommend any laboratory screening tests. At this time, the PHS agencies had not completed their own recommendations (Donohue, Foege interviews), and the FDA did not issue any recommendations.
Position of the National Hemophilia Foundation
The next day, the Medical and Scientific Advisory Council (MASAC) of the NHF met and recommended that cryoprecipitate (a blood product produced from the serum of a small number of donors), rather than AHF concentrate, be used for newborn infants and children under four, newly diagnosed patients, and those with mild hemophilia. According to the report, there was insufficient evidence to develop specific recommendations about blood product use (i.e., AHF concentrate or cryoprecipitate) in the treatment of severe hemophilia. Additional recommendations included delaying all elective surgical procedures and the use of a synthetic substance, DDAVP (desmopressin acetate), to elevate