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Dr Brian McClelland stated he would provide data on raised ALT levels in blood donors by Autumn 1986. The SNBTS directors agreed to consider funding

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Dr Forrester appeared sceptical about the introduction of surrogate screening which was reflected in his note on SNBTS Directors' meeting where he commented that there was "no justification for panic measures."

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Dr Forrester asked the Communicable Diseases Surveillance Unit in Glasgow for information on the likely incidence of NANBH in Scotland, the proportion of NANBH attributable to blood transfusion or administration of blood, and how far any proposed test could reduce this proportion.

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A journal article reported an association between anti-HBc and NANBH and that a high percentage of NANBH patients develop chronic hepatitis. It concluded that if surrogate screening could prevent approximately one third of transfusion-associated cases of NANBH, this could represent an annual reduction of 50,000 cases of hepatitis and 2,500 cases of cirrhosis in the US.

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The Statistics Expert Group's Report stated that post-transfusion HCV infections could not be properly estimated before reliable tests were adopted in the early 1990s, and so estimates of the number infected, when based on pre-1990 studies, needed to be treated with great caution.

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The Regional Transfusion Directors' meeting agreed that a study on NANB Hepatitis should not be carried out because of lack of time and resources.

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Dr Contreras wrote to the DHSS saying that a study of anti-HBc in British blood donors should be undertaken.

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Mr Justice Burton expressed the view that if a measure would prevent or reduce risk, it should be taken unless the disadvantages outweigh the advantages.

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It was argued during the case that the ALT tests were relatively inexpensive. Mr Underhill QC expressed that cost was not a factor in either ALT testing or anti-HBc testing.

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It was Dr Gunson's belief in the 1980s that the risk of infection was 3% for post-transfusion NANBH

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Mr Justice Burton assessed that the introduction of ALT and anti-HBc testing would have lost 2.5% and 4% of donations respectively but this would have been countered by the moving surplus blood supplies to centres in need. He believed there would not be a major shortage as Dr Gunson had described in 1991.

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Mr Justice Burton concludes that the idea of reducing donor numbers that were unwanted was never discussed by ACTTD or ACVSB and neither ALT or HBc testing overlapped. They should have introduced surrogate testing before 1 March 1988.

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Dr Gunson was a proponent of the minimum risk to maximum safety concept and concurred with both the opinions of Dr Barbara and Dr Contreras

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Dr Dow produced a report that stated the introduction of surrogate screening would have little to no impact on reducing the "already low level of NANBH PTH cases at present reported within the West of Scotland region".

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Dr Forrester reiterated Dr Dow in stating that the cost to benefit ratio of introducing surrogate screening in the West of Scotland means he would recommend against it.

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Dr Cash wrote to Dr Fraser to organise a consensus meeting to discuss NANB surrogate testing methods after Dr Fraser's prospective UK trial was turned down at the NBTS Directors' meeting.

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Dr Cash asked Dr Sandler American Red Cross) to enlighten his team on the current state of surrogate donation testing in the USA

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American Red Cross wrote to Dr Cash in response to his letter to Dr Sandler for an update on surrogate donation testing in the USA. This started after a presentation by Dr Harvey Alter at the 1985 AABB annual meeting. They were also preparing for implementing ALT and anti-HBc testing in blood centers.

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Dr Fraser confirmed to Dr Cash the lack of enthusiasm for a study amongst other regional transfusion directors in England and Wales: only he and Dr Contreras had supported it and the rest of the directors "were not very interested."

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Dr Contreras wrote to Dr Smithies (DHSS) with a proposed study of post transfusion Non-A Non-B hepatitis.

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