Introduction

In the fight against transfusion-transmitted infections (TTI), transfusion medicine has traditionally focused on assessing risk and deploying preventive measures, and less attention has been paid to other elements of risk management, such as implementing good risk communication practices or establishing a fair and balanced decision-making framework. The tragedy of transfusion-transmitted AIDS, with its aftermath of judicial, political and social effects, shaped the way transfusion medicine has faced the risk of TTI over the past two decades. Times have changed, however, and current challenges are quite different from those of the early 1980s. The risk for major TTI (HIV, HCV and HBV) has decreased to negligible levels, but public concern seems unabated, so the challenge now is finding how to communicate effectively with the public rather than how to further reduce risk. Nevertheless, resources continue to be detracted from areas of the health care system where they are urgently needed, to be allocated to preventive measures that may themselves be riskier than the risks of TTI they intend to prevent. While early risk reduction measures were unanimously accepted by all involved in transfusion safety, recent proposals have been more controversial, and some, such as universal leucoreduction, have produced a deep division among specialists. There is an increasing perception that risk assessment is biased toward product quality focusing on TTI at the expense of process safety, that regulations issued by governmental agencies are excessively self-protective, that some risk reduction measures are driven by the industry, and that a paradoxical reduction of transfusion safety may have resulted from all this (Dzik et al., 2000).