The Anti-D scandal
An All Too Familiar Story?


There is one particularly curious thing about the Blood Transfusion Service Board (BTSB), the organisation at the centre of the Hepatitis C scandal. It is this: the BTSB is a non-profit making organisation. Because it is, there is no easy explanation for the series of events that gave rise, in 1976 and 1977, to the contamination of one of the BTSB's main products, the agent known as "Anti-D".

How "Anti-D" got to be contaminated, why the contamination was not noticed and why when it was, the warnings were discounted, are the key questions that the Government-initiated Inquiry must answer. They are important questions, ones brought into sharp relief by the tragic death in October of Brigid McCole, a woman contaminated by "Anti-D" in 1977.

CONTAMINATION Why and how the BTSB came to be at the centre of this scandal is because of the important and valuable service that it provides. "Anti-D", the substance at the centre of the present scandal, was one of those services.

"Anti-D" was first manufactured by the BTSB in 1968 and has always been regarded as a revolutionary and safe treatment for a particular pregnancy complication that affects a minority of women. Since its introduction it has undoubtedly saved many lives. The problems with this normally safe treatment appear to have begun in late 1976 and early 1977 when the BTSB manufactured "Anti D" from the blood of a donor sAnti-D scandalaundice.

A short time later, after receiving "Anti-D" treatment, six women immediately developed jaundice (though subsequently each woman recovered). The connection between this unusual outbreak and the earlier use of contaminated blood to manufacture the "Anti-D" was not made.

INDISPUTABLE PROOF Fourteen years later, in 1991, following improvements in the testing of blood for Hepatitis C, an English hospital examined the old blood samples of the six women who developed jaundice in 1977 and indicated (to the BTSB) that it suspected that these women had been infected with Hepatitis C probably as a result of the BTSB's "Anti-D" agent. It appears that the BTSB discounted this "opinion" on the basis that it was "not scientific enough", and continued using its own "Anti-D" until 1994 when an investigation by a members of its own staff, uncovered indisputable evidence that its "Anti-D" was contaminated.

So began the long, comprehensive programme of testing that has now identified that there are about 1,000 women in Ireland with Hepatitis C. Of these, some 400 women are positive carriers of the virus, of whom 40, so far, have suffered liver damage. One woman, Brigid McCole, is dead.

The inquiry, forced upon the Government by the death of Mrs McCole, is, in actual fact, the second inquiry to be undertaken into the 'how, where and why' of the Hepatitis C scandal. The previous inquiry, in 1995, overseen by Dr Miriam Hederman O'Brien, "confirmed suspicions that the BTSB had failed to respond to a series of indications of potential contamination of anti-D" (Irish Times, October 9th 1996).

Among other points, this inquiry found "that there were major communication gaps between the board of the BTSB, the medical staff and senior management, and non-medical staff were not fully briefed on medical matters." Though it is not clear, as of yet, it may well be that this 'finding' is the key to understanding the disaster that overtook the BTSB in the late 1970s.

KEPT IN THE DARK
Many of us will be familiar with what is at issue here. Workers are often faced with being ignored, or being kept in the dark, or not being listened to by those who have the power to act at work. Whether it is the supervisor or the boss or the owner, workers are often faced with a situation where we are told: 'You are here to work, and not to think' or 'Just do as you're told and no more'.

It may well be that such a mentality, complemented by management ignorance, lies at the bottom of the Hepatitis C scandal. As things stand no other explanation fits one of the key elements in the "Anti-D" contamination: this is that the BTSB had no financial gain to make out of using 'jaundiced' blood to make 'Anti-D' back in 1976. The amount of money to be saved was simply negligible to such a non-profit organisation.

Anarchists oppose the division of society into 'order-givers' and 'order-takers' on principle. But it is often not appreciated that our opposition is also for good reason. Hierarchy, like that which is found in almost all places of work, is the enemy of openness and discussion. Who isn't familiar with being ignored at work or, even worse, being penalised for speaking your mind?

NEGLIGENT MANAGEMENT
In this society the hierarchy of the workplace is there because we are told it is for the good of business, and because it preserves management in a position of privilege. But in actual practice, hierarchy in the workplace is a dangerous and out-of-date idea. In a medical facility, like that of the BTSB, it is, and was, downright negligent.

The Tribunal Of Inquiry initiated by the Government on foot of Brigid McCole's death should, no matter what, throw some further light on the workings of the BTSB, and the circumstances surrounding the initial contamination in late 1976. By doing so, it might well help many women, whose lives have been affected and badly damaged by the contamination, to move on and survive. This, and adequate compensation, is surely a small but proper price to pay for a problem that should never have arisen, or been compounded by denials and disclaimers over the years.
We will wait and see.
Kevin Doyle


The Story So Far

1976: The BTSB manufactures "Anti-D" agent using blood products that originated from a donor who had jaundice.

1977: A number of weeks later six women develop jaundice (later identified as Hepatitis C) shortly after giving birth, after being treated with this contaminated "Anti-D".

1989: Hepatitis C first identified in the United States.

1990 : Some patients with haemophilia and other blood problems (who have availed of BTSB blood products) also noticed to be suffering from Hepatitis C.

1991 : The BTSB is alerted by an English hospital to the possibility that the six 1977 cases may be linked to its "Anti-D" agent. This alert is discounted.

1993 : Unrelated routine tests of 100,000 blood donors show 30 positive Hepatitis C carriers.

1994 : The records of 15 of these Hepatitis C positive donors is examined: 13 are found to have been given "Anti-D" agent. The connection is established and the BTSB announces that its "Anti- D" was contaminated, and given, unknowingly, to women about to have birth.


What is "anti-D"?

"Anti-D" was considered to be a revolutionary treatment for a condition that affects a small minority of pregnant women who have a rhesus-blood type opposite to their babies. If such a condition is left untreated in the mother, it can lead to severe anaemia and brain damage or death in subsequent babies. "Anti-D" itself is a substance that can be isolated from a group of blood donors who have naturally occurring anti-D antibodies. The BTSB began manufacturing it in 1968 at its laboratories at Pelican House in Dublin.