Decisions without data: An analysis of decision making concerningthe United States blood supply during the AIDS crisis.

Abstract

The purpose of this dissertation was to describe and analyze decision-making processes that led to the development of three key decisions in blood banking during the AIDS crisis:(UNFORMATTED TABLE OR EQUATION FOLLOWS)$$\vbox{\halign{#\hfil&&\enspace#\hfil\cr(1)\quad 1983&- Institution of Donor Exclusion Criteria\cr&- Not to do Anti-HBc Testing\cr(2)\quad 1986&- Lookback on Donors Identified to be anti-HIV-I Positive\cr&- Not to do Universal Lookback\cr(3)\quad 1987&- Institution of both Anti-HBc and ALT screening as\cr& \ \ surrogate markers for Non A-Non B (NANB) Hepatitis\cr}}$$(TABLE/EQUATION ENDS)The research was conducted by interviewing key decision-makers, combined with an extensive review of scientific journals, news articles, industry newsletters, minutes and notes of key meetings. The data was analyzed using a model derived from the organizational theory literature which recognized the factors which lead to group think decisions. (1) Pressure from outside the decision-making arena. (2) Heterogeneity of the decision-makers and groups that influence decision-makers $\to$ forced homogenity. (3) Sense of urgency-imperative to act quickly. (4) Moral dilemma encountered when dealing with life threatening disease. (5) Conflicting agendas of organizations involved. (6) Private, political motivations of key players within each organization. Based on this research, the following conclusions have been reached: (a) That the decisions made in 1982 and 1983 were appropriate, given what was known at that time. (b) That decisions made since then have been colored by the criticisms voiced about the 1983 decisions. (c) That some of these subsequent decisions reflect an element of group think. (d) That the model described in this dissertation provides insight into these decisions. In applying these lessons to future decision-making, it is essential to recognize that there is a fine line between consensus development and group think. It is important to step back from the debate and analyze the rationale behind the decisions in question. At the same time, one must recognize that external forces, as well as time pressures, will influence decision-makers. When decisions are reached other than through the scientific process, it is, none-the-less, important to document what the scientific alternative would be and the non-scientific reasons that led to the decision being adopted.