GPH: screening for others' benefit

hi all,

i thought of another example--but even more extreme than the rhesus screening--on when screening is done for others' benefit. blood product screening is an example of this, and i am not sure that the donor is always fully informed of the procedure or potential consequences.

when i was in chad for 6months in 2008 with MSF, we were able to start giving transfusions to kids with hemolytic malaria. it was a small miracle that we could do so in the middle of the desert, and i remember rapid testing donor blood by candlelight for HIV, HepC, syphilis and malaria before transfusions.

the controversy in my mind is this:

- if we found malaria, we would treat both donor and recipient. that's fine.

- if we found syphilis, we would treat the donor and obviously not give the blood

- if we found hep C, we would throw out the blood as well, and counsel the donor (although there is not a whole lot you can do for Hep C, this is certainly true in parts of Africa. i wondered whether we made these people feel sick for not very much benefit)

- most controversially in my mind, we were told to tell HIV+ donors that their blood was "not possible to give" without specifying why. the reasons given for this were - the extreme stigma involved - lack of facilities able to treat the disease in that country - possible false positives of the rapid screening. i kept protesting that surely the risk of further transmissions, and the fact that we initiated the process meant that we should fund further testing and treatment, back in europe if necessary, but those guidelines remained. thankfully, no donors tested positive during my 6 months.

this may surprise a lot of you for a respected organisation such as MSF, but i doubt they are the only ones to bend if not shatter the rules of informed consent when trying to save lives in emergencies.

Re: screening for others' benefit

by Obianuju Ezidinma Zoe GB-Dumaka - Wednesday, 14 November 2012, 9:04 PM

This is really interesting. Thanks for the insight on this David. I think its quite a difficult issue when it comes to screening for other people's benefit, especially in emergency situations like the one you've described.

In my opinion and from what I gather screening actually is, it requires that for the condition one is being screened, there is a line of treatment availabe or at least advice in place as to how to deal with it. How then does this apply if one is blind to the fact that they are being screened in the first place, and the person doing the screening does not have the resources to deal with a positive outcome? As in the case of these donors you speak of... Were they aware they were being screened for the 3 conditions you mentioned? Or were they just under the impression they were giving blood and thats it? If they knew the ins and outs, I wonder how many woud actually choose to donate (possibly why the MSF didnt fully inform them? I dont know) and even if so, whether they would want to know the outcome anyway?

In a low income country where facilities and resources for treatment are lacking, as controversial as it may be, I think it is counter intuitive to screen if there's nothing that can be done about a positive outcome. Stress levels, anxiety, and the possibility of social exclusion may be too high a price to pay for such people, especially with the slight chance of false positives and negatives with any screening procedure. In an emergency situation where screening must be done to ensure the safety of another, maybe something like an opt in, opt out type system could operate, in terms of getting results.