ABSTRACT The Canadian health care system has been the site of a tense relationship between blood donation policies and African Canadians (read as Blacks). This article explores the basis of that strain, specifically the Canadian blood system’s African Indefinite Deferral Policy and its relative underpinnings to, for example, the Creutzfeldt Jakob Disease Deferral Policy. Drawing from various data sources, the article demonstrates the subtle and diffuse aspects of the deferral policies in terms of the relationship between ethnicity and risk. The analysis provides important insights on the policies, based on the pejorative usage of ethnicity, especially its racial context, and related power dynamics, into understanding the lasting and plagued relationship that Blacks have had with the blood donation regime. Addressing questions around the institutional capacity of Canadian Blood Services and Héma Québec in dealing with minority ethnic groups is essential, particularly if the objective of blood donation policies is to address the health needs of Canada’s increasingly diverse population.