Will The FDA Ever Get Over Its Hemo-phobia? Ctd

Andrew Sullivan —  Jan 2 2015 @ 9:19am

A reader writes:

I am surprised how few of my fellow gay men are unwilling to consider the other side of this issue: the rights and interests of the recipients of donated blood.  The most fundamental oath doctors take is to do no harm and, for blood transfusions, that means ensuring that the risk of giving a patient contaminated blood is as low as humanly possible.  So, in altering the policy, we have to weigh our benefit from ending a stigma against the increased risk of transmitting HIV to a patient.  Put another way, how many additional people per year getting HIV is acceptable for us to feel better about ourselves?

Some (very) rough math to demonstrate this point:

About 50% of the country is male and about 5% of them have sex with men.  About 10% of MSM [men who have sex with men] have HIV and, of those, only about half know.  I am going to assume men who know they have HIV won’t donate, but the effects of shifting the stigma from gay men to HIV-positive men might not be that straightforward.  That means, in the absence of a ban, about 0.125% of all donated blood will be contaminated with HIV due to MSM (for simplicity, I assumed all HIV-negative people are equally likely to be donors).

However, as is pointed out, all blood is tested for HIV.  Even if we put in place controls that would increase the chance of catching new infections, no test is perfect.  Most modern HIV tests are weighted more towards false positives than false negatives (for obvious reasons), but still about 3 out of 10,000 tests of HIV-positive individuals will turn out negative.  That means, in the absence of a ban, an additional 0.0000375% of donated blood that reaches patients will be HIV-positive.  Put in other terms, an additional 1 in every 2.5 million blood transfusions would involve transmitting HIV contaminated blood.

That number might seem acceptably small, until you consider that in the US alone, there are about 5 million blood transfusions each year.  That means the absence of a ban could result in an additional two Americans every year being given HIV accidentally simply for going to the hospital.  That seems unacceptably high to me.

Now, most people do not support overturning the ban altogether.  That said, no one I’ve read has articulated what an acceptable increase in the risk would look like and whether their preferred policy meets that threshold. But that is precisely the issue that the FDA is grappling with and all the sanctimony in the world won’t change that.