Nucleic Acid Amplification Testing and Blood Safety : What is the Paradigm ?

Over the past 2 decades the pendulum of blood safety policy has swung wide and hit hard. Intense criticism of delayed responses to the early clues of the transfusion AIDS epidemic and of tolerance to the long standing problem of post-transfusion hepatitis has had enormous repercussions.( 1) Blood collection systems in a number of countries have been completely restructured. Policy makers and physicians hale gone to jail. Over the past five years the working paradigm has shifted toward “the precautionary principle” and the elusive mirage of a “zero risk” blood supply. However, recent commentary on the precautionary principle suggests that eventhis conservative approach must not seek zero risk or involve disproportionate responses, but rather should incorporate scientific data, consistency with comparable situations, and cost-benefit analyses into precautionary decision making.(2) In this issue of Transfusion, a number of papers on Nucleic Acid Amplification Testing (NAT) for infectious agents, illustrate some of the very different drivers that have influenced the formulation of blood safety policy: perception, science, ethics, international politics and economics. A review of the data and issues raised in these papers presents the opportunity to discuss recent evolution of blood safety decision making, and thus attempt to answer, or better yet influence, the question posed in the title of this editorial.