Mr. Fletcher, I'm prepared to answer that as the current head of the blood system in all of Canada, except for the province of Quebec.
I think your question is an important one, and I do think, as my colleagues said earlier this morning, this does need to be science-based and evidence-based to the extent that it can. But by their very nature, these exclusionary criteria are broad-based and blanket-approached, and I do think, as Dr. Germain has repeatedly said, it does not address every individual at the time of the criterion, but takes the broad approach to groups of individuals who may pose risk.
I think your points are well said. We are where we are in Canada because of some history of poor screening in a major component of the public health system, namely the blood program. We do have very similar deferral criteria today in the blood program. However, at the same time in that program, you have a slight distinction in that you have a much larger supply of raw materials than you do in the organ situation. Hence the deferral criteria currently in place in the blood system are even more rigid than those contemplated in the cells, tissues, and organs regulations, where first of all you have the current five-year policy, and second, you have the exceptional release component, precisely to balance the risk-benefit equation that a clinician and a transplanter will make at the time they are discussing with the recipient the receipt of an organ.
Those sorts of exceptional release criteria do not exist in the blood program, because we have a much larger supply to draw on and can provide alternate product to a patient in need. However, I think the premise of your question is that if we didn't have these sorts of rigorous, science-based, epidemiologically based and evidence-based approaches to deferral criteria, we could potentially be facing the situation of infected organ recipients as much as we faced transfusion recipients in the past.
My last comment, in closing, is that while I support all the questions and comments raised by committee members, if you're going to bring additional witnesses to bear to this committee, I would suggest you bring transfusion and transplantation recipients as well as bringing some other donors, and particularly groups of excluded individuals or potentially excluded individuals.