Introducing new tests before transfusion. Who shall decide?

The processes by which decisions are made to ensure the safety of the nation's blood supply are in disarray. Earlier decisions on the appropriate screening of donated blood, such as the test for the hepatitis B virus, were made on scientific grounds. Since 1983, because of the acquired immunodeficiency syndrome, decisions have been made under pressure from the public, the politicians, and the insurance companies. Ten years after the recognition of acquired immunodeficiency syndrome as a transfusion-transmitted disease, there is no orderly process to maintain both the safety and the availability of a national blood supply. The introduction of a decision-making system acceptable to all parties remains an urgent necessity. An attempt was made in 1988 to develop a new decision-making process under the aegis of the Institute of Medicine, National Academy of Sciences, Washington, DC. That may yet succeed.