Tuesday, May 06, 2014

American Red Cross rejects Israeli blood donors, cites bureaucratic error as reason

Israel listed as country with risk of mad cow disease, Red Cross doctor explains, even though there's only ever been one reported case here.

For the past six months, the American Red Cross has been refusing to accept blood donations from people who have lived in Israel for five years or longer. The reason: a “bureaucratic misunderstanding” that marked Israel as a risk for mad cow disease.
Raz, an Israeli student at Brandeis University in Massachusetts, signed up for a university blood drive last month. According to Raz, who insisted on anonymity, when the nurse on duty realized he was Israeli she rejected his donation, saying that Israel is one of the 54 countries which Red Cross guidelines preclude from donating blood.
The rejection surprised Raz. "People there saw me leaving the station after a minute and I bet they wondered what could be wrong with my blood," he said.
Red Cross guidelines indeed list 54 countries, most of which are European, where there is risk of Creutzfeldt-Jakob Disease (CJD or vCJD), the human form ofbovine spongiform encephalopathy (BSE, but commonly referred to as mad cow disease).
Bureaucratic maze
The incurable neurological disorder came to notoriety during a 1990s breakout, which resulted in the deaths of some 150 people believed to have eaten infected beef. The epidemic stirred mass panic and galvanized the extermination of tens of thousands of cattle, causing heavy damages to agriculture, particularly in Western Europe.
However, the one and only report of BSE in Israel occurred in 2002, when authorities located an infected cow in the Golan Heights. Furthermore, only a year ago Israeli officials announced that the World Organization for Animal Health (OIE) has added Israel to the list of countries in which there is only minor risk of BSE.
Asked why Israel is nevertheless red-flagged for BSE, Dr. Richard Benjamin, Chief Medical Officer at the American Red Cross, explained, “The American Red Cross is governed by the Food and Drug Administration, and the issue of donor deferrals for variant CJD, in particular, is governed by an FDA guidance dated May 2010”.
Yet the referenced document clearly states that only one BSE incident was identified in Israel, and that it “has not been considered by the FDA as cause to recommend donor deferral."
According to Benjamin, the FDA also references a list published by the Animal and Plant Health Inspection Service, a subdepartment of the U.S. Department of Agriculture, listing countries where risk of BSE exists. Benjamin said that Israel was added to that list (titled CFR 94.18(A)) in 2013.
“We were concerned as a number of countries had been added to the list, including Japan and Israel, but we hadn't heard any public notification that the countries involved in vCJD deferral of blood donors had changed”. Following this, “the American Red Cross formally requested clarification from the FDA and was told that we were required to use the new updated list. We therefore changed our requirements and began to defer donors with a history of living in Israel for more than five years since 1980."
It appears, though, that shortly after being put in place, the decision was reversed, due to Israeli intervention.
“We have been informed that the FDA no longer requires us to defer," said Dr. Benjamin, "and could revert to the old list.”
But while the Red Cross is currently working to reverse the deferral, Dr. Benjamin clarified that “this is not a trivial task, as each donor has to be fully investigated individually and the FDA has to agree to each donor we allow to be reentered."
Asked what he believes could be the reason for annulling such an acute decision within a few short months, Benjamin said that while he cannot speak for the FDA, his impression "was that the advice we received was more likely a bureaucratic error than one of intent."
Commenting on the issue, Jennifer Rodriguez, an FDA spokesman, countered some of Dr. Benjamin’s assertions. She maintained that the FDA does not recommend rejection of donors who have spent time in Israel. At the same time, she emphasized, “Blood establishments are able to adopt more stringent donor deferral criteria than recommended by the FDA."
The Department of Agriculture claimed that the list which marked Israel as an "affected country" is obsolete.
Last December, Israeli-Ethiopian MK Pnina Tamano-Shata (Yesh Atid) directed public attention to the sensitive issue of Israeli medical authorities’ rejection of donations by Ethiopian-born Israelis. In front of TV cameras, she attempted to donate blood during a drive at the Knesset, knowing she would be refused.
Asked if the Brandeis incident reminded him of the Ethiopian issue, Raz answered, “I was mostly just surprised. I never thought people will look at me, as an Israeli, the way people look at citizens of Third World countries, thinking, ‘There are diseases there.'"
Elder of Ziyon

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