This week, a new report from the Williams Insitute at the School of Law in the University of California (UCLA) calculates that a staggering 219,000 US pints (or 103,626 litres) of viable blood is not available to blood donation services in the United States. On top of that, approximately 900 organs are also being refused from transplantation because of the sexual orientation of the donors. The American Red Cross and the American Association of Blood Banks have both called on the US Food and Drug Administration to lift the ban as it is now “medically and scientifically unwarranted”. Earlier this year, 18 US Senators called for the ban on blood donation in the US to be abandoned because modern screening methods were able to identify and prevent unhealthy blood from entering blood stocks. In a joint statement, the senators decried the perpetuation of this anachronistic and harmful ban:
Healthy blood donors are turned away every day due to an antiquated policy and our blood supply is not necessarily any safer for it.
The ban on blood and organ donation in the United States reflects similar restrictions which exist in Ireland against blood and organ donation from gay and bisexual men or any man who has ever had sex with another man. This “permanent deferral” was originally introduced globally to stem the rise of HIV/AIDS. Now, after 30 years of progress in medical diagnosis and screening methods for HIV, the objectives of the ban can be achieved through scientific procedure. So, why has the Irish Blood Transfusion Board not revisited the justification for the ban? In Ireland, organ transplantation services quiz the next-of-kin of the donor about specific aspects of the potential donor’s history, e.g. has their loved one recently received a tattoo, ever injected non-prescription drugs, or ever spent time in prison. One such criterion, which can automatically eliminate a potential donor from the donating his organs, is if the potential donor is male and has ever had sex with another man. Similarly, blood donation services in Ireland impose a permanent ban on men who have ever had sex with men; regardless of whether the potential donor uses condoms, whether it was just one occasion, or whether he is in a monogamous relationship. The Irish Blood Donation Service (IBTS) has repeatedly accepted that the lifetime ban against men who have sex with men (MSM) is discriminatory and based on the norms in medical procedures three decades ago when little was known of the origins of HIV/AIDS or how it was contracted. So how have they been justifying a ban–that the IBTS acknowledges to be “blatently discriminatory“–which refuses the donation of healthy blood from a perpetually under-supplied stock of blood? The IBTS’ National Medical Director, Dr. William Murphy, has acknowledged time and again that the lifetime ban against gay men is outmoded and “offensive”, but the IBTS is of the opinion that the ban (which was introduced as an emergency measure worldwide in the 1980s due to the increased incidence of HIV/AIDS among gay men) is neither unwarranted or excessive. Dr. Conor Malone, interim honorary Chair of Gay Doctors Ireland, recently told the Irish Medical News:
The [IBTS is] still recycling information from about five years ago, which to me seems like rather than being based on evidence and science, is based on the old idea that because they have many STDs we just have to leave them out altogether because they are not trustworthy.
The transfusion service in Ireland was rocked by scandal in the 1990s when it was revealed that the safeguarding procedures used in donation screening failed to prevent the infection of recipients of blood transfusions with Hepatitis C and HIV. So, it is not hard to see why the service would be over-cautious now in its screening procedures. The IBTS, like many other transfusion services around the world, assert that since gay men caused the rapid dissemination of an infectious disease in the past, then they could do so again. That particular decades-old point-of-view is entrenched in a time when to be gay was to be a social pariah, forced to socialise in secrecy and when safer sexual practices among gay or bisexual men were unknown and condoms were not as widely available or used. Those who subscribe to this grossly uninformed generalisation are quick to point out that this opinion is based on sexual behaviour, not sexual orientation. However, sexual behaviour alone has not been addressed on a scientifically or medically objective basis in the criteria for eligibility to donate through the IBTS. The vast majority of other potential donors who can be grouped as high risk for the same infectious diseases are not subjected to a lifetime ban outright. For example, a person who gets a tattoo or body piercing is deferred from giving blood for six months, not permanently. Some argue that although all blood is now screened for HIV, Hepatitis B, Hepatitis C, and Syphilis, there is a “window” period of several weeks or months in which a virus may not be detectable after infection. However, many nations including Italy, Spain and New Zealand, have overturned the lifetime ban on men who have sex with men. Instead of donor elimination, they are favouring careful donor selection. The basis for this is: (1) an undetected virus doesn’t care who its host is, it will remain as undetected in a straight person as a gay person; and (2) gay or straight, it is risky sexual practices that give rise to risk of infection and, again, that is regardless of the sexual orientation of the potential donor.
Even today, the IBTS is calling out for donations in anticipation of a surge in demand on the service over the bank holiday weekend, which existing supplies will not be able to meet. To paraphrase the IBTS’ own adage: They need blood. What’s the excuse?