In The Days

• Source: The Globe and Mail
• Author: Andre Picard
• News Date: 4/24/08

Giving blood is not a right.

Days of Lot

“(For all these abominations have the men of the land done, which were before you, and the land is defiled;) That the land spue not you out also, when ye defile it, as it spued out the nations that were before you. For whosoever shall commit any of these abominations, even the souls that commit them shall be cut off from among their people.”
—Levitcus 18:27-29

Pestilences

“For nation shall rise against nation, and kingdom against kingdom: and there shall be famines, and pestilences, and earthquakes, in divers places.”
—Matthew 24:7

The overriding responsibility of blood collection and distribution agencies is not to ensure all Canadians are allowed to join in this altruistic act, but to ensure the safety of blood and blood products for recipients.

To do so, agencies such as Canadian Blood Services and H̩ma-Qu̩bec must not focus on concerns about rights. Instead they must discriminate Рin the true sense of the word.

Héma-Québec and CBS can and must exclude individuals (and sometimes entire groups) from donating to protect the integrity of the blood supply.

At the same time, these agencies must strive to ensure there is an adequate supply of blood, which saves the lives of thousands upon thousands of people each year.

This is not an easy balancing act, particularly in a country such as Canada, where the tainted blood tragedy has left us acutely sensitive to safety concerns.

There are, and always will be, restrictions on blood donors. Currently in Canada, you can’t donate blood if you are under the age of 17 or over the age of 71, if you weigh less than 110 pounds (50 kilograms), if you have a cold or the flu, or if you’ve had a tattoo or piercing in the past six months.

There are also “indefinite deferrals” – or lifetime bans, if you prefer – on members of certain groups. These include diabetics who use insulin and people who have lived in African countries such as Cameroon, Congo and Nigeria, where rates of HIV-AIDS are exceedingly high.

Because of fears of variant Creutzfeldt-Jakob disease (the human version of mad cow), CBS excludes from blood donation anyone who has spent three months or more in Britain or France between 1980 and 1996. (Héma-Québec puts the British time limit at one month.)

Anyone who has used intravenous drugs or who has taken money for sex cannot give blood. Also facing a lifetime ban from blood donation is any man who has had sex with another man, even once, since 1977.

Some donor exclusions are justifiable and necessary. Some are perhaps justifiable but are neither necessary nor useful. Regardless of what exclusions are in place, there is the additional safeguard of testing. Blood is tested for HIV-AIDS, hepatitis C, hepatitis B and syphilis, and these tests are quite sensitive. Is there still, then, a sound basis of scientific evidence for some of these deferrals?

When there is sufficient evidence, it’s not enough to simply state the rules; you need to explain them to the public.

And rules should be continually updated.

We owe it to ourselves to question these policies. For example, the ban on donations by visitors to Britain and France seems arbitrary and unjustified. It gives the illusion of doing something but, in effect, all it does is remove a huge pool of donors without any appreciable safety benefit.

The same appears true of the lifetime ban on men who have had sex with men.

That approach was entirely appropriate when it was introduced in 1983. At the time, the vast majority of those infected with HIV-AIDS were gay men with multiple partners and tests were quite crude.

Today, the policy seems horribly outdated, based on current science. (Again, rights are not the issue. The sole criterion is the balancing of risk and benefits.)

It makes little sense to defer a heterosexual man who has had unprotected sex with a female prostitute from blood donation for a single year, but to impose a lifetime ban on a homosexual man who has been celibate for many years.

Mark Wainberg and Norbert Gilmore of the McGill University AIDS Centre in Montreal (and two of the world’s leading researchers in the field) have been lobbying to have the policy changed, and their arguments are convincing.

They note that the “prohibition against all gay men from being blood donors forever fulfills no useful scientific purpose” and results in a tremendous loss of potential donors.

A recent study estimated that lifting the lifetime ban would result in 136,000 more donations annually without compromising safety. The same study calculated that there was a theoretical risk of one more contaminated unit of blood every 18 years, a risk that was classified as “infinitesimally low.”

To its credit, the CBS is not standing pat. It has commissioned a risk assessment, a survey of donors and at least three academic studies of donations.

Most research looking at the risk of blood donations by gay men have focused on the high-risk population, those with multiple partners. But few studies have been done on those – the majority – in long-term, stable relationships. There is no reason to believe their risk profile differs from most heterosexuals.

Continuing study cannot be an excuse for inaction in the face of overwhelming evidence, as it was during the tainted blood scandal.

Australia has recently changed its rules. It now refuses blood donations from gay men who have had “man-to-man sex” in the past 12 months. Italy, for its part, asks donors if they have had a new sexual partner or unprotected sex during the past year.

In our blood system, safety must be paramount. But as the science evolves, so too must the rules.

Giving blood is the gift of life. It is a gift by civic-minded people who operate largely on an honour system. We must discriminate for the purposes of safety, but we must not thwart these heartfelt, life-saving donations for no good reason.