In terms of the tinkering, one of the issues that's been raised is with regard to moving to a risk assessment of the behaviour. One of the concerns, particularly in organ donation--and let's use liver as an example--is that you're usually getting consent from the family of the deceased.
The understanding is, from the work that was done and from talking to people who do this, that it is very difficult to get good information about risk behaviour in those circumstances. It's often late at night, following a tragic accident, and you're asking family members. Sometimes they're the partner of the person; often they're not the partner of the person. You're asking that person, “Did your loved one who just died have anal sex? Did your loved one who just died use sex toys and share blood during sex?” It's difficult to get the answer you want there. That's why you blow it up to a population level, narrowing the population as much as possible.
An example of the tinkering would be, for instance, on the tattoo guideline. The tattoo guideline asks whether you have gotten a tattoo for which equipment was shared. My view would be that's just as difficult to determine from a family member's point of view as the type of sex a person has. If the person has had a tattoo, that should be listed, and that information should be given to the recipient. That would be the end of the discussion on that one. That is the kind of tinkering that I think needs to be looked at.
There was a comment raised about the prison system. I would actually suggest you all spend some time looking at the health status of the inmates in our prisons and our jails across this country, and you'll learn that it is exceptionally dismal.
I would say the tinkering is not in the limiting amount of time; it's the fact that there's a 12-month exclusion there as opposed to the longer five-year exclusion. That's the kind of tinkering that I think is going to need to be happening.
I've been in presentations by the ministry, and my understanding is they fully view that this will be an ongoing process and it will be modified. One of the reasons they went with the approach of using the standards organization and the regulatory process is that it would allow that to happen much more quickly. Remember, it has taken an 11-year process to get here.
Eleven years ago this was called for as necessary to regulate what was just an ad hoc guideline approach across the country--I probably shouldn't say “ad hoc”--which we recognize doesn't always work. It works for the people with laudable intentions. It doesn't work for the people who are cutting corners on a day-to-day basis.