Phendrana Drifts

I donated blood for the seventh time last week - I really enjoy the act (short, meaningful, helpful, free cookies) and it saves three lives. I recently got into... well not a debate and certainly not an argument but a discussion with a colleague about the Canadian Blood Services (CBS) screening practices, which prohibits any man "who have had sex with another man, even once, since 1977." They go on to say "This is based on current scientific knowledge and statistical information that shows that men who have had sex with other men are at greater risk for HIV/AIDS infection than other people." I, to an extent, defended the screening, as they ask a bunch of other potentially insulting and certainly limiting questions: Have you ever lived in Africa? Have you ever used intravenous recreational drugs? Do you have one of a long list of diseases? Have you ever taken or given money or drugs for sex? Have you had sex with someone new recently? Have you had sex with someone whose sexual history you don't know? All things that if you answer yes to you don't donate.

In my mind the practice of voluntary blood donation has two important components: safety of the blood supply and availability of the blood supply. You can't save people's lives with unsafe blood and you can't save people's lives if you don't have any blood. So, since we don't pay people to donate in Canada we have to make certain the donation process is inviting and easy but we also need to take every possible step to ensure we are limiting the risk of passing on infectious diseases to blood donation recipients. Makes sense, no?

The rub comes when you recognize some questions during the pre-screening process is probably a good thing - questions like "Do you have or have you ever been diagnosed with HIV?" makes sense to me. Even if the tests for HIV are accurate say 99.9% of the time that still leaves 0.01% of the time where the test fails so screening helps ensure the relative safety of the blood supply. Also without getting too much into risk management, I imagine the Canadian Blood Services board has a very expensive insurance policy and that insurance policy is contingent on some pre-screening. If I ran an insurance company, I know I would not insure Canadian Blood Services if they simply allowed all who wanted to donate to donate. However, I also recognize answering 200 questions all geared towards exhaustively identifying any and all risky behaviour (blood-wise) an individual participates in would greatly inhibit donations and alienate donors. So we need to have some questions but not too many - this seems to be the current policy of Canadian Blood Services - so which questions?

It would make sense that you should ask say the 20 or 30 questions that have the most relevance to ensuring safe blood. And if it comes down to it, I am reasonably fine if being a man who has had sex with other men is one of the criteria - if it is true. It also would mean that the criteria would have to be applied without exception to other demographic and charter-protected groups. What if the scientific evidence shows black individuals are far more likely to have HIV than the rest of the population? Do we then prohibit donations on the basis of race?

What shocked me most about this topic is how unwilling Canadian Blood Services is to making the data available on how much safer the Canadian blood supply is since they prohibit gay and bisexual men from donating blood. I've looked and looked and googled and googled (this topic was fairly active in the media about six months ago) and while the news stories are balanced with those who seek to change the policy and spokespeople from Canadian Blood Services and Health Canada, with a sprinkling of doctors, no one seems to be able to say how much safer. In the absence of data, and data that can be compared to other risk factors that are both on and off the eligibility list the policy seems bigoted. And shortsighted - fewer and fewer people are donating and shockingly few from my generation.

Labels: blood

8 Comments:

At 5:48 PM, Beatrice said…

I was looking into cord blood donation several weeks ago and encountered some of the questions that you describe. The same discriminatory and homophobic policy exists as well with the public cord bank here in AB.

In the end, we were screened out of cord blood donating because of the medication, endoscopies, and--most interesting and perhaps ironic--donated blood that Brett was given because of his experience with Dieulafoy's Lesion. I was disappointed for a while that we can't donate our baby's cord blood.
At 3:06 PM, michele said…

I've also been struck by the number of questions that you're asked during a donation.

I've always wished for some kind of bypass card or similar kind of flag on my file that would let me skip all those questions about medical conditions that I didn't have the first time I donated and haven't developed since then! Perhaps they could even just recognize that as a female from birth, I will never answer "yes" to the question about being a man having had sex with another man since 1977.

Maybe just a question that asks if I've developed "any of the following" since my last donation? (especially if my last donation was within the last year?)

Interestingly, from what I recall, the number of screening questions I was asked when I was being considered for a bone marrow donation was shorter than the blood donation questions, even though the act of marrow donation is far rarer and a more dangerous undertaking! (Maybe there are free cookies? I don't know because I was found not to be a close enough match, so didn't donate)
At 12:17 PM, Allie said…

I also was asked very few questions during my matching process for Bone Marrow donation. I don't know exactly why.

However I am torn about the restrictions because I believe that as many people as possible need to donate BUT I don't believe all people should donate because above all else I do believe that the safety of the blood supply needs to be protected, even if it is an excessive protection.

And I say this as someone who lost a family member to HIV that was contracted from a blood transfusion. Most people who get blood transfusions are already fairly sick and immune compromised. A blood transfusion gives one a small amount of hope for recovery and it it very important that that chance be the best possible.

I hope that the Canadian Blood Services continues to monitor the restrictions and change them as science and knowledge continues to improve. I did note that the old restrictions about piercings were reduced in half and I suspect that they continue to want to change these as is possible to allow for more donors.

I feel for people who can not donate (and I have been rejected myself at certain times in my life) but donating blood and other blood products is not a right.
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