Screening Blood: Public Health and Medical Uncertainty

Abstract

Use of the human T-lymphotropic virus type III (HTLV-III) antibody screening test for reducing the risk of contracting acquired immunodeficiency syndrome (AIDS) through blood transfusion has raised ethical issues regarding notification and confidentiality. It has also raised longterm questions about mass screening mandatory reporting of positive results to public health officials behavioral change and public health interventions under conditions of medical uncertainty. Initially blood banks resisted mandatory notification of antibody-positive donors on the grounds that it established a clinical relationship between donor and blood bank and also might encourage people to come to blood centers solely to get their tests results. Now that other agencies have had time to set up alternative sites for HTLV-III antibody testing blood banks will begin to inform people about their positive antibody status. Names of seropositive individuals will be kept in the American Red Cross confidential national deferral registry. Those who test positive on a single test only will not be notified and their names will not be entered in the national registry but their names will be kept in a local registry and subsequent donations will be discarded. A troubling question concerns whether to notify past recipients of blood from donors who are now seropositive. Most blood banks have adopted a policy of not notifying such recipients since it is not known whether the donor had antibodies at the time of the index donation. Because of the psychological trauma associated with notification blood centers and alternative test sites plan to offer counseling to seropositive persons. More compelling evidence of a public health threat than presently exists will be required to justify mass screening of all those at risk of contracting or spreading AIDS. Such testing would threaten the civil liberties of the persons tested.