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 |
