Blood Donation and Institutional Trust: Risk, Policy Rhetoric, And the Men Who Have Sex with Men Lifetime Deferral Policy in Canada‪.‬

BY THE LATE 1980s, an estimated 1,100 Canadians had become infected with the human immunodeficiency virus (HIV) through contaminated blood transfusions (Canadian Hemophilia Society 2010). The circumstances that gave rise to the HIV contamination tragedy resulted in the federal government's establishment of the Royal Commission of Inquiry on the Blood System in Canada, led by Justice Horace Krever. Between 1993 and 1997, the Krever Inquiry reviewed all Canadian blood system activities in an effort to determine what had caused HIV contamination. Krever singled out the "ineffective and half-hearted" (Krever 1997:283) risk-reduction strategies of the Canadian Red Cross, the organization managing the blood system at the time of contamination. He found that the Red Cross had not responded to the HIV crisis quickly enough by excluding populations said to pose a contamination risk to the blood supply, such as men who have sex with men (MSM). Indeed, the Red Cross had not implemented the MSM policy until 1989, in response to mounting evidence of greater HIV incidence among the MSM population. The contamination of the Red Cross blood supply and the infection of blood consumers--often referred to as the tainted blood scandal--sparked a public outcry and resulted in a decrease of public trust in the Canadian blood system. Krever issued a series of recommendations for overhauling the collection, processing, and management of blood in a report that was tabled in the House of Commons on November 26, 1997. In particular, he argued that the principle of safety should transcend all other principles and policies, and requested the use of the precautionary principle as a first line of defense against possible threats to the blood supply (Krever 1997:1048). The following year, the federal, provincial, and territorial governments of Canada replaced the Red Cross with two new organizations to oversee the blood system: Canadian Blood Services (CBS) and Hema-Quebec. CBS collects, tests, manufactures, distributes, purchases, and supplies blood products in all provinces except Quebec, where Hema-Quebec performs these duties. (1) Heeding Justice Krever's recommendation, CBS and Hema-Quebec implemented mechanisms of consultation with public stakeholders, such as blood consumers, to restore public accountability and confidence in the Canadian blood system's safety.