ABOUT 14 million blood transfusions have been carried out in Australia since screening for HIV began in 1985. Last week, a Victorian girl became the first known person in all those years to contract the virus from a transfusion.
What makes the case all the more heart-breaking is that the girl’s doctor father, aware that no blood bank could be 100 per cent safe, had tried to make a directed donation — to give his own blood for use during his daughter’s surgery — only to be strenuously discouraged by the blood bank.
Unthinkably awful as this family’s experience has been, the experts insist that directed donations such as that contemplated by the girl’s parents are, overall, twice as risky as transfusion using blood from an “”altruistic” blood supply.
Potential blood donors are asked a number of questions to rate their suitability for donation. Some of these relate to sexual activity and other behaviours which elevate an individual’s risk of contracting a blood-borne disease. Someone donating anonymously to a blood bank would have little reason to lie. In the event of their donation being refused only they and the blood bank would know. On the other hand, someone making a directed donation for a family member may be torn between family expectations that they will donate, and the fear that if they answer the questions honestly and their donation is refused, the refusal will have to be explained to a spouse or to other family members.
No blood bank can ever guarantee the complete integrity of its supply, any more than any surgeon can guarantee an operation will be complication-free. It would be wonderful if a method of screening newly-infected HIV carriers were suddenly to be discovered, but there will always a period after infection before any test will pick it up. In that period it will be possible for someone infected with HIV to give blood which no screening test will reveal as infected.
There could be an unfortunate side-effect from this week’s events. Many people might feel that the public blood bank is not safe and that therefore they will opt for directed donation in the mistaken belief that receiving blood from a family member will be safer. No so. The more donation by direction, the more likely there will be cases of HIV infection.
The case in Victoria is heart-wrenching, but it must be put into perspective. The blood bank is very safe indeed. The risk of infection is one in 15 million. The risk of being killed in a motor accident in a year is nearly 2000 times greater. The risk of being killed by a shark or crocodile are greater.
The trouble is that emotion displaces rationality in these debates. A further complication arises when the factor of cost is introduced. The blood bank could be made safer with cost. A new test can reduce the window between infection and the blood revealing infection by about a half. It might be possible to reduce the risk from one in 15 million to one in 30 million. But the cost might be as much as $30 million a year. Is that money well spent in a squeezed health system. It may sound brutal to put it like that, but the extra $30 million might prevent one HIV infection in a decade, or even none. But put in other parts of the health system it would save some lives and improve the quality of life of many others, for certain.
Tragic as this case is, we should not over-react to it. Australia has an excellent, if pressed, public blood bank, both in absolute terms and in comparative terms with the rest of the world. It would be more tragic if this case resulted in the undermining of this system with panic donation by direction or the setting up of rival private systems.