June 17, 2022
This article first appeared in AABB News, an AABB member benefit.
John D. Milam, MD, the 1983-84 AABB president, once observed that “Our diversified, dedicated, and energetic members (both institutional and individual) represent our greatest asset and strength.” Early in the decade, it was already quite clear that AABB and its members would need that strength.
The AIDS crisis overshadowed the 1980s, especially for the transfusion medicine community. But the 1980s saw other notable events, such as the eruption of Mount St. Helens, discovery of the wreck of the SS Titanic, protest by prodemocracy crowds in Tiananmen Square, explosion at the Chernobyl nuclear reactor, global population growth, tearing down of the Berlin Wall and the Exxon Valdez oil spill. The first woman in space (Sally Ride), the first mobile phone, the first disposable contact lenses, the first version of Microsoft Windows, the introduction of Post-It Notes and a generation of Baby Boomers entering middle age as “yuppies” — all grabbed headlines, too. However, perhaps nothing came close to the sustained attention brought by the discovery and spread of AIDS.
Deadly New Disease Defies Analysis
The first challenge faced by scientists was in the basic epidemiology. The retrovirus was unlike anything previously identified. The symptoms varied, with some patients manifesting Kaposi sarcoma and others with Pneumocytis pneumonia, lymphoma, toxoplasmosis or any of several other opportunistic infections. High-risk populations were initially difficult to identify (some individuals got infected, but not all; distribution widened to seemingly unrelated populations).
Once confirmed as transmissible by transfusion, the human immunodeficiency virus (HIV) spawned a second wave of challenges:
Like an onion, each challenge that was resolved might reveal yet another layer of questions and concerns. Additionally, each layer involved new terminology and acronyms, including confidential unit exclusion (CUE), intraoperative blood recovery (IBR), personal protective equipment (PPE), men who have sex with men (MSM) — among many others.
A third kind of challenge during the decade was that the AIDS crisis played out in the spotlight. Before that epidemic, issues and concerns related to blood banking and transfusion medicine were debated mostly in medical organizations, relevant government agencies and legislative hearings. However, after AIDS, HIV-related topics also featured prominently in the media (The Today Show, Nightline, 20/20, Money magazine, etc.), and not usually in a positive context. AIDS was discussed everywhere — in social settings, at school and at home. Additionally, this attention was sustained throughout the decade.
As a consequence of continued discoveries and interest related to blood, a fourth challenge presented itself in a kind of “ripple effect.” Both the public and lawmakers were mostly interested in AIDS. However, soon debate and legislation also involved topics such as home transfusion, transplants, “alternative sentencing,” legal age for blood donation, confidentiality, tax exemptions for blood donation, blood as a product versus a service, surrogate testing, denied or reduced insurance coverage and community-wide screening.
Silver Linings
Blood banking and transfusion medicine could hardly remain unchanged by HIV. One result was a close, direct, more effective working relationship among the professional organizations. For example, joint statements became common — in one year, four such documents were released by AABB, the American Red Cross and the Council of Community Blood Centers (later to be called America’s Blood Centers). Likewise, relationships with government agencies and patient groups also improved, with co-sponsored conferences and jointly developed guidance for affected segments of the health care system.
Engagement with the public was another silver lining for AABB. In an escalation of existing efforts, AABB conducted public opinion polls that strengthened the two-way communication between professionals and the public. The survey results enabled AABB to develop public education campaign materials (public service announcements for radio and television, brochures, a 10-minute video) that addressed specific concerns, misunderstandings and consequences for different audiences (donors, patients and physicians).
A third change that affected the AABB — and the professional community as a whole — was the acceleration of response to the emergence of new pathogens. By the end of the 1980s, lessons learned from the HIV epidemic could be applied to other infections just beyond the horizon. The pace of discovery and response had both quickened. In 1984, AABB began publishing a weekly newsletter, Blood Bank Week, to keep its readers up to date on developments that occurred too rapidly for a monthly publication. Similarly, in 1985 the Food and Drug Administration work group on HIV (then, HTLV-III) testing changed from monthly meetings to weekly meetings by conference call.
Then and Now
Perhaps in looking back at the 1980s readers may have a sense of déjà vu. If so, it is likely because many of the issues and relevant topics of those times are still with us. Examples of similarities include the following:
Or, as 1987-88 AABB President Paul J. Schmidt, MD, accurately predicted, “We face tremendous challenges in transfusion medicine, challenges that we expect will not diminish with time.” How right he was.
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