Notices of Positive AIDS Tests Urged : Panel Would Tell Blood Donors of Unconfirmed Results

A federal advisory panel declared Wednesday that there is “a clear ethical responsibility” on the part of blood banks to notify individuals that their blood initially has tested positive for exposure to the AIDS virus, even if subsequent testing indicates that the person is probably not infected.

“Because of the confusion and the obvious emotional problems involved in telling people, most blood banks have elected not to tell donors,” the panel chairman, Dr. Thomas C. Chalmers, distinguished service professor at Mt. Sinai School of Medicine, said. “They believe giving bad information is worse than giving none. We think that should stop.”

Studying Consequences

The panel, made up of biomedical investigators, blood bank specialists and academics, was convened by the National Institutes of Health to study the consequences of screening the blood supply for HTLV-III, the virus that causes AIDS. Such testing began in the spring of 1985.

Donors who repeatedly test positive on the initial test, known as ELISA, but negative on the confirmatory test, called the Western Blot, are considered uninfected and are usually not notified, under current procedures.

However, blood-collection agencies are required by federal regulations to destroy the blood of such persons as a precautionary measure and to enter their names into “donor deferral” registries--meaning that their blood will never be used again. About 15,000 to 20,000 people have fallen into this category thus far, the panel said.

Divided on Notification

The blood-banking community has been divided over the issue of whether to tell donors that their blood initially has tested positive when it is extremely unlikely that they have been exposed to the usually fatal disease.

“We have felt that it is pretty heavy-duty information to provide to someone,” Gene Jeffers, a spokesman for the American Red Cross, said.

But the panel called it “inappropriate to enter a person’s identity into such a registry without his knowledge and without giving him the personal advantage of sharing that knowledge and its meaning.” The panel said further that “anticipation of the donor’s fear and distress is not a valid basis for not informing the donor.”

Chalmers added: “There are many false positives on this test. It is purposely a very sensitive test. A lot of people not carrying the AIDS virus will test positive. We believe the great majority of them are perfectly safe. But, when people are in any way put on a list, they should be so informed.”

Donors whose blood repeatedly tests positive on ELISA, as well as on the Western Blot, are considered infectious and are notified immediately by blood banks.

Confidentiality Urged

The advisory panel urged that notification “be achieved in a manner that is sensitive, humane and supportive” and that confidentiality be “carefully and strictly maintained due to the sensitive nature of the information.”

The panel recommended also that blood-collection agencies adopt procedures to enable donors to confidentially indicate that their blood should not be used in transfusions. “Because of real or perceived social pressures, some persons at risk to transmit (the virus) may feel compelled to donate blood,” the panel said.

For example, a member of a high-risk group, such as a male homosexual, may be aware that his blood could be infectious but still feels that he cannot publicly refuse to participate in an office blood drive. Such a mechanism would enable him to donate blood, although it would not be used in transfusions.

The panel denounced “punitive and threatening measures” directed at members of high-risk groups, saying that “they drive individuals away from responsible behavior and make education almost impossible.”

Panel members said that the statement was a response to any proposals--including state or federal laws or policies--that would result in the “restriction of liberties” of any individual based on his antibody status.

‘Never a Perfect Test’

Although it said that “there is never a perfect test,” the panel called for continued research into “more sensitive tests that more specifically identify infectivity.”

The group estimated that about 120 units of contaminated blood a year--from a total of 12 million--may slip through the screening process. The danger of contracting AIDS from a blood transfusion is “substantially less” than 1 in 10,000, it said.

About 2% of the nation’s cases of AIDS, a disease that cripples the body’s immune system, have been caused by transfusions of tainted blood.