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Dr Gunson told the Working Party on Transfusion Associated Hepatitis that many of the samples from his previous MRC study had been lost due to a power failure. The Working Party acknowledged that this ruled out the chance of updating the testing of samples from that study with modern diagnostic assays.

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The Working Party on Transfusion Associated Hepatitis noted that no source of funding had been found to date for Dr Brian McClelland's proposed study.

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The Working Party on Transfusion Associated Hepatitis discussed the possibility of seeking funding from the MRC for a joint study involving Edinburgh and the North London Blood Transfusion Centre. Dr John Barbara planned to speak to the Director and submit a draft proposal.

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The Working Party on Transfusion Associated Hepatitis discussed potential requests to Dr James of the Freeman Hospital for access to samples from his prospective study of 248 patients who had undergone cardiac surgery.

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Dr James and his colleagues published the results of a study on post-transfusion hepatitis after cardiac surgery which suggested that NANBH after blood transfusion "from a largely British blood donor group probably leads to clinically significant chronic liver disease very rarely indeed."

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In oral evidence to the Inquiry, Dr Brian McClelland stated that he never saw a follow-up proposal from Dr Barbara in relation to a joint study involving Edinburgh and the North London Blood Transfusion Centre.

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In oral evidence to the Inquiry, Dr Brian McClelland described the transfusion service as "losing sight of" NANBH for several years from 1983 due to preoccupation with HIV/AIDS.

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In oral evidence to the Inquiry, Dr Brian McClelland explained that ALT levels was only a small element of his proposal for a comprehensive study.

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In oral evidence to the Inquiry, Dr Brian McClelland accepted that nothing had really moved on since the beginning of the 1980s in relation to NANBH surrogate screening study.

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In oral evidence to the Inquiry, Dr Brian McClelland explained that the letter "Testing blood donors for Non-A, Non-B Hepatitis: irrational, perhaps, but inescapable" published in the Lancet was written partly out of extreme frustration at the fact that the appropriate epidemiological studies with donors and recipients had repeatedly not been done.

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In oral evidence to the Inquiry, Dr Brian McClelland agreed with the description of "decision paralysis" in relation to the situation with introduction of surrogate screening and undertaking of the respective study from the early 1980s through to the end of 1988.

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Dr Gunson stated in his court evidence that he had failed to secure a study of donor recipients around 1983, he said, "I was trying to generate it [data] and seemed to be blocked at every stage."

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Dr Gunson was asked in his court evidence if all the material showed that the introduction of ALT screening would have a beneficial effect if one looked at the concept of minimal risk for the recipient, if the the material was to that effect? Dr Gunson responded, "yes, it would reduce the risk to the recipient."

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An article published in the Annals of Internal Medicine considered the role of anti-HBc as a surrogate, suggesting that the incidence of NANBH might have been reduced by about one third through anti-HBc screening.

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An article in Transfusion by Wicks et al highlighted the drawbacks of both ALT and anti-HBc screening, and proposed greater medical education and more restrained blood usage to minimise new post-transfusion NANBH cases.

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In a letter to The Lancet, Dr Gillon and colleagues called for a study of acute post-transfusion NANB Hepatitis in the UK and stated that surrogate screening was not justified at the time.

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Lord Penrose noted that the study on NANBH in the West of Scotland neither provided a basis on which the prevalence of post-transfusion NANB Hepatitis could, or should, have been drawn, nor indicated the potential value of ALT surrogate testing, or a basis for assessing that value.

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Dr Dow concluded in his PhD thesis on Non-A, Non-B Hepatitis in West Scotland that transfusion associated NANBH was very rare, an average of 3 reported cases were reported annually.

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Dr Dow stated that he thought surrogate testing would have been likely to reduce the incidence of post-transfusion NANBH in Scotland by 70 percent.

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Dr Alter and Dr Dienstag stated in an article on Non-A, Non-B Hepatitis that "the accumulating data that chronic NANB hepatitis leads to cirrhosis in 10 to 20% of cases has served as compelling evidence for the need to rely on indirect assays as an interim measure until such time as specific NANB hepatitis assays are developed."

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