In Chapter 2 it was explained that, to the recipient, the use of human blood for medical purposes could be more lethal than many drugs. The transfusion and use of whole blood and certain blood products carries with it the risk of transmitting disease, particularly serum hepatitis, malaria, syphilis and brucellosis. Not only are there risks in infected blood and plasma, but there are also risks in the use of contaminated needles and apparatus in the collection and transfusion processes. A brief summary of these risks was provided in Chapter 2.

In the United States, Britain and other modern societies the most dangerous of these hazards in 1970 is serum hepatitis. It is becoming a major public health problem throughout the world. No scientific means have yet been found to detect in the laboratory the causative agent or agents of hepatitis in the blood before it is used for a transfusion or for conversion into various blood products. The quantity of infected blood that can transmit hepatitis may be as little as one-millionth of a millilitre.

Preliminary findings of studies carried out in the United States and Britain, published in 1969, reported the identification of a special factor in the serum of patients with acute viral hepatitis. This factor has been shown to behave as an antigen and has been called ‘Australia antigen’ because it was first found in the serum of an Australian aborigine. The British Medical Journal, discussing these reports in an editorial, concluded: ‘There have been many false trails to the elusive hepatitis virus and to the development of an effective vaccine. This may be another, but meanwhile results of attempts to grow this agent in tissue culture are awaited with great interest and the use of tests for the antigen in screening potential blood donors certainly merits further evaluation.’

The absence of a scientific check on quality and safety means that the subsequent biological condition of those who receive blood constitutes the ultimate test of whether the virus was present in the donation; in effect, therefore, the patient is the laboratory for testing the quality of ‘the gift’.