There was no reason why a system to trace what happened to blood infected by HIV should not have been introduced by mid-1986, a decade before its eventual implementation in Ireland, an American expert told the Lindsay tribunal yesterday.
Dr James AuBuchon, professor of pathology and medicine at the Dartmouth-Hitchcock Medical Centre, New Hampshire, said the "look-back" system of tracing was standard practice by 1986 in the US.
He said there was no reason why HIV testing should not have been introduced generally by April or May 1985.
HIV antibody testing of blood donations was introduced in the Republic in October 1985.
Although senior medical consultants compiled a list of HIV-positive donors for the Blood Transfusion Service in July 1987, the BTSB did not adopt a so-called "look-back" system until April 1993, and it was not formally initiated until September 1996.
The tribunal has already heard that a former nurse at St Luke's Hospital in Kilkenny, was infected with HIV through a blood transfusion from a "Donor A" in July 1985.
Another donation by "Donor A" in September 1986 tested positive for HIV, but the Kilkenny health worker was not informed.
She discovered for herself that she was HIV-positive in December 1996, ten years later.
Dr James AuBuchon, who agreed he was familiar with the history of the introduction of HIV testing in the USA, worked with the American Red Cross headquarters in the 1980s.
He told the tribunal that HIV testing kits were readily available shortly after the Food and Drug Administration licensed them in March 1985, and by May 1985 virtually all blood banks in the US would have used HIV testing.
About six weeks after its introduction, only tested units of blood were used, he said.
He noted concerns at the time about the reliability of the tests, but added, "the balance clearly swung to employing those tests as soon as possible."
He said a "look-back" system to trace what happened to the blood of donors found to be HIV-positive was introduced in 1986, and in general, most clinics were doing it by mid-1986.
Dr AuBuchon said the practice was to notify the most recent donation prior to the finding of HIV-positive status first, and usually, two donations were identified. Generally, the look-back went no further back than five years, the period for which hospital records had to be kept.
In answer to counsel for the tribunal, Mr Gerard Durcan SC, he said there was no reason why, as of May 1986, look-back should not have been standard practice.
Dr AuBuchon spoke of a "balancing exercise" in the decision to introduce HIV testing to all blood centres in the USA by summer 1985.
He said that while data now suggested that persons infected with HIV become infective themselves after a week, that infection might not show up in tests for four to six months. There was therefore a window period where testing could show a negative result for a HIV-positive individual.
That concern was coupled with what Dr AuBuchon called "the magnet effect", where people were drawn to donate blood, not because they wanted to give blood, but because they wanted to have a HIV test.
"It turned out not to be just a theoretical fear; it was a problem," he said. He cited one study where a quarter of donors who had denied risk factors in questionnaires prior to donating, admitting during counselling for HIV that they had donated primarily to be tested for the disease.
He said the problem had not gone away, nor had US concern about it diminished.
He agreed with counsel that the balance that had to be drawn in the US decision to introduce HIV testing in blood clinics was the risk of the magnet effect and the identification of HIV-positive donors if the test was introduced. The US judgment was "that the testing should be introduced as soon as possible," he concluded. The tribunal continues today.