SAFETY OF THE BLOOD-SUPPLY IN THE UNITED-STATES - OPPORTUNITIES AND CONTROVERSIES

The risk for viral transmission by transfusion has been reduced dramat ically through improved techniques for selecting and testing blood don ors. Initiatives to further improve the safety of the blood supply, in cluding more stringent donor qualifications, additional testing for in fectious disease markers, viral inactivation processes, and refinement of transfusion decisions, are possible. However, because the risk for viral transmission by allogeneic transfusion is already low, addition al measures will have limited yield and poor cost-effectiveness. Furth ermore, unexpected side effects of some of these ''improvements'' may reduce the safety of the blood supply by introducing new risks. Cost-e ffectiveness analyses of blood safety initiatives have highlighted suc h successes as the introduction of virus-specific assays for screening donated blood and have identified other interventions that have poor cost-effectiveness estimates. They have also quantitated the threshold level at which the risks of an intervention outweigh its benefits. Th ese analyses have had little effect on decisions about blood safety, p ossibly because of overwhelming fear of AIDS and difficulties in apply ing cost-effectiveness estimates to a politically and emotionally char ged issue. Future interventions for improving blood supply safety must be evaluated thoroughly and chosen carefully so that the intended goa ls are met. Communication with the public should be undertaken so that the public understands that some of the desired measures may result i n inefficient allocation of health care resources.