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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.
Posted by David Elkins and others at 4:43 PM
Labels: Canadian Blood Services, HIV, Kyle Freeman, tainted