On Sunday, Feb 9, 2003, at 23:36 Australia/Perth, Pamela Morrison wrote:

> Another interesting thing about the Orloff study is that it appears to
> be
> conclusive about the safety of Holder Pasteurization in inactivating
> HIV.  Logically, this would mean that donors should not really need to
> be
> screened for HIV, since pasteurization renders the virus harmless.
> But of
> course, I'm hearing gasps of horror that babies might receive the milk
> of
> unscreened women!

I'd gasp in horror too - all systems have a failure mode, and given
enough time, something will work (or not work) in an unintended way. We
regularly hear of patient recalls when it is discovered that an
endoscope, for example, hasn't been sterilised correctly. There need to
be multiple barriers to infected milk entering the donor pool, not just
one.

A parallel (not perfect, but it'll do for now): Despite the fact that
all donated blood is tested for HIV and hepatitis, donors are very
carefully screened for risk factors. This is for two reasons: the viral
testing has a level of sensitivity that approaches 100%, but is not
100%. Eventually infected blood (either through test failure or through
being in the "window period") will slip through the net, and the result
could be catastrophic. If all donors are screened carefully first, the
chance of infected blood being infused into a recipient are greatly
decreased.

Same with milk; one major difference being, a lot of donor milk is
being given to a healthy receipient, not someone who without it is at
risk of imminent death or other serious consequences[1]. If all milk
donors are screened both for risk factors and for current infection,
very little infected milk will then enter the pasteurisation process.
When the pasteurisation inevitably eventually fails on an occasion in
the future - wrong temperature, operator error, whatever - there is a
decreased likelihood that a recipient will drink milk containing virus,
resulting in possibly an infected baby and/or a major lawsuit.

We need to be realistic about the limits of technology.

Lara

[1] This is not to say that ABM doesn't carry with it negative health
consequences; but there is the matter of degree. It is recognised that
receiving blood products carries a certain amount of risk; I doubt most
people would accept the same level of risk in receiving donor milk.

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