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According to Karin Jackson's evidence to the Inquiry, it is believed that six files addressing lookback from 2000 to 2006 had been lost in Northern Ireland.

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Witness W2781's wife was infected through a renal transplant from a donor who suffered a serious traffic accident and received blood transfusion contaminated with HIV during attempted resuscitation.

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Manchester Royal Infirmary conducted an HIV lookback exercise after a patient tested HIV positive following a renal transplant. It was discovered that the organ donor was given a unit of blood from a HIV positive donor in resuscitation and his other organs had also been traced and identified to be HIV positive.

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The first attempt at HIV lookback started with an ex-donor identified with AIDS.

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At a meeting to discuss surveillance of AIDS in relation to blood transfusion, a lookback protocol was agreed which was reactive rather than proactive due to the lack of screening (as opposed to diagnostic test) available.

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The follow-up of past donations relying on HTLV-3 testing of donations, rather than notifications of a diagnosis of AIDS in a donor, was first considered.

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A report was prepared by the Working Party of the Regional Transfusion Directors' Committee. It included the first fully articulated policy for lookback post-introduction of HTLV-3 testing.

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The question of informing recipients of HIV-infected blood was being discussed again at a regional transfusion directors' meeting despite lookback having been incorporated in the protocol for the introduction of screening of blood donations in 1985.

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Dr Harold Gunson produced a report on anti-HIV-1 testing of blood in the UK. It was the first formally documented instance of a 'window period' transmission in the UK, where a tested (antibody negative) donation was subsequently shown to have been infectious and to have transmitted infection to recipients.

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Dr Janet Mortimer prepared a reported entitled "NBTS 'LOOK-BACK' October 1985 - December 1989", described by Dr Patricia Hewitt as one of the more complete records of some of the work that the blood services did on lookback.

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A meeting was held between the Department of Health, CDSC, and NBTS. It was confirmed that 90% of all traceable HIV positive donors had been informed of their HIV positivity, and told not to donate again. NBTS was in a position to trace the donors with the donation number from the hospital.

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Dr Kenneth Calman, Chief Medical Officer, wrote to a wide range of clinicians and public health professionals about recipients of infected donations. This direct involvement and direction by the CMO marked a distinction from the earlier approach and, according to Dr Patricia Hewitt, "provided considerably more weight than Dr Gunson trying to convince clinical colleagues by persuasion."

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Dr Patricia Hewitt, consultant haematologist of the North London Transfusion Centre, managed the HIV lookback programme and covered Central and Northwest London, and Bedfordshire, Hertfordshire and parts of Berkshire.

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Regarding Dr Wallington's abandoned study to gather epidemiological data from HIV lookbacks, Dr Patricia Hewitt noted resource difficulties and the lack of directive from the Department of Health or Chief Medical Officer to undertake the study.

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The National Blood Transfusion Service was only able to screen donations from active blood donors. The HIV status of the self-excluded donors remained unknown and the NBTS relied on clinians and/or seropositive individuals to inform the blood service voluntarily for lookback to be done on those donations.

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According to Dr Patricia Hewitt's evidence to the Inquiry, when the main thrust of HIV lookback in England took place, there was no national organisation of the English blood services nor national mechanism for collecting data or ensuring uniformity of practice.

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According to Dr Jack Gillon's evidence to the Inquiry, unlike the HCV lookback which put no time limit on retrospective identification of recipients, the UK HIV lookback was limited to five years prior to the index positive donation.

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Dr Kieran Morris conducted an initial review of documents that had been identified as potentially relevant to the Inquiry. He was not able to find any trace-back notifications for the period 2000-2006 nor records related to the plasma recall by the Scottish National Blood Transfusion Service of batch pools containing plasma from two donors who subsequently developed vCJD. However, upon detailed review, Dr Morris discovered a trace-back file dated 2001 and concluded that nothing was missing.

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According to Dr Vanessa Martlew, the counselling process at the Mersey & North Wales Regional Transfusion Service for donors found to be carrying an infection was to "gently inform, advise and refer" rather than to provide therapeutic support.

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Catherine Nalty

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