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Better pink than dead

Canada goes too far in excluding gay men from blood donation

It was fairly predictable that Canadian Blood Services would win their negligence suit against Kyle Freeman, the gay Ontario man who introduced syphilis into the blood supply after lying about his sexual history in a donor screening interview.

Mr Freeman lied, he gambled on the safety of his blood, and he lost. He must now repay the $10,000 that CBS spent tracking down and destroying his blood. Public sympathy is most unlikely to be on his side.

But things might have been very different if a more honest gay man had forthrightly challenged, in the courts, a policy that many consider discriminatory. Several such cases are now in the works, and here, the CBS is on much shakier ground.

The current policy demands that would-be male donors reveal, in a private interview, whether they have had sex with another man at any time since 1977. If the answer is yes, they can’t donate.

Obviously, Canada’s strict donor regulations – which prohibit plenty of other groups from donating – were born of the ghastly tainted blood scandal. Overreaction is natural after such an event. Few doubt that there was heavy pressure from Ottawa to err on the side of caution. That has certainly been the case in organ donation, where many specialists say retrictions imposed by Ottawa are far too tight.

In fact, Canadian Blood Services was set up with a mandate not just to be safe, but to be seen to be safe, to “(re)gain the trust, commitment and confidence of Canadians, particularly patients”. That may necessitate going beyond what the evidence justifies.

But with changing technology, the gap between the current policy and what the evidence justifies is growing every year. Until quite recently, there was a longish latent period during which HIV infection in blood could not be detected prior to seroconversion. But with nucleic acid testing, that window of danger has been reduced to about 12 days.

So why does CBS have a deferral period after sex between men of 33 years (and getting longer all the time)? One year would surely be enough, and indeed, that’s the period in numerous countries, including Japan, Australia, and Sweden. Already Héma-Québec, responsible for collection in that province, has said it wants to move to a 5-year deferral.

Nowadays, every single bag of blood is being rigorously tested before it reaches the patient. Mr Freeman’s syphilis infected no-one; the system worked.

The job of Canadian Blood Services is to keep the blood supply safe and visibly so. It has no mandate to make gay people happy. It isn’t required to treat everyone equally, but is free to differentiate between groups based on legitimate safety concerns. I myself am disqualified from giving blood, because I’ve spent too much time in Britain and am judged at risk of variant Creutzfeldt-Jacob disease.

That said, CBS does clearly want to accommodate the concerns of gay people. In fact, it’s had grant money on offer for years to study whether the rules can be safely relaxed. No qualified researchers have taken up the offer. That puts CBS in a weak position in any dispute with Health Canada, who will always be driven by the overriding political need to avoid new tainted blood scandals.

But, as a CMAJ article pointed out earlier this year, the policy may be costing Canada needed blood. Not only are we losing donations from gay men, there are also numerous blood drive boycotts by organizations who once helped, but who now opt out because they find this rule discriminatory. University blood drives have particularly suffered.

So much has changed since this rule was laid down. It’s time to change the rule. It would be nice if any new dispensation could be based on solid research. Because if scientists don’t step up and address this issue, lawyers may do it for them.
Owen Dyer

4 comments:

said...

This is a great topic. It seems like today we treat everyone as equals, but this shows that things are not quite like that. Kudos to you guys for covering this and bringing light on this important ethical and medical and even legal issue.

sharon [aka purley quirt] said...

The name of the decision game in health care provision is NOT Equality.... it is Equity.

RE: Ethical

EQUALITY creates imbalance as it assumes that the desires of both the donor and recipient are the same.
We have heard from the ? human rights perspectives of the donors.
Now find me a representative sample of recipient types who hold the same view (that the source of the blood should have more ?flex in the standards...... ?and distribution and application?).

RE: medical

EQUITY can handle imbalance in terms of removing blanket assumptions and establishment of new norms. Perhaps the production of cryoprecipitate which requires many pints could be gleaned from blood sources that are subject to greater refinement in the preparation process (as opposed to the selection process)?
Review the new Health Equity Assessment Tools ( HEAT )emerging from Australia and adapted in Canada as HEAIT... adding I for Implementation )

RE: legal

Breaking the law demands "knowledge of" the law for both providers and users.
Therefore the existing declaration of industry norms based on medical facts ( and assumptions) and resulting policies, procedures stemming from them ....can only be adjusted by a change in " regulation" where the " norms" rise to a new level that permits legislative overview.
Then the long journey from legislation to law that further divides the consumer on what broad or narrow usage of the end service will be..... and whether they will use it at all.

SUMMARY

"cha-ching"

sharon [aka purley quirt] said...

yes.... this is a good article.... presenting the case for debate as opposed to menu selections.
Good job!

Away with simply a repeat of mainstream news items, "campy" tips, or repeats from other frequently read medical journals

:)

said...

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