During the late 1950s, it became clear that posttransfusion hepatitis was contributing significantly to morbidity in all forms of treatment, requiring transfusion with many separate units of blood. This was and is particularly dramatic in cardiovascular surgery, when the hepatitis, with its incubation period of 30 to 70 days, becomes apparent long after the risky operation and immediate postoperative period.
Attack rates of hepatitis after cardiovascular surgery ranged from 2% to as high as 20%, with at least one in 15 of these cases of hepatitis affecting future health. It also became clear that blood for transfusion from commercial suppliers was responsible for a higher incidence of hepatitis than blood from suppliers dependent on volunteer donors. At this point, in the early 1960s, it was apparent that elimination of payment for blood, as usually identified with the commercial suppliers, and the presumed expansion of volunteer procurement programs would lower the