PoPulationand Public HealtH etHics

policy
public trust might also include maintaining the status quo to minimize the
harm inflicted by the tainted blood scandal. By changing the criteria for
blood deferral and eliminating the permanent ban for specific groups, there
is a potential increase in risk to donor recipients, albeit very minimal. 2 It is
important to consider whether any increase in risk is acceptable and on what
basis. 3 Even as blood-screening technology has improved, and new screening
tests have been developed (such as nucleic acid testing, or nat), obtaining
blood donations from low-risk donors is still important, as no one procedure
is 100% effective. 4 Most specifically, low-risk blood donors serve to minimize
the introduction of infected blood within the period during which HIV is
invisible to laboratory screening procedures.
The initial policy was implemented using the justification of the precautionary
principle in the absence of scientific evidence or robust tests to
determine the presence of HIV. 3 As indicated in the case study, HIV testing
has improved significantly since the 1980s, when the permanent deferral
was introduced. Should the precautionary principle, then, still be used as a
guiding principle when scientific evidence has demonstrated otherwise? If
we know that there is potential for infected blood to enter the blood supply,
thereby possibly causing harm to the population, should the lifetime ban be
lifted? Not all MsM, though affected by the lifetime ban, are at the same risk
level for transmitting the disease; the minimal risk posed by many of these
men means that their exclusion from donation does not protect the population
from any actual harm. In addition, the window period during which
HIV is invisible to laboratory screening procedures has been reduced from
three months to 12 days, further supporting policy change and minimizing
the potential for infected blood in the blood supply. Finally, policies related
to other groups considered “at risk” have also been changed, lending support
to the re-examination of this policy. 3
Proportionality involves protecting the public from harm by balancing expected
benefits against any possible burdens. 1 One interpretation of the
proportionality principle might suggest that, given the minimal increase in
risk involved in allowing MsM to donate blood, the broad exclusion of MsM
as blood donors is indeed not proportional with the risk assumed. A one-year
deferral on monogamous gay men only increases the risk of one HIV-positive
unit being potentially undetected in every 11 million collected, 5 meaning that
risk of receiving contaminated blood is minimal (albeit not zero). 5
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