Blood Typing in Disputed Paternity Cases

Capabilities of American Laboratories

H. F. POLESKY AND H. D. K R A U S E

From the Minneapo1i.s War Memorial Blood Bank. Minneapolis. Minnesoia and the Universiiy of Illinois ai Urbana-Champaign, Champaign. Iliinois

This paper summarizes a survey of the blood typing ca- pabilities of representative American laboratories as they are: I ) currently applied to disputed paternity cases and 2) these laboratories potential for utilizing additional tests in disputed paternity cases.

EVALUATION of the current state of the art of testing used in cases of disputed paternity was prompted by a series of recent develop- ments which together make the ascertain- ment of paternity more feasible than it had been under the outdated procedures now be- ing replaced. These developments include: I ) a series of cases decided by the United States Supreme Court which establish that the child born out of wedlock is entitled to legal equality with the ,legitimate child in most substantive areas. On the authority of these cases, numerous state and federal statutes discriminating against illegitimate children have been declared unconstitutional, and the bulk of the remaining legislation on this sub- ject is under severe constitutional doubt. 2) a new procedural framework for the paternity action, facilitating the utilization of medical evidence regarding paternity, has been created by the Uniform Parentage Act.4 That Act was adopted by the National Conference of Commissioners on Uniform State Laws in 1973 and was approved by the American Bar Association in 1974. It has been enacted by several states and others are expected to follow. 3) formation of a joint committee of t he American Medical Association and the American Bar Associa-

Received for publication August 9, 1976; accepted September 6, 1976.

tion to provide detailed, reliable and up-to- date guidelines for the proper production of medical evidence in the laboratory and its proper utilization in the courts in cases of disputed paternity. This report’ was ap- proved in 1976 by both groups and will supersede the report of 1957.6 The im- portance of many additional genetic systems including HLA:’, serum proteins and red blood cell enzymes’ is recognized in these guidelines. 4) committee hearings which led to enactment by Congress in 1975 of P.L. 93- 647, as amended. This legislation has injected Federal funds and interest into this area. Under the Act, each state is required to develop an appropriate plan for the (large scale) ascertainment of paternity (and child support enforcement) within the framework of the A.F.D.C. program. Section 303.5(c) of Regulations promulgated by H.E.W. under the new law provides as follows: “The IV-D agency shall identify laboratories within the State which perform legally and medically acceptable tests, including blood tests, which tend to identify the father or exclude the alleged father from paternity. A list of such laboratories shall be available to appropriate courts and law enforcement officials, and to the public upon request.”

Because of these four developments, the ascertainment of paternity is becoming fi- nancially more meaningful than it had been when the child born out of wedlock had only narrowly circumscribed rights against his father. The opportunity and reward thus created a r e expected to gene ra t e - a considerable increase in demand for blood

52 1 Transfusion Scp1.-Oct. 1977

Volume 17 Number 5

522 POLESKY A N D KRAUSE Transfusion Sept.-Oct. 1977

Table 1. Characteristics of Surveyed Population

Classification Number Number Number Doing

Surveyed Responded (%) Paternity Testing

AABB Reference Laboratories Workshop participants Blood groupers

Totals

31 30 (96.8) 138 53 (38.41

8 7 (87.5) 177 90 (50.8)

19 40

6 65

typing tests in disputed paternity cases. This raises the question whether existing American laboratories have the capability and capacity to satisfy this new demand.

Materials and Methods

A questionnaire was sent to 31 laboratories designated as Reference Laboratories by the American Association of Blood Banks (AABB), to 138 participants attending a series of workshops on paternity testing offered at the biannual na- tional meetings of the American Society of Clinical Pathologists (ASCP) and a group of eight laboratories known to the authors as centers doing or consulting on paternity testing problems. Respondents were asked to provide data on the extent of routine testing done at the time of the survey (late 1974). Inquiry was made concerning the volume of testing between January I and December 31, 1973, current charges, who did the testing and how individuals tested were identified. Each laboratory's potential for providing addi- tional tests beyond those now applied in paternity matters was ascertained by questions on current availability of specific additional tests (now ap- plied to other uses).

The responses were tabulated and compared by the type of institution (hospital, community blood bank, private laboratory), location (metropolitan vs. nonmetropolitan, the latter covering locations

with a population of less than 250,000), and annual volume of activity (high: more than 5,000 units of blood, intermediate: 1,000 to 5,00Ounits, low: less than 1,000 units).

Results

Responses were obtained from 90 (5 I per cent) of the 177 laboratories surveyed. All but one of the AABB Reference Laboratories responded. Sixty-five (72 per cent) of those responding (see Table 1) routinely did paternity testing. During 1973, these laboratories had tested 2, I75 groups of three or more individuals in cases of disputed parentage. More than half (52 per cent) of the laboratories had done less than ten studies and only 1 1 (19%) reported doing more than 50 studies during the year (see Table 2).

All respondents included ABO, Rh [Rho (D), rh'(C), rh"(E), hr'(c) and hr"(e)] and M in their routine testing. Table 3 shows that a wide variety of other blood group antigens, serum proteins and erythrocyte enzymes were used by one or more laboratories. Specifically, a t the time of the survey, 16 per cent of AABB Reference Labora- tories were doing some erythrocyte enzyme test- ing compared to only 2 per cent of the rest of the sample. Similarly, 16 per cent of the AABB Reference Laboratories had capacity for HLA typing compared to only 2 per cent of the other respondents.

Table 2. Volume of Paternity Testing Reported by Respondentsfor 1973

Number of Laboratories Grouped by Work Load Type of Laboratory < 10' 10-20 21-50 50-1 00 > 100

~

AABB Other

Metropolitan Nonmetropolitan

8 22

15 15

Community blood bank 2 Hospital 21 Other'. 7

3 2 2 4 4 3

5 6 5 2 0 0

2 0 1 4 2 2 1 4 2

*Based on groups of three or more individuals. * *Private laboratories and nonhospital government facilities.

Volume 17 Number5 PATERNITY TESTING 523

Table 3. Comparison of Tests Available and those Routinely Used in Paternity Testing (PT)

AABB Reference Labs All Other Labs Number of Labs

Available Routine in Available Routine in Test System (30) PT(19) (60) PT (46)

AI CW N S

K k Kpa Kpb Fy a FY

S

Jk a

Jk Lu a P x g a Le a Le b Se Gm Km

Gc AcP PG M Hb H LA

HP

100'

100 96.7

96.7 93.3

96.7 79.3 79.3

86.7 96.7 73.3 83.3 76.6 73.3 83.3 76.6 86.7 20.0

6.6 34.0 16.6 13.3 16.6 26.6 16.6

100

100

84.2 36.8

63.2 57.9 57.9 36.8 21.1 21.1 47.4 31.6 36.8 15.8 15.8 21.1

5.3 15.8 15.8 5.3

21.1 5.3

15.8 15.8 15.8 15.8 21.1 0

100

96.7 51.7 90.0 76.7 68.3 78.3 60.0 26.7 24.9 63.3 53.3 51.7 38.3 39.8 20.0 15.0 51.7 48.3 28.3

6.6 0 20.0

5.0 1.7 0

16.6 1.7

78.3 15.2 97.8 63.0 52.2 58.9 37.0

4.3 2.2

37.0 21.7 23.2 13.0 10.9 6.5 2.2 6.5 4.3 2.2 0 0 3.3 0 0 0 1.7 0

Percentage of respondants.

The extent of testing by A A B B Reference Laboratories was significantly greater than that done by others. More testing was also routine in laboratories classified as metropolitan compared to those in nonmetropolitan areas. Moreover, in- stitutions located in metropolitan areas and those handling larger numbers of units of blood (more than 5,00O/year) were shown to have a greater testing potential, i .e. , the capacity to do inforrna- tive tests not now routinely used in cases of disputed parentage than was possessed by labora-

Table 4. Charges in 1973 for Testing a Group of Three Individuals

Charges ($1

Type of Laboratory Range Mean

AABB reference Laboratories 10-1 50 45

Others 16-82 39 Community blood

banks 25-50 34 Hospitals 16-1 50 42 Others 10-82 44

tories in nonmetropolitan areas or those engaged in less blood banking activity.

The mean charge for testing three individuals was $42. Charges ranged from $10 to $150 (see Table 4) and did not correlate with the extent or volume of testing or the location or type of institu- tion.

In most of the laboratories surveyed (and in all of the A A B B Reference Laboratories), samples submitted for determination of parentage were tested in duplicate. Only 10 per cent responded that tests were done singly. A few laboratories tested in triplicate. Twenty-two per cent of respondents reported that repeat samples were drawn if an exclusion was found.

Test ing usually was done by a medical technologist (92.3 per cent of respondents) al- though in some cases samples also were tested by a physician (26.2 per cent). Physicians do the procedure in only 5 per cent of the A A B B Reference Laboratories and in 20 per cent of the nonmetropolitan laboratories, as compared to about 30 per cent in all other categories.

While most laboratories prefer to draw blood themselves from the persons to be tested, 60 per

5 24 R. B. DAWSON Trasfusion Srpt.-Ocl. 1977

cent of the AABB Reference Laboratories stated that they accepted mailed samples in contrast to only I I per cent of the low (or unknown) volume group and only 23 per cent of the nonmetropolitan laboratories. Of the total sample, 43 per cent stated that mailed specimens would be accepted.

Individuals appearing for paternity tests were identified as follows: Children by a heel or hand print; 42 per cent of the total sample obtained fingerprints, 39 per cent photographed the indi- viduals and 35 per cent relied on drivers licenses for identification. Another method (used by ap- proximately 10 per cent of the respondents) is mutual identification by the involved persons. No single method was used by a majority of the respondents.

Because of increasing interest, especially in Europe, in using statistical calculations to de- termine the “probability” of paternity of alleged fathers in cases which produce no exclusion, it was asked how many laboratories routinely perform these calculations (paternity index = PI).’ Forty per cent of the laboratories surveyed stated their capability of making such calculations, but only 12 per cent do them routinely. The AABB Reference Laboratories reported that they calculate PI only on request.

Conclusion

This survey of paternity testing practices in the USA for the year 1973 indicates that a diverse group of laboratories, many with a relatively small volume of cases, are providing paternity testing services of greatly varying sophistication and de- tail. This contrasts with the practice in Europe, especially in Scandinavia, where rather extensive testing is done in few centralized institutions many of which specialize in forensic medicine:’ As a group, the AABB Reference Laboratories (which are so designated because of their expertise in handling transfusion problems), do substantially more paternity testing than any of the other labo- ratories surveyed. This group of laboratories also

reported the greatest capacity for adding further genetic systems to their routine tes t ing of paternity samples.

Acknowledgments

Funds for clerical work, postage, computer work by the University of Illinois Survey Research Laboratory and research assistance were provided principally by the Department or Health, Education and Welfare, Office of Child Development, OCD-CB-452.

References I . Dykes, D. D., and H. F. Polesky: The usefulness of

serum protein and erythrocyte enzyme polyrnor- phisms in paternity testing. Am. J. Clin. Pathol. 65:982, 1976.

Hummel, K., P. Ihm, V. Schmidt and G. Wallisser: Biostatistical Opinion of Parentage, Based Upon the Results of Blood Group Tests. Stuttgart, Gustav Fischer Verlag. Vol. I , 1972, Vol. 2, 1972.

Jeannet, M., A. Hassig, and J . Bernhiem: Useof the HL-A antigen system in disputed paternity cases. Vox Sang. 23:197, 1972.

Krause, H. D.: The uniform parentage act. Family Law Quarterly 9:1, 1975.

Lee, Chang L.: Current status of paternity testing. Family t a w Quarterly 9:615, 1975.

Medicolegal applications of blood-grouping tests, Committee of Medicolegal Problems. J A M A 164:2036, 1957.

Miale, J. B., J . P. Abbott, W. D. Dolan, W. A. H. Rettberg, E. R. Jennings, K. W. Sell, and H. D. Krause: Present status of serologic testing in problems of disputed parentage. Family Law Quarterly: 10:247, 1976.

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H. F. Polesky, Minneapolis War Memorial Blood Bank, 2304 Park Avenue South, Minneapolis, Minne- sota 55404.

H. D. Krause, University of Illinois at Urbana-Cham- paign, College of Law, 209 Law Building, Champaign, Illinois 6 1820.