Transfusion Safety in the 21st Century: How Tightly Should the Blood Community Close the Window(s)?

HIV was present in 1.1% of transfused blood during the early 1980s in some communities [1]. Perceived shortcomings in the response of the blood community, regulators, and public health authorities led to an exceptionally precautionary approach to transfusion-transmitted infections [2]. In return for unprecedented protection of transfusion recipients, blood donors have since been subjected to behavioral interrogation and testing, which uses 9 assays for 6 transfusion-transmissible infections, with great success. Behavioral deferrals (blood donor deferrals for high-risk behaviors) are surrogates, usually developed in the absence of acceptable laboratory tests, and they are blunt instruments. Still, for HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV), donor recruitment and interviewing reduce the prevalence of infection in donations from first time blood donors by ~80% [3], compared with the US population. Behavioral deferrals are retained after test deployment as a layer of