Removing unfair barriers to blood donation

Abstract

On June 14, 2021, the criteria for blood donation in the UK were changed to permit men who had sex with men in the past 3 months to donate blood. Although this change marked a beneficial shift of focus from the identity of the donor to the risk of their individual experiences, the decision also drew attention to a longstanding clause that limits donation from Black communities. The clause, which requires donors to state whether they have recently had sex with someone who might have been sexually active in areas where HIV is endemic, has led to a large number of Black African and other potential donors being unable, or feeling discouraged, to donate blood. On Oct 11, 2021, the UK Department of Health and Social care announced that this eligibility clause will be removed from the donor safety check form. Coming into effect by the end of the year, potential blood donors will no longer be screened for sexual contact with people from areas with high prevalence of HIV. As part of existing blood testing measures, all donations will continue to be tested for many possible infections, including HIV, whereby the government report estimates that the risk of HIV-infected blood being undetected by these measures corresponds to one in 23 million. The UK Department of Health's decision was taken following research done by the For Assessment of Individualised Risk (FAIR) group, a steering committee established in 2019 comprising experts in UK blood services and LGBTQ+ charities that aims to increase inclusiveness in blood donation in line with the latest scientific evidence. As their name suggests, updating eligibility criteria in line with evidence is a fairer and more equitable approach to blood donation, and is hoped to increase the number of people from Black African, Black Caribbean, and Black mixed ethnicity backgrounds who donate blood. This campaign is urgent. People from these backgrounds are more likely to have rare blood groups, such as Ro, that are in very short supply. In 2019, NHS Blood and Transplant reported that the need for donations from Ro blood donors had increased by 80% since 2016 owing to the sharp rise in the number of patients with sickle cell disease, as well as the increased use of blood transfusions (including in the Ro blood group) to treat other conditions. Moreover, this need is speculated to further increase following the additional challenges involved in caring for patients with complicated conditions, such as sickle cell disease, throughout the COVID-19 pandemic. These challenges relate not only to decreases in donor participation following the implementation of lockdown restrictions, but also to the decreased number and availability of health-care professionals to collect and process the donations, disruption of supply chains resulting in shortages of medical equipment, and additional treatment considerations required for patients who need blood donations who are also critically ill with COVID-19. In 2021, despite the reduction of barriers, important challenges still remain. As noted by Danny Beales, head of policy and campaigns at National AIDS Trust, “There's currently a lifetime exclusion for anyone who has ever injected drugs, regardless of when this took place (for example even if it was 10 years ago).” The blanket ban on donating blood for people who have ever injected drugs also excludes people who have ever taken body-building drugs, injected tanning agents, or injected chemsex drugs. Regulations on blood donation are enforced because of the increased likelihood of blood-borne diseases in people who engage, or who have previously engaged, in specific behaviours. However, as improvements in screening techniques are made, such as the development of so-called pathogen-reduction technologies that aim to inactivate pathogenic organisms in donated plasma, the haematology community must regularly engage in conversations around the risk–benefit ratio of blanket bans and window periods on blood donation from particular groups to ensure that donation guidelines are evidence-based, proportionate, and do not lead to unfair discrimination of specific groups in society. As demand for rarer blood types increases, it is more important than ever that previously deemed high-risk groups are assessed on an individual basis for their suitability for donating blood. Addressing our fears, misconceptions, and biases in these groups is a vital first step for safely removing additional barriers to blood donation and to help save lives. Every drop that can be safely used, should be used.