During the early years of the AIDS epidemic, thousands of Americans became infected with HIV through the nation's blood supply. Because little reliable information existed at the time AIDS first began showing up in hemophiliacs and in others who had received transfusions, experts disagreed about whether blood and blood products could transmit the disease. During this period of great uncertainty, decision-making regarding the blood supply became increasingly difficult and fraught with risk. This volume provides a balanced inquiry into the blood safety controversy, which involves private sexual practices, personal tragedy for the victims of HIV/AIDS, and public confidence in America's blood services system. The book focuses on critical decisions as information about the danger to the blood supply emerged. The committee draws conclusions about what was doneâ€"and recommends what should be done to produce better outcomes in the face of future threats to blood safety. The committee frames its analysis around four critical area: Product treatmentâ€"Could effective methods for inactivating HIV in blood have been introduced sooner? Donor screening and referralâ€"including a review of screening to exlude high-risk individuals. Regulations and recall of contaminated bloodâ€"analyzing decisions by federal agencies and the private sector. Risk communicationâ€"examining whether infections could have been averted by better communication of the risks.

This volume discusses the current state of the nation's blood supply--including studies of blood availability, ways of enhancing blood collection and distribution, frozen red cell technology, logistical concerns in prepositioning frozen blood, extended liquid storage of red cells, and blood substitutes.

Blood Supply of Bone: Scientific Aspects provides a comprehensive description of the development and physiology of blood supply to the skeleton. Investigative techniques for different types of bone in the body are discussed and the effects of disturbed circulation and the vascular control of osteogenesis is described. This highly illustrated and authoritative volume contains much revised material and many new illustrations reflecting 25 years of advances in this research field since the publication of its well-known precursor in 1971. The wealth of information will not only be invaluable to orthopaedic surgeons, rheumatologists, and radiologists but also pathologists, sports medicine specialists and bone metabolism research workers.

Richard Titmuss (1907-1973) was a pioneer in the field of social administration (now social policy). In this reissued classic, listed by the New York Times as one of the 10 most important books of the year when it was first published in 1970, he compares blood donation in the US and UK, contrasting the British system of reliance on voluntary donors to the American one in which the blood supply is in the hands of for-profit enterprises, concluding that a system based on altruism is both safer and more economically efficient. Titmuss’s argument about how altruism binds societies together has proved a powerful tool in the analysis of welfare provision. His analysis is even more topical now in an age of ever changing health care policy and at a time when health and welfare systems are under sustained attack from many quarters.

In both rich and poor nations, public resources for health care are inadequate to meet demand. Policy makers and health care providers must determine how to provide the most effective health care to citizens using the limited resources that are available. This chapter describes current and future challenges in the delivery of health care, and outlines the role that operations research (OR) models can play in helping to solve those problems. The chapter concludes with an overview of this book – its intended audience, the areas covered, and a description of the subsequent chapters. KEY WORDS Health care delivery, Health care planning HEALTH CARE DELIVERY: PROBLEMS AND CHALLENGES 3 1.1 WORLDWIDE HEALTH: THE PAST 50 YEARS Human health has improved significantly in the last 50 years. In 1950, global life expectancy was 46 years [1]. That figure rose to 61 years by 1980 and to 67 years by 1998 [2]. Much of these gains occurred in low- and middle-income countries, and were due in large part to improved nutrition and sanitation, medical innovations, and improvements in public health infrastructure.

Individuals who donate their blood provide a unique and precious gift in an act of human solidarity. In order to donate blood, prospective donors should be in good health and free from any infections that can be transmitted through transfusion. Most blood donors perceive themselves to be healthy, but some are unsuitable to donate blood due to the potential risk of compromising or worsening their own health or the risk of transmission of infections to patients. Blood transfusion services (BTS) have a duty of care towards blood donors as well as to the recipients of transfusion. This duty of care extends to prospective donors who are deferred from donation--whether on a temporary or permanent basis--as well as those who donate blood and are subsequently found to have unusual or abnormal test results. BTS have a responsibility to confirm test results and provide information, counseling and support to enable these individuals to understand and respond to unexpected information about their health or risk status. Counseling is part of the spectrum of care that a BTS should be able to provide to blood donors--including referral to medical practitioners or specialist clinical services. Pre-donation counseling was recognized as one element of the strategy to reduce and, if possible, prevent the donation of blood by individuals who might be at risk for HIV and other TTI including hepatitis B and C viruses as well as to inform the donor of the donation process and testing of blood for HIV. Post-donation counseling was acknowledged to be a necessary element of donor management as an adjunct to informing donors of unusual or abnormal test results. Blood donor counseling by trained specialist staff is now considered to be a key component of the blood system in most countries with a well-developed blood transfusion service. It may be required at a number of stages in the blood donation process or following blood screening and should be available at any point at which the BTS has an interface with donors. In many countries, however, blood donor counseling is not yet available in a structured way. Blood Donor Counselling: Implementation Guidelines has therefore been developed to provide guidance to blood transfusion services that have not yet established donor counseling programs.