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Gardiner D, McGee A, Simpson C, Ahn C, Goldberg A, Kinsella A, Nagral S, Weiss MJ. Baseline Ethical Principles and a Framework for Evaluation of Policies: Recommendations From an International Consensus Forum. Transplant Direct 2023; 9:e1471. [PMID: 37138553 PMCID: PMC10150897 DOI: 10.1097/txd.0000000000001471] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 11/26/2022] [Accepted: 12/15/2022] [Indexed: 05/05/2023] Open
Abstract
To maintain public trust and integrity in organ and tissue donation and transplantation (OTDT), policymakers, governments, clinical leaders, and decision-makers must ensure that policies proposed to increase donation and transplant activity satisfy baseline ethical principles established by international agreement, declaration, and resolution. This article describes the output of the Baseline Ethical Domain group of an international forum designed to guide stakeholders in considering these aspects of their system. Methods This Forum was initiated by Transplant Québec and co-hosted by the Canadian Donation and Transplantation Program partnered with multiple national and international donation and transplantation organizations. The domain working group members included administrative, clinical, and academic experts in deceased and living donation ethics and 2 Patient, Family, and Donor partners. Identification of internationally accepted baseline ethical principles was done after literature reviews performed by working group members, and a framework for consideration of existing or novel policies was completed over a series of virtual meetings from March to September 2021. Consensus on the framework was achieved by applying the nominal group technique. Recommendations We used the 30 baseline ethical principles described in World Health Organization Guiding Principles, Declaration of Istanbul, and Barcelona Principles to generate an ethical framework-presented graphically as a spiral series of considerations-designed to assist decision makers in incorporating these ethical principles into practice and policy. We did not seek to determine what is ethical but instead described a method of evaluation for policy decisions. Conclusions The proposed framework could be applied to new or existing OTDT policy decisions to facilitate the transformation of widely accepted ethical principles into practical evaluations. The framework includes adaptation for local contexts and could be applied broadly internationally.
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Affiliation(s)
- Dale Gardiner
- Medical Directorate, NHS Blood and Transplant, Nottingham, United Kingdom
| | - Andrew McGee
- Australian Centre for Health Law Research, QUT, Brisbane, Australia
- Faculty of Business and Law, QUT, Brisbane, Australia
| | - Christy Simpson
- Australian Centre for Health Law Research, QUT, Brisbane, Australia
- Department of Bioethics, Dalhousie University, Halifax, Canada
- Canadian Blood Services, Ottawa, Canada
| | - Curie Ahn
- Division of Nephrology, National Medical Center, Seoul, South Korea
| | - Aviva Goldberg
- Department of Pediatric Nephrology, University of Manitoba, Winnipeg, Canada
| | - Austin Kinsella
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Sanjay Nagral
- Department of Surgical Gastroenterology, Jaslok Hospital and Research Centre, Mumbai, India
- Co-chair: Declaration of Istanbul Custodian Group
| | - Matthew J. Weiss
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
- Transplant Québec, Montréal, Québec, Canada
- Division of Critical Care, Department of Pediatrics, Centre Mère-Enfant Soleil du CHU de Québec, Québec, Québec, Canada
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Fisher WA, Kohut T, Woo H, Haw J. Alternatives to blood donor deferral of gay, bisexual, and other men who have sex with men: Acceptability of screening the sexual risk behavior of all blood donors. Transfusion 2023; 63:531-540. [PMID: 36637350 DOI: 10.1111/trf.17241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/01/2022] [Accepted: 12/01/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Blood operators screen donors to reduce the risk of transfusion-transmitted infections (TTIs). Many are evolving screening procedures from those that defer all who have had a sexual interaction with gay, bisexual, or other men who have sex with men (gbMSM) to an approach that assesses individual donors' recent sexual risk behavior with any partner. STUDY DESIGN AND METHODS A representative sample of current blood donors (N = 1194) was recruited online and randomized to complete either the existing (at the time of the study) Canadian Blood Services' donor questionnaire (DQ) that screens out those with recent gbMSM sexual experience, a modified donor questionnaire (MDQ) that assesses individuals' recent sexual behavior with any partner, or an MDQ that assesses individual sexual behavior with any partner and explains why these questions are asked. Respondents were asked for their perceptions concerning difficulty, comfort, and acceptability of these screening questionnaires. RESULTS Across experimental conditions, current donors regarded screening questionnaire difficulty to be low; discomfort in responding was minimal; screening questionnaires were perceived to be relatively inoffensive and justified, and very few donors would cease donating if the screening questionnaire they responded to became the one in general use. Some minor sex differences were observed, and in some cases, perceptions of the MDQ with explanation were somewhat more positive than those of the DQ and MDQ without explanation. DISCUSSION An individual risk behavior screening approach appears to be acceptable to current blood donors as an alternative to screening out all who have recently engaged in gbMSM sexual interactions.
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Affiliation(s)
- William A Fisher
- Department of Psychology and Department of Obstetrics and Gynaecology, Western University, London, Ontario, Canada
| | - Taylor Kohut
- Department of Psychology, Western University, London, Ontario, Canada
- Institut de Recherche en Sciences Psychologiques, Université Catholique de Louvain, Louvain-La-Neuve, Belgium
| | - Hyunjin Woo
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jennie Haw
- Donation Policy and Studies, Canadian Blood Services, Ottawa, Ontario, Canada
- Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada
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Hofkirchner A, Kohut T, O'Brien SF, Fisher WA. Assessing unintentional creation of bias against men who have sex with men as a function of exposure to blood donor screening questionnaire: A national randomized controlled trial. Transfusion 2022; 62:1399-1407. [PMID: 35621117 DOI: 10.1111/trf.16930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Canadian Blood Services (CBS) screens donors based on group status (e.g., men who have sex with men, MSM) instead of specific, high-risk sexual practices (e.g., occurrence of condomless sex). The MSM screening question is embedded in a cluster of questions about stigmatized attributes such as history of imprisonment and illicit substance use. This juxtaposition of the "MSM question" and stigmatized attributes may unintentionally cause blood donors to perceive MSM more negatively. The aim of this research is to determine whether the CBS donor eligibility questionnaire generates negative bias against MSM. STUDY DESIGN AND METHODS A national, randomized online study of 903 CBS donors was conducted. Participants completed either the existing blood donor eligibility questionnaire or a modified donor questionnaire that repositioned the MSM question among neutral questions. After completing the existing or modified questionnaire, bias against MSM was measured using the sexuality implicit association test (IAT) and Modern Homonegativity Scale - Gay Men (MHS-G). Lastly, participants estimated prevalence rates among MSM of certain stigmatized behaviors. RESULTS Participants who completed the existing donor eligibility questionnaire more strongly associated gay men with negative attributes on the IAT (pone-tailed = .045), suggesting question position generated implicit negative bias toward MSM. Responses to the MHS-G (pone-tailed = .506) and prevalence estimation task (p = .443) indicated that question order had no significant impact on explicit bias. DISCUSSION Positioning the MSM screening question among stigmatizing questions creates implicit negative bias against MSM. Policy makers should be mindful of question positioning when designing donor questionnaires.
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Affiliation(s)
| | - Taylor Kohut
- Department of Psychology, Western University, London, Ontario, Canada
| | - Sheila F O'Brien
- Department of Epidemiology & Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada
| | - William A Fisher
- Department of Psychology, Western University, London, Ontario, Canada.,Department of Obstetrics and Gynaecology, Western University, London, Ontario, Canada
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Wilson K, Sher G, Philpott J. Se préparer à la prochaine pandémie en créant la « Société canadienne de l’immunisation ». CMAJ 2021; 193:E1446-E1447. [PMID: 34518353 PMCID: PMC8443278 DOI: 10.1503/cmaj.210670-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- Kumanan Wilson
- Département de médecine (Wilson), Université d'Ottawa; Institut de recherche Bruyère (Wilson); Institut de recherche de l'Hôpital d'Ottawa, Ottawa (Wilson); Société canadienne du sang (Sher), Ottawa, Ont.; Département de médecine familiale (Philpott), Université Queen's, Kingston, Ont.
| | - Graham Sher
- Département de médecine (Wilson), Université d'Ottawa; Institut de recherche Bruyère (Wilson); Institut de recherche de l'Hôpital d'Ottawa, Ottawa (Wilson); Société canadienne du sang (Sher), Ottawa, Ont.; Département de médecine familiale (Philpott), Université Queen's, Kingston, Ont
| | - Jane Philpott
- Département de médecine (Wilson), Université d'Ottawa; Institut de recherche Bruyère (Wilson); Institut de recherche de l'Hôpital d'Ottawa, Ottawa (Wilson); Société canadienne du sang (Sher), Ottawa, Ont.; Département de médecine familiale (Philpott), Université Queen's, Kingston, Ont
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Seifner A, Fox AW. Why Does the Precautionary Principle Suffice for Blood Regulation? Pharmaceut Med 2021; 35:281-286. [PMID: 34491565 PMCID: PMC8421462 DOI: 10.1007/s40290-021-00400-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 10/26/2022]
Abstract
Traditional approaches to blood regulation emphasise the precautionary principle and pursue zero-risk for viral transmission; these traditional approaches have usually followed tragedy, such as the HIV and hepatitis C infections that followed the use of factor VIII concentrates. However, a much more haphazard haemovigilance system operates for general adverse events. Such imprecise assessment of hazards prevents sound benefit-risk assessment, and for blood products this is further confounded by the fact that their efficacy has attracted little systematic study. The ongoing COVID-19 pandemic has now prompted the proposal of a convalescent plasma (CP) blood product. Clearly, mere freedom from infectious agents will not suffice in assessing CP, and an objective measure of efficacy, so as to permit formal benefit-risk analysis, is essential. This is both a scientific and an ethical demand, as has been the case for other experimental COVID-19 treatments. With special reference to COVID-19 CP, the well-recognized adverse events of transfusion-associated lung injury (TRALI) and transfusion-associated circulatory overload (TACO) will be important. Furthermore, not only efficacy but also product quality attributes (e.g., antibody titre) will have to be defined. Both of these are outside the traditional regulatory philosophy for blood products and are needed to truly assess the benefit-risk of this putative therapeutic product.
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Affiliation(s)
- Alexandra Seifner
- Pharmaceutical Medicine Group, Faculty of Life Sciences and Medicine, King's College London, 150 Stamford Street, London, SE1 9NH, England.
| | - Anthony W Fox
- EBD London Ltd., 147 Sulgrave Road, London, W6 7PX, England
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6
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Wilson K, Sher G, Philpott J. Preparing for the next pandemic by creating Canadian Immunization Services. CMAJ 2021; 193:E1092-E1093. [PMID: 34281969 PMCID: PMC8315196 DOI: 10.1503/cmaj.210670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Kumanan Wilson
- Department of Medicine (Wilson), University of Ottawa; Bruyère Research Institute (Wilson); Ottawa Hospital Research Institute (Wilson); Canadian Blood Services (Sher), Ottawa, Ont.; Department of Family Medicine (Philpott), Queen's University, Kingston, Ont.
| | - Graham Sher
- Department of Medicine (Wilson), University of Ottawa; Bruyère Research Institute (Wilson); Ottawa Hospital Research Institute (Wilson); Canadian Blood Services (Sher), Ottawa, Ont.; Department of Family Medicine (Philpott), Queen's University, Kingston, Ont
| | - Jane Philpott
- Department of Medicine (Wilson), University of Ottawa; Bruyère Research Institute (Wilson); Ottawa Hospital Research Institute (Wilson); Canadian Blood Services (Sher), Ottawa, Ont.; Department of Family Medicine (Philpott), Queen's University, Kingston, Ont
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7
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Grace D, Gaspar M, Klassen B, Lessard D, Anand P, Brennan DJ, Lachowsky N, Adam BD, Cox J, Lambert G, Jollimore J, Hart TA. Stepping Stones or Second Class Donors?: a qualitative analysis of gay, bisexual, and queer men's perspectives on plasma donation policy in Canada. BMC Public Health 2021; 21:444. [PMID: 33663450 PMCID: PMC7932904 DOI: 10.1186/s12889-021-10480-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/18/2021] [Indexed: 11/25/2022] Open
Abstract
Background Men who have sex with men (MSM) are not eligible to donate blood or plasma in Canada if they have had sex with another man in the last 3 months. This time-based deferment has reduced since 2013; from an initial lifetime ban, to five-years, one-year, and now three-months. Our previous research revealed that gay, bisexual, queer, and other MSM (GBM) supported making blood donation policies gender-neutral and behaviour-based. In this analysis, we explored the willingness of Canadian GBM to donate plasma, even if they were not eligible to donate blood. Methods We conducted in-depth interviews with 39 HIV-negative GBM in Vancouver (n = 15), Toronto (n = 13), and Montreal (n = 11), recruited from a large respondent-driven sampling study called Engage. Men received some basic information on plasma donation prior to answering questions. Transcripts were coded in NVivo following inductive thematic analysis. Results Many GBM expressed a general willingness to donate plasma if they became eligible; like with whole blood donation, GBM conveyed a strong desire to help others in need. However, this willingness was complicated by the fact that most participants had limited knowledge of plasma donation and were unsure of its medical importance. Participants’ perspectives on a policy that enabled MSM to donate plasma varied, with some viewing this change as a “stepping stone” to a reformed blood donation policy and others regarding it as insufficient and constructing GBM as “second-class” donors. When discussing plasma, many men reflected on the legacy of blood donor policy-related discrimination. Our data reveal a significant plasma policy disjuncture—a gulf between the critical importance of plasma donation from the perspective of Canada’s blood operators and patients and the feelings of many GBM who understood this form of donation as less important. Conclusions Plasma donor policies must be considered in relation to MSM blood donation policies to understand how donor eligibility practices are made meaningful by GBM in the context of historical disenfranchisement. Successful establishment of a MSM plasma donor policy will require extensive education, explicit communication of how this new policy contributes to continued/stepwise reform of blood donor policies, and considerable reconciliation with diverse GBM communities.
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Affiliation(s)
- Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.
| | - Mark Gaspar
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Benjamin Klassen
- Community-Based Research Centre, 1007-808 Nelson Street, Vancouver, BC, V6Z 2H2, Canada
| | - David Lessard
- Centre for Health Outcomes Research, McGill University Health Centre, 5252 de Maisonneuve West, Montréal, QC, H4A 3S5, Canada
| | - Praney Anand
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - David J Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St W, Toronto, ON, M5S 1V4, Canada
| | - Nathan Lachowsky
- Community-Based Research Centre, 1007-808 Nelson Street, Vancouver, BC, V6Z 2H2, Canada.,School of Public Health & Social Policy, Faculty of Human & Social Development, University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC, V8W 2Y2, Canada
| | - Barry D Adam
- Department of Sociology, Anthropology, and Criminology, University of Windsor, 401 Sunset Ave, Windsor, ON, N9B 3P4, Canada
| | - Joseph Cox
- Direction de santé publique de Montréal, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, 1560 Sherbrooke St E, Montreal, QC, H2L 4M1, Canada
| | - Gilles Lambert
- Direction de santé publique de Montréal, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, 1560 Sherbrooke St E, Montreal, QC, H2L 4M1, Canada
| | - Jody Jollimore
- Community-Based Research Centre, 1007-808 Nelson Street, Vancouver, BC, V6Z 2H2, Canada
| | - Trevor A Hart
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.,Department of Psychology, HIV Prevention Lab, Ryerson University, 350 Victoria St, Toronto, ON, M5B 2K3, Canada
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8
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Klein HG. A novel virus transforms blood transfusion: This is the first in a series of periodic commentaries by leaders in transfusion medicine reflecting on transformational events in their careers. Transfusion 2020; 60:2745-2747. [PMID: 33026100 PMCID: PMC7675590 DOI: 10.1111/trf.16113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 09/17/2020] [Indexed: 12/02/2022]
Abstract
See editorial on page 2463–2463, in this issue
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Affiliation(s)
- Harvey G Klein
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
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Klein HG. Canadian blood collectors do the right thing: a view from the outside. Vox Sang 2020; 115:249-251. [DOI: 10.1111/vox.12892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 01/15/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Harvey G. Klein
- Scientist Emeritus National Institutes of Health Bethesda MD USA
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10
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Wilson K, Atkinson KM, Fergusson DA, Brown A, Forster A, Murphy MSQ, Tinmouth AT, Keelan J. Problems with precaution: the transfusion medicine experience. JOURNAL OF RISK RESEARCH 2017; 22:137-149. [PMID: 29348731 PMCID: PMC5770215 DOI: 10.1080/13669877.2017.1351478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 04/20/2017] [Indexed: 06/07/2023]
Abstract
The precautionary principle is a dominant paradigm governing risk-based decision-making. Today, there are increasing pressures to re-examine aggressive precautionary approaches, and to assess how the principle should be applied in the modern system. In this paper, we examined three key applications of precautionary approaches in the field of transfusion medicine to provide insight into the risks and benefits of these approaches. The three case studies examined were the donor deferral policies to safeguard against transfusion transmission of human immunodeficiency virus, variant Creutzfeldt-Jacob disease, and, lastly, xenotropic murine leukemia virus-related virus. Characterization of precautionary applications was conducted using an embedded case study design. Our findings indicate that transfusion transmission mitigation strategies have become increasingly aggressive in the face of theoretical risks. In contrast, the review processes for implementation and reversal of precautionary policies have been slow, and historical donor deferral policies are still in place today. Application of precautionary approaches has proved challenging with both benefits and pitfalls. In light of emerging threats to the blood system, policy-makers should consider the implementation of frameworks to guide the appropriate application of precaution in transfusion medicine in the future.
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Affiliation(s)
- Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Departments of Medicine, and Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | - Katherine M. Atkinson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Dean A. Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Departments of Medicine, Surgery, & of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | - Adalsteinn Brown
- Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
| | - Alan Forster
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Malia S. Q. Murphy
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Alan T. Tinmouth
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Jennifer Keelan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Denburg A. Institutional Knots: A Comparative Analysis of Cord Blood Policy in Canada and the United States. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2016; 41:73-99. [PMID: 26567379 DOI: 10.1215/03616878-3445619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Umbilical cord blood is a rich source of blood stem cells, which are of critical clinical importance in the treatment of a variety of malignant and genetic conditions requiring stem cell transplantation. Many countries have established national public cord blood banks; such banks often coexist with a panoply of private options for cord blood banking. Until recently, Canada was the only G8 country without a national cord blood bank. This differs markedly from the United States, which years ago established a national cord blood bank policy and inventory. This article investigates potential reasons for this discrepancy through a comparative analysis of the evolution of programs and policies on national cord blood banking in Canada and the United States. My analysis suggests that cross-national discrepancies in policy on public cord blood banking were determined primarily by institutional factors, principal among them formal governmental structure and the legacy of past policies. Institutional entrepreneurialism in the health sector played a constitutive role in the earlier evolution of national cord blood policy in the United States as compared to Canada.
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Goldman M, Lapierre D, Lemay L, Devine D, Sher G. Donor criteria for men who have sex with men: a Canadian perspective. Transfusion 2014; 54:1887-92. [PMID: 25041149 DOI: 10.1111/trf.12592] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 01/06/2014] [Accepted: 01/12/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Mindy Goldman
- Medical Services and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
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13
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Newbold KB, Heddle NM, Lane SJ, Arnold E, Eyles J, Webert K. Risks, benefits and the role of stakeholders in pathogen reduction technology. HEALTH RISK & SOCIETY 2014. [DOI: 10.1080/13698575.2014.943159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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14
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Wilson K, Atkinson K, Keelan J. Three decades of MSM donor deferral policies. What have we learned? Int J Infect Dis 2013; 18:1-3. [PMID: 24211477 DOI: 10.1016/j.ijid.2013.09.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 09/17/2013] [Accepted: 09/20/2013] [Indexed: 11/16/2022] Open
Abstract
In the early 1980s, donor deferrals targeting men who have sex with men (MSM) and other high-risk groups were implemented in response to the outbreak of HIV/AIDS. It has now been three decades since the implementation of these deferrals. We review the international experience with developing these policies, which involves combining scientific evidence with ethical and moral concerns and the challenge of moving from precautionary to risk management policies as scientific knowledge and technology evolves. We provide key lessons that can guide blood policymakers as they confront potential new threats to the safety of the blood system and also provide lessons to the wider public health community on how best to incorporate precaution into the policymaking process.
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Affiliation(s)
- Kumanan Wilson
- Departments of Medicine and of Epidemiology and Community Medicine, University of Ottawa, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Administrative Services Building, Room 1009, Box 684, Ottawa, ON, K1Y 4E9, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Katherine Atkinson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jennifer Keelan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Eyles J, Heddle N, Webert K, Arnold E, McCurdy B. Do expert assessments converge? An exploratory case study of evaluating and managing a blood supply risk. BMC Public Health 2011; 11:666. [PMID: 21864330 PMCID: PMC3223866 DOI: 10.1186/1471-2458-11-666] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Accepted: 08/24/2011] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Examining professional assessments of a blood product recall/withdrawal and its implications for risk and public health, the paper introduces ideas about perceptions of minimal risk and its management. It also describes the context of publicly funded blood transfusion in Canada and the withdrawal event that is the basis of this study. METHODS Interviews with 45 experts from administration, medicine, blood supply, laboratory services and risk assessment took place using a multi-level sampling framework in the aftermath of the recall. These experts either directly dealt with the withdrawal or were involved in the management of the blood supply at the national level. Data from these interviews were coded in NVivo for analysis and interpretation. Analytically, data were interpreted to derive typifications to relate interview responses to risk management heuristics. RESULTS While all those interviewed agreed on the importance of patient safety, differences in the ways in which the risk was contextualized and explicated were discerned. Risk was seen in terms of patient safety, liability or precaution. These different risk logics are illustrated by selected quotations. CONCLUSIONS Expert assessments did not fully converge and it is possible that these different risk logics and discourses may affect the risk management process more generally, although not necessarily in a negative way. Patient safety is not to be compromised but management of blood risk in publicly funded systems may vary. We suggest ways of managing blood risk using formal and safety case approaches.
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Affiliation(s)
- John Eyles
- School of Geography and Earth Sciences, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada
| | - Nancy Heddle
- Transfusion Medicine Program, McMaster University, 1200 Main St West, Hamilton, Ontario, Canada
| | - Kathryn Webert
- Transfusion Medicine Program, McMaster University, 1200 Main St West, Hamilton, Ontario, Canada
| | - Emmy Arnold
- Transfusion Medicine Program, McMaster University, 1200 Main St West, Hamilton, Ontario, Canada
| | - Bronwen McCurdy
- Transfusion Medicine Program, McMaster University, 1200 Main St West, Hamilton, Ontario, Canada
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16
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Wilson K. A Framework for Applying the Precautionary Principle to Transfusion Safety. Transfus Med Rev 2011; 25:177-83. [DOI: 10.1016/j.tmrv.2011.01.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Ferguson E, Spence A, Townsend E, Prowse C, Palmer J, Fleming P, Van Hilten JA. What type of information is trusted by whom? A multilevel analysis of the stability of the information source-trust association for blood transfusion. Transfusion 2011; 49:1637-48. [PMID: 19392778 DOI: 10.1111/j.1537-2995.2009.02179.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND It has been suggested that transfusion information from scientific sources (vs. popular sources) is seen as more trustworthy and that interventions should consider using scientific styles. Before such suggestions can be implemented, it is necessary to know if this science source-trust link is observed across different sociodemographic groups and psychological characteristics. A large-scale field-based study examining the importance of sociodemographics and psychological characteristics on the source-trust link was conducted. STUDY DESIGN AND METHODS A large field-based experiment (the Euro Blood Substitutes Project) was conducted on four different samples (the general public, blood donors, patients, and health experts) in the UK and The Netherlands (total n = 3935). Questions examined levels of trust about sources of transfusion medicine, various aspects of knowledge, and demographic data. RESULTS People differentiated between scientific and popular sources, with scientific sources perceived as more trustworthy. General trust in transfusion medicine was higher for those who believe that they or scientists were knowledgeable about transfusion medicine or genetic modification (GM). This suggests that people do not differentiate in their subjective knowledge between GM and transfusion medicine. This science trust-source relationship was moderated by a variety of demographic (e.g., younger people were more likely to trust scientific sources) and psychological (e.g., those who rate science as knowledgeable were more trusting of scientific sources) factors. CONCLUSION The trust-source link is not stable and communications should be targeted to the specific population samples for which they will be most effective; scientifically styled information will be particularly effective for communicating information within certain populations.
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Affiliation(s)
- Eamonn Ferguson
- RASPH (Risk, Analysis, Social Processes and Health) Research Group, School of Psychology, University of Nottingham, Nottingham NG7 2RD, UK.
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Isbister JP, Shander A, Spahn DR, Erhard J, Farmer SL, Hofmann A. Adverse blood transfusion outcomes: establishing causation. Transfus Med Rev 2011; 25:89-101. [PMID: 21345639 DOI: 10.1016/j.tmrv.2010.11.001] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The transfusion of allogeneic red blood cells (RBCs) and other blood components is ingrained in modern medical practice. The rationale for administering transfusions is based on key assumptions that efficacy is established and risks are acceptable and minimized. Despite the cliché that, "the blood supply is safer than ever," data about risks and lack of efficacy of RBC transfusions in several clinical settings have steadily accumulated. Frequentist statisticians and clinicians demand evidence from randomized clinical trials (RCTs); however, causation for the recognized serious hazards of allogeneic transfusion has never been established in this manner. On the other hand, the preponderance of evidence implicating RBC transfusions in adverse clinical outcomes related to immunomodulation and the storage lesion comes from observational studies, and a broad and critical analysis to evaluate causation is overdue. It is suggested in several circumstances that this cannot wait for the design, execution, and conduct of rigorous RCTs. We begin by examining the nature and definition of causation with relevant examples from transfusion medicine. Deductive deterministic methods may be applied to most of the well-accepted and understood serious hazards of transfusion, with modified Koch's postulates being fulfilled in most circumstances. On the other hand, when several possible interacting risk factors exist and RBC transfusions are associated with adverse clinical outcomes, establishing causation requires inferential probabilistic methodology. In the latter circumstances, the case for RBC transfusions being causal for adverse clinical outcomes can be strengthened by applying modified Bradford Hill criteria to the plethora of existing observational studies. This being the case, a greater precautionary approach to RBC transfusion is necessary and equipoise that justifying RCTs may become problematic.
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Affiliation(s)
- James P Isbister
- Society for the Advancement of Blood Management, Department of Haematology, University of Sydney, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
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Pruss A, Caspari G, Krüger DH, Blümel J, Nübling CM, Gürtler L, Gerlich WH. Tissue donation and virus safety: more nucleic acid amplification testing is needed. Transpl Infect Dis 2011; 12:375-86. [PMID: 20412535 DOI: 10.1111/j.1399-3062.2010.00505.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In tissue and organ transplantation, it is of great importance to avoid the transmission of blood-borne viruses to the recipient. While serologic testing for anti-human immunodeficiency virus (HIV)-1 and -2, anti-hepatitis C virus (HCV), hepatitis B surface antigen (HBsAg), anti-hepatitis B core antigen (HBc), and Treponema pallidum infection is mandatory, there is until now in most countries no explicit demand for nucleic acid amplification testing (NAT) to detect HIV, hepatitis B virus (HBV), and HCV infection. After a review of reports in the literature on viral transmission events, tissue-specific issues, and manufacturing and inactivation procedures, we evaluated the significance of HIV, HCV, and HBV detection using NAT in donors of various types of tissues and compared our results with the experiences of blood banking organizations. There is a significant risk of HIV, HCV, and HBV transmission by musculoskeletal tissues because of their high blood content and the high donor-recipient ratio. If no effective virus inactivation procedure for musculoskeletal tissue is applied, donors should be screened using NAT for HIV, HCV, and HBV. Serologically screened cardiovascular tissue carries a very low risk of HIV, HCV, or HBV transmission. Nevertheless, because effective virus inactivation is impossible (retention of tissue morphology) and the donor-recipient ratio may be as high as 1:10, we concluded that NAT should be performed for HIV, HCV, and HBV as an additional safety measure. Although cornea allografts carry the lowest risk of transmitting HIV, HCV, and HBV owing to corneal physiology, morphology, and the epidemiology of corneal diseases, NAT for HCV should still be performed. If the NAT screening of a donor for HIV, HCV, and HBV is negative, quarantine storage of the donor tissue seems dispensable. In view of numerous synergistic effects with transfusion medicine, it would be advantageous for tissue banks to cooperate with blood bank laboratories in performing virological tests.
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Affiliation(s)
- A Pruss
- Institute of Transfusion Medicine, Charité- Universitätsmedizin Berlin, Berlin, Germany.
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Borkent-Raven B, Janssen M, van der Poel C, de Wit G, Bonsel G, van Hout B. Cost-effectiveness of additional hepatitis B virus nucleic acid testing of individual donations or minipools of six donations in the Netherlands. Transfusion 2009; 49:311-9. [DOI: 10.1111/j.1537-2995.2008.01968.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Attaran A, MacDonald N, Stanbrook MB, Sibbald B, Flegel K, Kale R, Hébert PC. Listeriosis is the least of it. CMAJ 2008; 179:739-40, 743-4. [PMID: 18796531 DOI: 10.1503/cmaj.081477] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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