THE BLOOD BROKERS; Third in a series.


THE BLOOD BROKERS - FEAR OF AIDS SPURS CHANGE

Gilbert M. Gaul, Inquirer Staff Writer, PHILADELPHIA INQUIRER; Tuesday September 26, 1989

Also visit The Blood Brokers:
Part 1 - How Blood, The 'Gift of Life,' Became a Billion Dollar Business
Part 2 - The Loose Way The FDA Regulates Blood Industry
Part 4 - Red Cross: From Disaster Relief to Blood
Part 5 - America: The OPEC of The Global Plasma Industry

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William Polikoff survived the Bataan Death March and was a POW in the Pacific for 3 1/2 years during World War II. But he could not survive AIDS.

Three years after receiving three pints of tainted blood while undergoing cardiac bypass surgery in San Diego, Polikoff died at age 70 on Dec. 9, 1987, of complications from AIDS.

"He went through hell and back, and then to have this happen was just so unfair," Polikoff's widow, Dorothy, said.

In May 1988, Dorothy Polikoff told the Presidential Commission on AIDS that her husband had never been advised that there were alternatives to being transfused with blood from the hospital's blood bank.

"If we had known the risk, his family could have given blood. His golf buddies would have given blood. His (four) children could have given blood," Polikoff said in an interview. "The fact is, they never told us."

Dorothy Polikoff is herself now infected with AIDS, which she contracted through sexual relations with her husband. Had doctors warned them, they would have abstained from sex, she said.

"It's very hard coping," she said. "I spend each day just waiting to see what happens. The same thing my husband went through I know I will have to go through. I'll be 65 next October and each day is precious.

"I ask myself, 'Where was the government to prevent this from happening?' " Polikoff said. "Someone has to try to make sure this devastation doesn't ever happen. It should never happen again." *

Read on to Part 4 - Red Cross: From Disaster Relief to Blood

TRACKING DOWN BLOOD-TRANSFUSION PATIENTS AT RISK FOR AIDS

Blood-bank officials say that since the advent of the AIDS antibody test in 1985, the danger of a person getting AIDS through a blood transfusion is virtually gone.

What about all the people who received transfusions before blood banks began to test for AIDS?

The Presidential Commission on AIDS, in its final report in June 1988, recommended that hospitals and blood banks be required to notify all people who had received a transfusion since 1977 of their potential exposure to the virus.

Such a plan would involve sending notices to approximately 25 million Americans, many of whom undoubtedly have moved or died. Since there would be substantial cost, the plan has not been universally embraced.

"I think the pickup (number of persons who don't know they are infected) would be very minimal for the amount of money that would be spent," said Dr. Morton Spivack, blood-bank director at Mount Sinai Medical Center in New York.

Most blood banks are already using "Look-Back" programs that trace recipients of blood from donors who subsequently tested positive for AIDS. Under this more modest approach, blood centers notify hospital blood banks each time a donor tests positive. The hospitals then check their records for any blood donated previously by the infected person until it can be shown that recipients of the earlier donations did not develop AIDS or there are no records.

Under federal law, hospitals are required to keep transfusion records at least five years. Many keep them longer. But in at least some cases, blood banks have found that some hospitals are destroying the records as soon as they may do so legally because of fear of AIDS-related lawsuits.

In Oklahoma City, for instance, a hospital destroyed its five-year-old transfusion records after the Oklahoma Blood Institute's Look-Back program spurred two AIDS-related lawsuits, according to Dr. Ronald O. Gilcher, director of the Oklahoma Blood Institute.

"There have been only two AIDS cases here and both have been brought during Look-Back," Gilcher said. "I'm sure, they (hospital officials) figured since they (the plaintiffs) brought suit as a result of what OBI was doing, they . . . wouldn't be liable if they had no records."

Proponents of the Look-Back approach say it is a reasonable and cost-effective way to identify those people most likely to have been infected. By comparison, the American Hospital Association estimates that notifying all blood recipients since 1977, when AIDS was first detected, could cost up to $2 billion. (The latency period of the virus could be as long as 10 years.)

But some blood-bank and hospital officials say that Look-Back programs cast too small a net and leave some infected blood recipients undetected. As a result, those people may unknowingly help spread the disease.

For example, a general notification program operated by the Kaiser Health Plan in Oakland, Calif., has identified at least 15 people who got AIDS from blood transfusions but didn't know it. The transfusions took place at hospitals owned by Kaiser in Northern California.

To date, Kaiser officials have contacted 46,500 people who received blood at 14 of its hospitals, recommending that they be tested for AIDS. More than 5,000 of those people were subsequently tested at Kaiser facilities, and 15 tested positive. Kaiser officials believe many other transfusion recipients were tested by their private doctors and may also have tested positive for AIDS.

"One of the key benefits we identified was that there were people out there who never realized they had received a blood transfusion," said Patricia Tanquary, Kaiser's director of member services. "Therefore, they did not know they were in a high-risk group. Some of them were children and their parents did not know (they had received blood)."

Before the implementation of AIDS testing in 1985, some hospitals did not require a patient's consent before a transfusion. Thus, unless a doctor informed them, they would be unaware they had received a transfusion.

"We think it's good for everybody to get tested," said Bernard J. Pino, president of the Blood Center for Southeast Louisiana in New Orleans. This July, the center recommended at a press conference that all people who received blood at the center between 1977 and March 1985 be tested for AIDS.

"It's better to remove all doubts instead of living in a realm of not knowing, especially if you are young," Pino said. "We felt it was the responsible thing to do morally and ethically."

The American Hospital Association and the three major groups representing blood banks have rejected the concept of nationwide notification of blood recipients, leaving the decision to the federal government.

More than a year after the report of the Presidential Commission on AIDS recommended a general notification, the FDA is still formulating a response. "We're going to publish a regulation . . . that's in response to the President's AIDS Commission," said Joel Solomon, director of the agency's Division of Blood and Blood Products.

But that regulation will stop short of a general notification plan, Solomon said. "I think the hospital association in its statement answered that as (being) not feasible and having high costs and a low return."

Instead, the FDA will require Look-Back programs, Solomon said.

Robert Rigney, a spokesman for the American Association of Blood Banks, said most hospital blood banks and blood centers have been conducting Look-Back plans since 1986, when the three major groups representing nonprofit blood collectors endorsed the concept.

"Generally speaking, everybody is doing it," Rigney said. "The bottom line is when the program was instituted (in 1986) virtually everybody immediately started tracing the donors."

Solomon and another FDA spokesman said they did not know why the FDA was only now formulating a regulation for tracking past recipients of blood.

"This formalizes the process. That's the way a lot of things have occurred (at the FDA)," said FDA spokesman Brad Stone.

Read on to Part 4 - Red Cross: From Disaster Relief to Blood

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