During the early years of the AIDS epidemic, thousands of Americans became infected with HIV through the nation's blood supply. Because little reliable information existed at the time AIDS first began showing up in hemophiliacs and in others who had received transfusions, experts disagreed about whether blood and blood products could transmit the disease.

During this period of great uncertainty, decisionmaking regarding the blood supply became increasingly difficult and fraught with risk. This volume provides a balanced inquiry into the blood safety controversy, which involves private sexual practices, personal tragedy for the victims of HIV/AIDS, and public confidence in America's blood services system.

The book focuses on critical decisions as information about the danger to the blood supply emerged. The committee draws conclusions about what was done--and recommends what should be done to produce better outcomes in the face of future threats to blood safety.

The committee frames its analysis around four critical area

• Product treatment--Could effective methods for inactivating HIV in blood have been introduced sooner?
• Donor screening and referral--including a review of screening to exlude high-risk individuals.
• Regulations and recall of contaminated blood--analyzing decisions by federal agencies and the private sector.
• Risk communication--examining whether infections could have been averted by better communication of the risks.

Contents

• COMMITTEE TO STUDY HIV TRANSMISSION THROUGH BLOOD AND BLOOD PRODUCTS
• Preface
• Executive Summary
• 1. Introduction
  • HIV Infection Via Blood Transfusion
  • The Committee's Charge
  • Organization Of The Report
  • References
• 2. The U.S. Blood Supply System
  • Introduction
  • Blood And Blood Products
  • Blood Collection Organizations
  • Professional Associations
  • Hemophilia Organizations
  • Role Of The U.S. Public Health Service
  • Blood And Blood Product Regulation
  • Regulatory Authority Of The Fda
  • Summary
  • References
• 3. History of the Controversy
  • Introduction
  • The Risk Of AIDS
  • Immediate Responses To Evidence of Blood-Borne Aids Transmission
  • Reconsidering The Evidence: Further Attempts To Formulate Policies
  • Research Activities
  • References
• 4. Product Treatment
  • Introduction
  • Critical Time Period: 1970–1983
  • Analysis And Conclusions
  • Summary
  • Afterward
  • References
• 5. Donor Screening and Deferral
  • Introduction
  • Donor Screening Practices
  • Analysis And Findings
  • Conclusions
  • Afterword
  • References
• 6. Regulations and Recall
  • Introduction
  • Framework of Analysis
  • Findings And Conclusions
  • Influence And Responsibilities Of Other Organizations
  • The Advantages Of Marginal Thinking
  • Summary
  • References
• 7. Risk Communication to Physicians and Patients
  • Introduction
  • Framework For Analysis
  • Risk Reduction Options
  • Case Studies
  • Obstacles To Communication
  • Conclusions
  • References
• 8. Conclusions and Recommendations
  • General Conclusions
  • Recommendations
  • References
• Appendixes
  • A Individuals Interviewed by the Committee
  • B Individuals Providing Oral and Written Testimony (for a public meeting held September 12, 1994)
  • C Chronological Summary of Critical Events, National Hemophilia Foundation (NHF) Communications, Knowledge Base, Risk Assessment, Clinical Options, and NHF Actions
  • D Key Documents Provided to the Committee
  • E Glossary of Acronyms and Terms
  • F Committee and Staff Biographies

Support for this study was provided by the Office of the Assistant Secretary of Health, Department of Health and Human Services (contract no. 282-93-0045).

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.