Framework of Indian Blood Transfusion Services

Implications of the Precautionary Principle in Blood Safety Policy

Abstract

Over the past 2 decades the pendulum of blood safetypolicy has swung wide and hit hard. Intense criticism of delayed responses tothe early clues of the transfusion AIDS epidemic and of tolerance to the longstanding problem of post-transfusion hepatitis has had enormous repercussions.Blood collection systems in a number of countries have been completelyrestructured. Policy makers and physicians have gone to jail. Over the pastfive years the working paradigm has shifted toward “the precautionaryprinciple” and the elusive mirage of a “zero risk” blood supply. However,recent commentary on the precautionary principle suggests that even thisconservative approach must not seek zero risk or involve disproportionateresponses, but rather should incorporate scientific data, consistency withcomparable situations, and cost-benefit analyses into precautionary decisionmaking. In this issue of Transfusion, a number of papers on Nucleic AcidAmplification Testing (NAT) for infectious agents, illustrate some of the verydifferent drivers that have influenced the formulation of blood safety policy:perception, science, ethics, international politics and economics.