Abolishing Deferral Policies would End Blood Supply Shortages

Imagine getting ready with your friends for a night out on the town, and then your world suddenly comes crashing down - this is unfortunately becoming the norm rather quickly. On June 12, 2016, hundreds of individuals went out to a nightclub, known as Pulse, in Orlando, Florida, to enjoy what should have been a fun filled night for many - that was until a gunman walked into the club and opened fire on the crowd. Approximately fifty people lost their lives that night and over fifty more were left injured, being rushed to nearby hospitals for immediate medical attention. Why is this becoming the norm, people wonder?

Well, just a little over a year after the Orlando, Florida nightclub shooting, on October 1, 2017, thousands of people traveled to Las Vegas, Nevada, from all across the country, to attend a county music concert. Again, what should have been a fun-filled, peaceful night, yet again, ended in tragedy; nearly one hundred people died that night and over eight hundred were injured, due to a gunman, from a nearby hotel, opening fire on the crowd. Due to the injuries, people were, again, rushed to nearby hospitals for immediate medical attention, most needing blood transfusions to replace the blood they had lost. This leads to a current major issue - a shortage of blood supply.

Due to the lack of voluntary blood donors, there is a constant need for blood donations. However, some people who are willing to donate blood are being deferred, due to a number of reasons - sexual orientation being one. Given the constant need for blood, there should not be anyone prohibited from donating blood, especially based on their sexual orientation, being that for the most part it's assuming all men who have sex with men (MSM) are infected with HIV/AIDS. Although many people understand and agree the needs for taking precautions for spreading diseases, all blood donations are screened for any abnormalities before they're passed on to a recipient; therefore, blood doesn't have a sexual orientation - it's either healthy or it's not.

Millions of people are in need of blood transfusions every day, but every day there is a shortage of blood supply. One pint of blood is known to save up to three lives and according to Carren Bersch, an editor for the Medical Laboratory Observer, property of Nelson Publishing, states, 'approximately 37% of the U.S. population is eligible to give blood, only 5% actually donate, while the number of transfusions nationwide increases by 9% every year' (10). The need for blood is due to every day needs, such as a cancer patient who needs blood during his or her chemotherapy treatment, or unexpected disasters, such as car accidents or shootings mentioned previously. Although blood donations are needed every day throughout the year, the summer months seem to be when shortages are the highest; however, being that blood cannot be manufactured or substituted, it cannot be produced without donors - which is why it's essential to stress the importance of becoming a generous blood donor.

While everyone has blood in their body, everyone's blood is not categorized the same. Blood is classified by types: A-positive, A-negative, B-positive, B-negative, AB-positive, AB-negative, O-positive, and O-negative. Carren Bersch notes, 'according to the American Red Cross, type O-negative blood (red cells) can be transfused to patients of all blood types; it is always in great demand and often in short supply. Only 7% of people in the U.S. have O-negative blood type' (10). Often times, donation centers will send a bloodmobile to a public location, such as businesses and schools to set up a blood drive. A bloodmobile is a vehicle equipped with everything needed for a blood donation procedure, and although people can make appointments to donate blood, walk-ins are always welcome and highly encouraged. If a bloodmobile isn't in an area at the time a person is willing to donate blood, they are always able to go directly to a local donation center during their regular staffed hours to donate.

Although blood donations are given by volunteers, a donor usually receives some type of incentive for their generous donation. Most donation centers will give a donor free items, such as t-shirts, venue tickets, gift cards and more. Also, if a donor is willing to donate more than just whole blood, there are some centers who will pay them money to donate their plasma, which is a lengthier process, but as equally in high demand as whole blood. According to Bersch, donating blood is simple - from start to finish, a donor can anticipate on spending an average of one hour at a donation center. Most donation centers even offer childcare for convenience. Upon arriving, a donor will complete their registration, go over their medical history, have a 'mini physical', donate their blood, then relax for around 10-20 minutes with refreshments to make sure there aren't any complications from the donation (14). After each whole blood donation, a donor is eligible to donate again in fifty-six days.

While blood donations are voluntary, there are some guidelines a donor must meet before they are given the all clear to donate. A few general guidelines to donating are: a donor must be 18 or older, or 16 with a parent or guardian's permission, they must weigh at least 110 lbs., be in good health and they must provide a valid form of government issued identification. Even if a donor meets all of the general guidelines, they are still at risk for being turned away from donating due to several stipulations. While certain criteria may temporarily restrict a person from donating blood, there are other criteria that will defer them permanently.

According to James P. AuBuchon, a doctor who specializes in Pathology and spent eighteen years at Dartmouth-Hitchcock Medical Center as a Medical Director of the Blood Bank and Transfusion Service, claims, 'about 5% of prospective donors are turned down because of their answers to questions about medical history, demographic factors, or risk-related behaviors in the remote past' (905). If a person's iron count is too low, if they are taking certain medications or have received certain vaccinations within a particular time frame prior to donating, they are temporarily deferred - while traveling to certain countries, having certain diseases and having sex with a man who has had sex with another man will lead them to longer, if not indefinite, deferrals - which leads to the next discussion.

A deferral policy for anyone who has had sex with a man began in the late 1970s, due to an outbreak of HIV among gay men. HIV is a virus that attacks a person's immune system, interfering with the body's ability to fight infections. As many people know, HIV is the leading cause of AIDS if left untreated. Over one million people in the United States are HIV positive, yet there are many people who are unaware they're infected. Although gay men, mostly African American, are, stereotypically, known to be infected with HIV, women and transgender individuals are at risk, too. Therefore, the MSM deferral policy prohibits anyone, male or female, from donating blood if they have had sex with a man who has had sex with another man.

Being that gay men were officially banned from donating blood in the early 1980s, there became a blood supply shortage, so a group of lesbians known as the San Diego Blood Sisters, traveled around to U.S. cities, organizing blood drives to replenish the blood supply. According to Beth Hutchison, who holds a PhD in English and is an assistant professor at Portland State University in the Department of Women, Gender and Sexuality Studies, mentions, 'in San Diego, Blood Sisters participants were recognized in the local gay newspapers and gay bars as providing an important community service' (120). Because of the San Diego Blood Sisters, awareness of HIV/AIDS and knowledge of blood supply shortages was brought to the forefront in the early 1980s.

While HIV is not a gay disease, gay men are aware of their risks with HIV and most of them are proactive about keeping themselves from becoming infected. In contrast, some researchers are studying the relation between male circumcision and HIV, trying to show how male circumcision potentially leads to higher HIV prevention. With medications people are allowed to take daily to prevent HIV, testing and awareness, the number of infected people has drastically decreased throughout the years. Also, modern dating plays a key role in gay men knowing whether or not their partner is HIV positive.

According to Brandon Andrew Robinson, a doctoral candidate in the Department of Sociology at the University of Texas at Austin, who has published work on HIV/AIDS, reports, 'a total of 40 to 52 percent of men who engage in some form of same-sex sexual behavior meet online' (383). People are more likely to open up when they're not face-to-face, as fear of rejection often times leads to people being untruthful about themselves. Online dating provides a safe way for same-sex individuals to screen their potential partners before engaging in a form of sexual activity, therefore lowering their risks of becoming infected with HIV. Having said that, gay men becoming sexually responsible and the risks of HIV dropping drastically should allow them to donate blood now, right? Wrong.

The United States Food and Drug Administration doesn't have enough solid information for the justification of the MSM deferral policy, yet they're not showing any signs of abolishing the policy any time soon. Charlene Galarneau, an associate professor in the Women's and Gender Studies Department as well as the director of the Health and Society Minor at Wellesley College in Wellesley, MA, acknowledges, 'the FDA strategy for blood safety consists of 'five overlapping layers of safeguards': donor screening and deferral, a registry of deferred donors, blood testing, blood 'quarantine', and oversight of blood manufacturing processes' (30).

The FDA is responsible for ensuring the safety of the public health through control over any and all aspects affecting everyone's lives, such as the blood donor policies. While the FDA deemed gay blood donors deferred indefinitely in 1977, around 2014 they did, however, revise the life-long policy to a 12 month deferral. The majority of people view the MSM deferral policy as discriminatory, but the FDA views it as protection and prevention. Years ago, before gay men were banned from donating blood, a blood transfusion recipient contracted AIDS, due to the blood being infected; because of this, the FDA wants to ensure this doesn't happen again.

Although the entire U.S. population isn't 100% satisfied with their decisions, the FDA aims to treat all policies equal, to create the safest and healthiest environment for all. According to the FDA, regarding the backlash on discrimination against gay men and the deferral policy, they feel as if it is their obligation to defer anyone who holds the potential to be at risk for HIV/AIDS, even though they recognize the policy turns away eligible donors. The FDA also claims their decision isn't swayed by a donor's sexuality, simply just the risks that are involved. Men who have sex with men just so happen to be a high-risk factor, being that HIV is prominent in anyone who has had sex with a male who has had sex with another male. Because of testing not being 100% accurate on donated blood and their goal is to protect blood recipients, the FDA rules this policy to remain in effect (31).

While the FDA claims to have valid reasoning for the MSM deferral policy and denies being discriminatory towards gay men, discrimination is exactly what it is. As mentioned previously, HIV isn't only positive in men, just as HIV isn't only spread through man-to-man sexual contact. Gay men can have sexual interactions with one partner, protected, and be 100% healthy and disease-free, while heterosexual individuals can have sexual interactions with multiple partners, unprotected, and be at risk for acquiring STD's and HIV - so why are MSM blood donors the only ones being deferred? All blood donations are screened before they are passed on to an individual in need, therefore, everyone should equally be given the opportunity to donate blood if they're willing - regardless if they're deemed high-risk or not. Without screening blood, there isn't any way to determine whether or not a person has any blood abnormalities, such as HIV.

Ronald Bayer, who holds a PhD from the University of Chicago and has been a consultant to the World Health Organization on ethical issues related to the public health surveillance, HIV and tuberculosis, states, in 2013, 'the American Medical Association declared that the lifetime ban on blood donation for men who have sex with men was 'discriminatory and not based on sound science' (232). People shouldn't be singled out, prior to donating blood, based on their sexual orientation/relations, when in fact they could be one of the healthiest individuals and able to save hundreds of lives throughout their entire life.

With the technology and screening we now have for blood donations, blood is safer today than it ever has been. According to AuBuchon, 'expansion of blood donor screening and improvements to laboratory markers have reduced the risk for HIV infection from as high as 1 in 100 units in some U.S. cities in the early 1980s to approximately 1 in 680,000 units' (904). Although the FDA revised the policy in 2014 to be a 12-month deferral, instead of a life-long deferral, it's still not justified - the policy needs to be abolished completely.

While there is a significant amount of research, facts and statistics about why there is a blood donation deferral policy for MSM blood donors and the related, studies today also explain how and why this policy should be abolished in its entirety. The FDA needs to re-visit the MSM policy, again, to allow blood donations from all eligible donors, despite their sexual orientation. Having said that, the questionnaires given to a donor, prior donating blood, needs to be revised, as well, to eliminate any and all discriminating questions. Blood doesn't compromise a person's immune system for no reason, people who practice unsafe activities do. Blood isn't able to produce itself, people who donate blood do. Most importantly, blood doesn't discriminate - people do; end the discrimination, end the blood shortage! 

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