DOS Cable on Blood/Genetic Testing for Immigrant Visas
DOS Advises on Blood/Genetic Testing for Immigrant Visa and Acquisition of Citizenship Cases
Ref: A) 85 A-45; B) 9 FAM 42.41 PN 4; C) 7 FAM 1131.5-4(B); D) 9 FAM 42.66 PN2; E) 94 STATE 14685 PARA 3C
1. Department has received an increasing number of inquires regarding the use of blood/genetic testing to determine the validity or relationships for immigrant visa and acquisition of citizenship cases. While blood/genetic testing can be an extremely valuable tool in cases in which it otherwise would be impossible to verify a relationship, posts should remember that testing should never become a routine part of the adjudication process. This message outlines the circumstances under which posts may request that applicants submit to testing, provides a general description of testing methods, and provides guidance on the procedures for conducting the tests. It also provides the most recent list of accredited parentage testing laboratories compiled by the American Association of Blood Banks (AABB).
What is Parentage Blood Testing?
2. Parentage tests involve laboratory procedures performed on blood samples or other genetic material obtained from the child and putative parent or parents. The statistical analysis of the blood test results provides a likelihood of parentage if the putative parent is not excluded. The likelihood of parentage increases with increasing information, such as increasing the number of genetic systems tested. Likewise, it is diminished with the absence of information. In cases in which one of the principals is unavailable for testing, it is also possible to test siblings and other relatives in an effort to establish the origin of the genetic markers.
3. Blood consists of red and white blood cells, platelets, and liquid plasma. Each component of the blood contains several antigens, or markers. The blood group antigens are structures on the surface of the cells which help to distinguish individuals within a population. The antigens, inherited from parents, are controlled by genes on a pair of chromosomes. Each parent contributes half of each chromosome pair carrying the genes that determine the detectable properties of the offspring's blood. The presence of a specific antigen indicates a particular genetic composition or marker. Conclusions in parentage blood testing are based upon the principle that the child inherits genetic markers in his or her blood from each of his or her biological parents.
Conventional Tests
4. There are four basic tests. The laboratory begins by conducting the first test. If parentage cannot be ruled out based upon the results of that test, if then conducts the second test. The process continues with only as many of the tests as are required to either absolutely rule out a putative relationship, or to provide a good statistical probability that the relationship is bona fide. In all cases, the laboratory should provide the statistical probability of accuracy of the results it obtains. The joint ANA-ABA guidelines provide the following interpretation of the ratio for likelihood of parentage:
| Plausibility of Parentage (Percent) | Interpretation |
| 99.80 - 99.90 | Practically Proved |
| 99.1 - 99.75 | Extremely Likely |
| 95 - 99 | Very Likely |
| 90 - 95 | Likely |
| 80- 90 | Undecided |
| Less than 80 | Not Useful |
Test 1: Basic Red Cell Antigens - ABO, MN, CDE
6. The groups of blood factors which have been known for the longest time are composed of Bio-Chemicals which are bound to red blood cells. These factors are referred to as red cell antigens because they produce antibodies when they are introduced into blood that does not contain the same factors. These factors are called ABO, MN and CDE. A test may be made for each set of these factors.
7. The ABO test is performed on the subject's red blood cells and serum. This test breaks the blood group down into the broadest terms, classifying all subjects as belonging to either types A, B, AB, or O. ABO testing is not conclusive evidence of paternity in that it can only exclude twenty percent of those tested. However, if the test does determine that a relationship cannot possibly exist because of a difference in subjects blood types, no further testing is necessary.
8. The MN test further excludes the parentage of subjects tested. MNS are located on the surface of the red blood cells. These markers are associated with other groups in specific patterns. This test is based on two pairs of co- dominant allelic genes (MNS) and three phenotypes (M, N, and MN). It involves four chromosomes and further confirms the credibility of gene related elements of blood compatibility. The MN test will exclude 31 percent of those tested.
9. RH testing breaks down the components further, the test is somewhat complicated. In addition to showing a factor of RH positive or RH negative, it can now decipher characterization of 40 phenotypes or markers. This test will exclude 25 percent of those tested.
10. The cumulative exclusion rate of ABO, MN and CDE tests is approximately 59 percent. Thus, in approximately 41 percent of cases, it will be necessary to proceed with another stage of testing, either to rule out or establish the relationship.
Test 2: Extended Red Cell Antigens
11. These group systems test specific red cell antigens through the use of antisera which define specific markers on the red blood cells. The procedure is quite simple to perform and relatively inexpensive. The handling of the specimen poses no special problem, because the process involves no living tissue. If a person is excluded by red cell antigen testing, no further tests are required. The exclusion rate of red cell antigen test is approximately 77 percent.
Test 3: White Cell Antigens (Human Leukocyte Antigen or HLA, Test)
12. HLA tests the histocompatibility system of white blood cells and can only be performed by a laboratory capable of doing tissue typing for transplants. HLA testing involves the exposure of living human leukocytes to antibodies specific to the various antigens. Antibodies that cause cell death are specific to antigens present in the individual leucocyte sample. Because HLA testing involves a very wide range of possibilities, and because the leukocytes must be handled while they are still living, the procedure is significantly more expensive than red blood cell testing. In addition, blood samples that are to be used for HLA testing must be handled much more expediently than other samples; labs generally require HLA samples to arrive at the lab no more than 24 hours after they are drawn from the donor. Nevertheless, HLA testing is an exceptionally valuable resource for paternity establishment; it is especially useful when not all parties are available for testing. When red blood cell test fail to produce conclusive results, HLA testing may settle the controversy. Cumulative probability of exclusion is 90 percent.
Test 4: Red Cell Enzymes and Serum Proteins
13. A relatively new test is the serum protein and red cell enzymes test. Numerous types of proteins either are bound to the surface of red blood cells or suspended in the nonparticulate component of the blood known as serum. Scientists have identified many variations of each of these proteins; the variations manifest themselves as observable differences of shape and electrical charge. Electrophoresis is a laboratory process that identifies protein variations. Because electrophoretic testing does not require living tissue, procedures for handling samples are quite flexible. When electrophoresis is combined with red blood cell testing, the probability of excluding a person can exceed 95 percent. When electrophoresis is combined with red cell antigen and HLA testing, the exclusion rate is 99.98 percent.
DNA Testing
14. DNA (Deoxyribonucleic Acid) parentage testing provides an alternative to more conventional parentage blood testing methods. DNA testing can be especially useful in countries with limited medical and transportation facilities because unlike HLA testing it does not require the use of live blood cells. Some posts may be limited to DNA testing due to the difficulty in shipping live blood samples to a laboratory quickly enough for accurate analysis. DNA parentage testing can often provide conclusive results even with not all parties available for testing.
Further, as more laboratories in the United States are accredited for DNA parentage testing (there are currently 23 laboratories in the United States included in the AABB's list of accredited parentage testing laboratories to perform DNA test) the cost decreases.
DNA Testing Employing Buccal Swabs as a Specimen Collection Technique
15. Although use of blood samples is preferable, Buccal (Cheek or Mouth Cavity) Swabs are alternative specimen collection technique sometimes used in DNA testing. Cells are collected from the inside cheek using a long cotton swab. A number of the laboratories on the AABB list of accredited parentage testing facilities have indicated that, while they can do DNA testing using buccal swabs, they would usually use this method only as a last resort where blood is not available (ie, in forensic cases). A person must be specially trained to collect tissue sample using buccal swabs or the result may be a quantity not sufficient for testing. Specimen must be packed and shipped correctly since poor quality control could also affect test results. Testing on blood samples allows laboratories greater flexibility in performing the hierarchy of tests that may be required. Although buccal swabs are sometimes viewed as an ideal method for testing infants, blood samples usually may be safely taken from infants of all ages. Phlebotomist with little experience in drawing blood from babies may be reluctant to do so, however.
16. As in all blood testing cases, the panel physician should consult with the laboratory chosen by the applicant from the accredited list to determine the appropriate collection method (see paras 5 and 21). The laboratory will forward the test kit and detailed instructions for drawing samples and identifying donors directly to the panel physician.
17. Because buccal swabs are a less intrusive specimen collection method, the likelihood of a "stand in" being used is increased. The presence of the consular officer at the time samples are obtained is strongly urged in cases where buccal swabs are used in lieu of blood samples. Samples obtained by buccal swab must be collected by a trained medical professional. Under no circumstances should consular officers attempt to collect sample themselves. (See paras 21 through 24).
Testing Not Permitted for Consular Adjudication of I-130s
18. Genetic testing is never appropriate in cases in which post has been asked to accept an I-130 petition. As noted in 9 FAM 42.41 N4.2(C), post may accept and approve I-130s only in cases in which the petition is "clearly approvable." Therefore, post must be certain based upon documentary evidence presented by the petitioner, that the relationship is valid. If post cannot make such a determination, the consular officer must forward the petition and all supporting documents to the appropriate INS office outside the United States for adjudication.
Circumstances Which Justify Testing: Immigrant Visa Cases
19. Posts should not routinely rely on genetic testing in immigrant visa cases. In most cases, an immigrant visa application should be able to provide documentary evidence to establish the bona fide of his or her relationship to the petitioner. However, in cases in which conclusive documentary evidence is unavailable or unreliable, posts may have no alternative to suggesting genetic testing. Posts may not under any circumstances require that either the petitioner or beneficiary submit to testing. However, in cases in high adjudication without testing is impossible, the consular officer should inform the applicant that he/she is ineligible for a visa under section 221(G) of the INA. The officer should further inform the applicant that blood/genetic testing may/may establish the validity of the relationship. The applicant should be offered the option of testing, and informed that a) testing is absolutely voluntary, b) the costs of testing and related expenses (such as doctor's fees and the cost of transmitting testing materials and blood samples) must be borne exclusively by the petitioner/beneficiary and must be paid in advance, and c) that submitting to testing in no way guarantees the subsequent issuance of an immigrant visa. If post suggests genetic testing in very high profile cases, especially those likely to result in congressional inquiries, ConOff is requested to so advise the Department.
Circumstances Which Justify Testing: Acquisition of Citizenship Cases
20. Parentage blood testing and the more sophisticated DNA testing are useful tools in developing acquisition of nationality cases. However, due to the expense, complexity and logistical problems inherent in parentage testing, the Department favors very limited use of the tests. All other evidence should be examined before testing is recommended. CA/OCS/CCS will forward to all posts a copy of its one page information flyer on parentage blood testing for use in explaining to parents the circumstances in which testing might be necessary to establish a relationship. In the matter of the chain of custody of the specimens, identification of the parties to be tested and preparation of test results, strict adherence to the AABB standards should be required. Evidence from parentage blood testing should be protected from allegations of tampering by an adequate chain of custody. If post suggests genetic testing in very high profile cases, especially those likely to result in congressional inquiries, ConOffs is requested to so advise the Department.
Testing Procedures
21. The laboratory to conduct the testing will supply post with sterile tubes, packing material and explicit instructions on how the blood is to be drawn. Instruction usually requires the participation of a witness, the identification be taken from all adult parties involved (usually photo identification copied front an back), that polaroid photographs be taken of all parties whose blood is to be drawn, and in some cases that fingerprints or footprints be taken. Instructions will also be given as to how to label the collection tubes and the manner in which blood should be packed and shipped. Under no circumstances may the diplomatic pouch be used to transport blood or other genetic tissue materials for genetic testing.
22. Post should avoid any appearance of favoring one laboratory over another. The petitioner/beneficiary should be provided with the AABB's list of accredited parentage testing laboratories. Once they have identified a laboratory from the list, they should contact the laboratory directly for information on the cost of testing and the procedures for depositing fees. The laboratory should send the testing kit and instructions directly to the panel physician. Once it is received, the panel physician may contact the parties to schedule and appointment for drawing the blood. Department of State medical officers and facilities may not be sued for drawing the blood.
Identification of Persons Being Tested
23. Consular Officers are reminded of their responsibility to take every safeguard to verify that the individuals whose blood is drawn are, in fact, the petitioner and beneficiary. The Consular Officer shall take appropriate steps to preclude the substitution of persons at medical examinations or other fraud. The panel physician should be advised of the need for careful comparison of the identities of all donors with the photograph attached to the alien's passport or with other documents of identity to prevent potential fraud. Posts should take precautions to guard against fraud and misrepresentation by panel physicians including, if necessary, being present at the time that blood is drawn and taking physical custody of blood samples for transition to the testing facility.
24. This telegram grants posts discretion to determine whether or not the presence of a Consular Officer is advisable when blood is drawn. Consular Officers, of course, may choose to be present at the time the blood is drawn in posts that are particularly vulnerable to fraud to ensure that "stand ins" are not used.
Communicating the Results of the Test
25. In all phases of testing, communication must be directly between the laboratory or panel physician and the Consular Officer. Under no circumstances should any other party, including those being tested, be permitted to carry or transport blood samples or test results. The laboratory or panel physician should ensure that all test results are delivered to the Consular Officer in a manner which precludes tampering. Since the applicant or sponsor is bearing full financial responsibility for testing, Department has no objection to that person receiving a copy of the results from the laboratory or panel physician.
Laboratory Facilities Approved for testing
26. The Department maintains a current list of accredited parentage testing laboratories compiled by the American Association of Blood Banks. Accreditation standards were developed by the committee on parentage testing of the AABB under a grant from the Federal Office of Child Support Enforcement of the Department of Health and Human Services and with the assistance of special consultants and representatives from the American Bar Association, American Medical Association, American Society of Clinical Pathologists, American Society for Histocompatibility and Immunogenetics and the College of American Pathologists. Laboratories are accredited for a three year period. The current AABB list does not include any laboratories located overseas. See paragraph 28 regarding the use of parentage blood testing or DNA facilities abroad.
27. See para 29 for a list of American Association of Blood Banks accredited parentage testing laboratories. All of these laboratories can perform parentage tests as described in paragraphs 4 through 13 of this message. Those laboratories which can perform DNA testing are so noted. The Department of State does not assume responsibility for the professional calibre or practice of these agencies.
28. The Department is aware that parentage blood testing facilities and DNA testing facilities exist in foreign countries and they may meet the basic standards for laboratories of the AABB or comparable professional standards in their own country. The Department therefore delegates further authority to posts to use posts' discretion in accepting parentage blood testing or DNA testing conducted abroad. Posts should be reasonably satisfied that strictures regarding testing procedures, comparable to those set forth in paragraphs 21, 22, 23 and 25 above have been net and that the testing facility is appropriately accredited in accordance with applicable laws of the foreign country. If post desire, Department can provide posts in countries where facilities for testing exist with a copy of the AABB standards.
29. AABB accredited laboratories in the United States:
Arizona:
Blood Systems, Inc.
G220 East Oak Street
Scottsdale, AZ 85757
602/946-4201
California:
CA Medical Center/HLA Laboratory
101 City Drive South
Route 145
Orange, Ca 92668
213/634-5889
Long Beach Genetics
Parentage Testing Center
2384 East Pacific Place
Ranco Domingue, CA 90220
213/632-8900
Irwin Memorial Blood Centers
Scientific Services/HLA Laboratory
270 Masonic Avenue
San Francisco, CA 94118
415/567-6400
Colorado:
Analytical Genetic Testing Center, Inc.
7808 Cherry Creek South Drive, Suite 201
Denver, CO 80231
303/ 750-2023
Also does DNA testing
Connecticut:
Hartford Hospital
Istocompatiblity Laboratory
80 Seymour Street
Hartford, CT 86115
203/ 574-2810
Lifecodes Corporation
550 West Avenue
Stanford, CT 90902
203/328-9584
Only does DNA testing
Florida
Central Florida Blood Bank, Inc.
Paternity Testing
32 West Gore Street
Orlando, Fl 32806
407/849-6100
Georgia:
American Red Cross Blood Services
Parentage Testing
1925 Monroe Drive NE
Atlanta, GA 30324
Hawaii:
St. Francis Medical Center
Parentage Testing
2230 Lululha Street
Honolulu, HI 96817
808/547=6536
Indiana:
American Red Cross, Ft. Wayne Region
Parentage Testing
1212 E. California Road
Ft. Wayne, IN 46825
219/480-8266
Kansas:
Cross Clinical Laboratories
3433 Rainbow Blvd., Suite 100
Kansas City, KS 66103
913/677-3838
Kentucky:
University of Kentucky Medical Center
Blood Bank HA 678
800 Rose Street
Lexington, KY 40536-0084
606/233-5403
Louisiana:
Southern Baptist Hospital
Division of Transfusion Medicine
2200 Napoleon Avenue
New Orleans, LA 70115
504/897-5946
Gentest Laboratories, Inc.
3330 North Causeway Blvd.
Suite 318
Metairie, LA 70007
504/830-4760
Only does DNA testing
Massachusetts:
CBR Laboratories, Inc.
Parentage Testing
800 Huntington Ave.
Boston, MA 02115
615/731-6470
University of Massachusetts Medical Center
Parentage Testing Blood Services
55 Lake Ave., North
Worchester, MA 01655
508/856-2428
Brigham and Women's Hospital
Parentage Testing Laboratory
75 Francis Street
Boston, Ma 02115
617/732-4401
Maryland:
National Center of Forensic Science
Parentage Testing
1901 Sulphur Spring Rd.
Baltimore, MD 21227
Also does DNA testing
Celimark Diagnostics
20271 Goldenrod Lane
Suite 120
Germantown, MD 20876
301/428-4980
Only does DNA testing
Baltimore RN Typing Laboratory Inc.
400 West Franklin Street
Baltimore, MD 21201
301/225-9595
Also does DNA testing
Maine:
Maine Medical Center Research Institute
125 John Roberts Road, Suite 8
South Portland, ME 04106
202/761-9090
Michigan:
E.W. Sparrow Hospital
Paternity Laboratory
1215 E. Michigan Ave.
Lansing, MI 48989-7980
517/483-2515
Also does DNA testing
William Beaumont Hospital
Clinical Pathology
3601 W. 13 Mile Road
Royal Oak, MI 48073-6769
313/551-9011
National Legal Laboratories, Inc.
Parentage Testing
2748 E. Mont Hope, Suite 103
Okemos, MI 48864
517/349-3890
Also does DNA testing
Minnesota:
Memorial Blood Center of Minneapolis
Parentage Laboratory
2304 Park Ave. South
Minneapolis, MN 55404
612/871-3300
Also does DNA testing
Mississippi:
Medical Genetics Consultants
Legal Genetics
910 Desold Street
Ocean Springs, MS 39564
601/872-3680
Only does DNA testing
North Carolina:
Genetic Design, INc.
7017 Albert Pick Road
Greensboro, NC 27409
800/247-9540
Also does DNA testing
Roche BioMedical Laboratories, Inc.
Department of Paternity Evaluation
1447 York Court
P.O. Box 2230
Burlington, NC 27215
800/334-5161
Also does DNA testing
Duke University
Transfusion Services
Two University Place
Durham, NC 27707
919/684-3084
New Jersey:
Clinical Testing and Research, Inc.
20 Wilsey Square
Ridgewood, NJ 07450
201/652-2088
New Mexico:
Presbyterian Hospital Blood Bank
Histocompatibility Dept.
1100 Central SE
Albuquerque, NM 87102
505/841-1323
Also does DNA testing
New York:
Suny Health Science Center at Syracuse
Parentage Testing Laboratory
750 E. Adams Street
Syracuse, NY 13120
315/464-4775
Ohio:
Good Samaritan Hospital
Molecular Diagnostics Center
375 Dixmyth Ave
Cincinnati, OH 45220
513/872-3737
Only does DNA testing
Community Blood Center
Paternity Testing Laboratory
349 South Main Street
Dayton, OH 45402-2715
513-461-3450
National Paternity Laboratories, Inc.
5689 Springboro Pike
Dayton, OH 45449
513/294-0973
Oklahoma:
Children's Medical Center
5300 East Skeely Drive
Tulsa, OK 74135
918/628-6363
Also does DNA testing
Chapman Institute of Medical Genetics
Children Medical Center
5300 E. Skelly Drive
Tulsa, OK 74135
918/628-6363
Sylvan N. Goldman Center
Oklahoma Blood Institute Parentage Testing
1001 N. Lincoln Blvd.
Oklahoma City, OK 73104
405/239-7659
Also does DNA testing
Oregon:
A.R.C. Blood Services
Pacific Northwest Region
3131 North Vancouver Ave
P.O. Box 3200
Portland, OR 97229
503/284-0011
Pennsylvania:
American Red Cross
Penn Jersey Region
23rd and Chestnut Streets
Philadelphia, PA 19103
215299-4825
Only does DNA testing
Harrisburg Hospital Blood Bank
Parentage Testing Laboratory
South Front Street
Harrisburg, PA 17101
717/782-5721
Rhode Island:
Rhode Island Blood Center
Parentage Testing Laboratory
405 Promenade Street
Providence, RI 02908
401/863-8363
Tennessee:
University of Tennessee Medical Center at Knoxville
Parentage Testing Laboratory
D-108, 1974 Alcoa Highway
Knoxville, TN 37920-6999
615/544-9083
Texas:
J.K. Susie and L. Wadley Research Institute
B.B. Parentage Testing Laboratory
9000 Harry Hines Blvd.
Dallas, TX 75235
214/351-8531
Genescreen
7600 Stemmons Fwy
Suite 133
Dallas, TX 75207
214/631-6152
Only does DNA testing
Medical Center Hospital Blood Bank
Parentage Testing Laboratory
4502 Medical Drive
San Antonio, TX 78229
512/694-2800
South Texas Regional Blood Bank
318 McCullough Ave.
P.O. Box 15613
San Antonio, TX 78215
512/223-6667
The Methodist Hospital
Histo/Clinical Immunology Laboratory
6565 Fannin MS F501
Houston, TX 77030
713/790-3127
Also does DNA testing
Virginia:
Fairfax Identity Laboratory
Genetics and IVF Institute
3075 Hamaker Court, Suite 203
Fairfax, VA 22031
703/698-3919
Only does DNA testing
Washington:
Genelix Corporation
2203 Airport Way South
Suite 350
Seattle, WA 98134
206/382-9591
Only does DNA testing
Wisconsin:
Blood Center of S.E. Wisconsin, Inc.
Parentage Testing Laboratory
1701 W. Wisconsin Avenue
Milwaukee, WI 53213
414/937-6198
Also does DNA testing
American Red Cross Badger Region
4860 Seboygan Ave.
Madison, Wi 63705-0905
608/233-9300