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Is Blood Donation Finally Entering The 21st Century?

Blood donations and transfusions save and improve thousands of lives every year. The donation criterion is expanding hopefully allowing more volunteers to donate blood. Currently, around an estimated 825,000 to 900,000 people donate blood each year.

On 14 December 2020, Matt Hancock announced that there would be changes surrounding the donation of blood by men who identify as bisexual or gay.  Currently, the current rules are that these men have to abstain from oral or anal sex with another man for 3 months before they are allowed to donate.  The new rules mean that men who are in a sexual long-term relationship for longer than 3 months will be able to donate blood. Men who have engaged in sexual intercourse with other men will no longer be asked to declare if they have done so or their sexuality. The hope is that this will make blood donation ‘gender neutral and more inclusive’.

The 3 month wait is to reduce the risk of recently acquired infections which have not been detected on any screening or any further tests. The 3 month wait applies to all donors whose partners may be at a higher risk of blood borne infections. Even though every blood donation is tested, there is a small possibility that very recent infections don’t get picked up but could still be passed on through blood due to the window period between getting an infection and it showing up reliably and accurately on tests. At a population level, men who have sex with other men are at an increased risk of acquiring certain infections through sex.

Blood Donation Rules

There is an expert committee called Advisory Committee on the Safety of Blood, Tissues and Organs, also known as SaBTO. The three month wait was based on the advice by SaBTO and they created an independent report about the 3 month wait in 2017, when it was first introduced. SaBTO advice covers a wide-range of risk factors that could hinder someone from giving blood for a range of time periods. These include lifestyle and sexual activity, travel, illness and medical conditions and getting a tattoo or piercing.  

You can check whether you are eligible to donate blood here: https://my.blood.co.uk/Check/0. This site will ask you about any potential barriers which would prevent someone from donating blood, including dental treatment, piercings, tattoos, pregnancy and travelling abroad.

From personal experience, I know that medical conditions can also be a barrier for donating blood. Personally, I know that I have diabetes, which as mine is controlled by insulin and not diet, is a barrier to me donating blood. I also have Cystic Fibrosis, which is a further barrier to donating blood.

History of the Blood Donation system and the rules

Blood Donation rules have evolved over the years as understandings and evidence in relation to risks improve through medical science and technology.

In 1946, the National Blood Transfusion Service was established and it was made up of regional blood centres. At that time, 200,000 units of blood were collected from 270,000 donors. Currently, 1.6 million units are provided thanks to around 900,000 donors. In 2005, the NHS Blood and Transplant department was formed as the National Blood Service evolved and merged with the UK Transplant department. In 1946, the only test they carried out on donated blood was for syphilis. Screening improved and now covers a wide range of viruses and infections like HIV and the Zika virus.

In the 1970’s and 1980’s there was a scandal, known as the Contaminated Blood Scandal. An estimated 2,800 people, most of whom suffered from haemophilia became infected with Hepatitis C and/or HIV as a result of receiving contaminated blood products. This scandal, as horrible as it was, strengthened the calls for blood to be tested for a range of infections instead of just syphilis.

Before 2011, gay or bisexual men who have sexual intercourse with other men were not able to donate blood. From 2011, a 12 month wait was introduced for them, until November 2017 where a 3 month wait was introduced.

The current guidance for blood donation, including advice on whether you can give blood, is available on the NHS Blood and Transplant website.  The 3 month wait also applies to sex workers and people who have partners who:

  1. HIV or HTLV or Syphilis positive, a carrier of Hepatitis B or C
  2. Partner who has ever received money or drugs for sex
  3. Partner who has ever injected or been injected with drugs          or
  4. A partner who has been sexually active in parts of the world where HIV or AIDS is very common. This includes most countries in Africa.

You can never give blood if the rules above a)-c) apply to yourself and not a partner.

There are time restrictions for donating blood; men can donate every 12 weeks whereas women can only donate every 16 weeks.

Criticism of the Blood Donation System

The current blood donation rules have previously been criticised for being discriminatory. They have improved since they were first introduced, where gay or bisexual men or men who had sex with other men were not allowed to donate blood whatsoever. They have evolved over time.

This is a good step forward, however as highlighted by Nancy Kelley, the Chief Executive of Stonewall, there still needs to be more done to make the system more inclusive for sex workers, African communities and trans communities so they can donate blood. It is worth noting that these groups are at a higher risk of acquiring HIV and other Sexually Transmitted Infections.

When the 3 month wait was introduced Gay Rights groups called for a move to an individualised risk assessment, which takes into account the risk associated with their sexual behaviour regardless of the gender or sex of their partner. This would have reflected a similar model to Italy which changed in 2011.

There were calls as early as 2015 by Tim Farron (remember him?). This was when the 12 month wait was in force. Farro said that those rules were based upon ‘assumptions of fixed, binary sex and gender identities that make no sense’; he continued saying ‘as well as being offensive..not just to those affected…it’s frankly stupid to lock out millions of people who are willing and able to help’.

Conclusion

As a country, we do have a progressive stance on blood donation involving those who can and cannot give blood despite its arguably discriminatory nature, for example in Germany, their ruling is that gay and bisexual men have to abstain from sex for a year before they are able to donate blood. There was previously a complete ban on them donating blood until 2017.

Hopefully it will not be long until the criteria for people to satisfy in order to donate blood is widened further. It is obvious reason why the criteria has to be stringent, but as Tim Farron and Nancy Kelley said, the system is not as inclusive as it can be and those marginalised groups are having to satisfy additional criteria in order to donate. It seems like something could be done when there are people in those groups who would happily donate blood. Same-sex relationships are not uncommon, chronic illnesses and disabilities are not uncommon. We live in a diverse society and that should be reflected in who can donate blood.

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