Protester Janet Conners in Ottawa accuses the government and Canadian blood supply managers of silence and coverups during the tainted blood scandal of the 1970s and '80s. The woman's husband died from AIDS contracted from a blood transfusion. (Andrew Wallace/Canadian Press)

Blood is probably the most precious liquid on Earth. It nourishes and restores life and is shared widely within communities, countries and around the world.

Bad or tainted blood is a human disaster on a similarly vast scale, as scandals in Canada, France, Australia and Britain have shown. A decade ago, this country finally began to come to terms with the criminal tragedy of blood infected with HIV and hepatitis C, and the thousands upon thousands of innocent Canadians who contracted the diseases through blood transfusions.

In November 1997, a royal commission headed by Justice Horace Krever of the Ontario Court of Appeal roundly vilified governments and blood collection agencies for their roles in that dark episode. Criminal charges were laid and the country belatedly took extensive steps to protect the blood supply.

Independent public agencies were set up to collect and protect blood donations in Quebec and the rest of Canada. Extensive testing was introduced at every stage of the process. Politicians and victims of the scandal squared off across a minefield of compensation and liability issues, and slowly but surely the crucial central issue of ensuring a safe blood supply began.

So where do we stand now? Is Canada's blood supply safe? Is it being adequately protected from existing threats and those that might come along in future? And will we have enough blood to serve an aging population when demographics show that most blood donors are themselves aging, with younger people yet to pick up the demographic slack?

Agency focuses only on blood

CBC News put these and other questions to several key players in the blood supply system. Canadian Blood Services (CBS) is the agency set up to manage supplies outside of Quebec. Dr. Kumanan Wilson is an internist and specialist in public health at the University of Toronto. David Page is executive director of the Canadian Hemophilia Association, which represents the interests of the largest group of regular users of the blood supply system, and the community most adversely affected by the tainted blood scandal. Thousands of Canadian hemophiliacs contracted HIV, hepatitis C or both for more than a decade before the current system was created.

There seems little doubt that blood in Canada is safer and better protected now than it was in the 1970s and '80s. CBS is a completely different agency from the Canadian Red Cross, which used to manage blood supplies and was roundly condemned by the Krever Commission for negligence, coverups and worse.

Unlike the Red Cross, the new blood agency has a single responsibility, managing Canada's blood supply. It collects, tests and distributes blood, and according to a spokeswoman, "is responsible for a national blood supply system which assures access to a safe, secure, cost-effective, affordable and accessible supply of quality blood, blood products and … alternatives."

Page agrees that blood is far safer than it was, "but you can't be 100 per cent sure. That's why you need multiple layers of screening and testing for each individual donation as well as monitoring users for adverse reactions. That's what's being done, and it's working so far."

Controversial restrictions

Just over three per cent of Canadian adults donate blood, but the country is largely self-sufficient in blood products. An exception is plasma, much of which still comes from paid U.S. donors. (Frank Gunn/Canadian Press)

Donating blood in Canada isn't for everyone. To keep blood supplies free of disease, various people are barred from giving blood. Fears of variant Creutzfeldt-Jacobs disease (vCJD) — the human version of mad cow disease — mean that people who've lived in Britain, France or Western Europe at certain times aren't allowed to donate. Controversially, so are men who've had sex with men, even once or protected, since 1977. That same fear of HIV/AIDS contamination drives other bans on people from southern African countries and places with high infection rates. Intravenous drug users and those who've had body piercings or tattoos also face restrictions and prohibitions.

Blood users and supply managers say such measures are necessary to ensure safe blood stocks — a goal that outweighs both the discriminatory nature of bans, and the exclusion of millions of willing donors from a system that is largely self-sufficient but hardly oversupplied.

"Yes, it's discrimination," says Page, "because we are excluding groups of people based on research into their behaviour or profiles, but how ethical would it be to take steps that might result — again — in thousands of deaths? We have to strike a balance."

The chilling knowledge that vCJD can be spread through blood supplies has vindicated the decision to exclude past residents of Britain, according to Wilson. There is no test that can detect the human variant of mad cow disease in blood, he says, so safety is paramount.

"Precautionary measures work," he says, "in ensuring blood safety. We had one of the most unsafe blood supplies; now post-Krever, we're among the safest. It's an enormous success story, but we have to test and be vigilant on every front."

CBS restrictions on blood donations exclude about half of the adult population of Canada, according to most estimates. That seems a lot. But only three per cent of eligible Canadians actually donate blood, so there is substantial room to expand the pools of donors, CBS says, at little or no risk to the system.

Blood for all

Science and technology can also help expand the amount and type of blood available for transfusions and medical needs. One example is research by a CBS scientist on so-called "stealth donations," where the RH negative or positive factor of blood is masked in the laboratory. That widens the pool of donated blood that a patient can receive. An American bio-technology firm has just announced that it's working on a way to render blood type irrelevant, again allowing recipients to be transfused with almost any available units of blood.

Then there's the issue of paid donations, which vexes blood supply managers and medical ethicists the world over. The source of many tainted supply problems in earlier years was blood products from paid donors in the U.S. In many cases, this included prison populations and blood clinics based in poor neighbourhoods where prostitution and drug use were rife.

Canada is still largely dependent on plasma products obtained from paid U.S. donors, but standards are far, far higher than they used to be, according to Page.

"It's a big business, but it's changed since the 1980s," Page told CBC news, "The system is heavily regulated and the integrity of the [blood supply] companies has improved. It's served us very well recently."

Other methods of ensuring and managing blood supply might include making hospitals pay for transfusions that are now covered directly by provincial health budgets, according to Wilson. "We're finding that transfusing blood or blood products as a first response isn't always valid medically," he says, "and imposing a cost for units of blood should conserve supplies for essential needs."

So far, the consensus seems to be that Canada's blood supply is largely safe and adequate. But vigilance and creative ways to keep the blood flowing are increasingly necessary. The country cannot afford the consequences of failure on either front.