A policy analysis of major decisions relating to Creutzfeldt-Jakob diseaseand the blood supply

Creutzfeldt-Jakob disease (CJD) is the first major challenge that the blood system has faced since the completion of the Krever inquiry in 1997. We re port the results of a detailed policy analysis comparing 2 CJD-related deci sions: a 1995 recall of blood from a donor with classic CJD and the 1999 de cision to defer donations from individuals with a 6-month travel history to the UK between 1980 and 1996 due to concerns related to variant ED. Overal l, we observed that decisionmaking improved significantly from 1995 to 1999 . In 1998/99 the potential threat of variant CJD was identified at an early stage, and a systematic risk assessment process was initiated. Decision-ma king was consultative and involved consumers. However, the perception exist ed that further improvement could take place in the areas of transparency o f process and interaction of organizations. We observed that the presence o f a second operator had an important impact on decisionmaking in 1998/99.