To achieve the highest level of safety, Canadian Blood Services uses a standardized questionnaire to screen potential donors, as well as blood tests on each donation. Layering donor screening with blood testing has been successful to ensure the blood supply in Canada is safe and sustainable. This approach is used by blood systems internationally.
Donor eligibility criteria help reduce risk of bloodborne pathogens in two ways. Firstly, blood tests exist only for select pathogens (for example hepatitis C, hepatitis B, Chagas disease, West Nile virus and HIV). Hence, for emerging pathogens and for those that cannot be identified by testing, screening questions minimize the risk of transmission.
Secondly, even with pathogens for which there is a test, there is a window period between when a person is infected and when the test can detect the infection. The donor eligibility questionnaire helps reduce the risk of missing infections in the window period.
Many individuals who complete the eligibility questionnaire may be ineligible to donate blood, either on a short-term or permanent basis. Someone who has a fever or a flu or who has had a recent minor surgical procedure may be excluded for a short period of time, while someone who has a history of certain cancers can be excluded permanently. These exclusions exist to ensure that blood donations do not harm recipients.
While the window period for HIV is approximately nine days, the window period for other viruses, such as hepatitis, is much longer. In the time-based deferral approach, there are also some individuals who have a shorter or longer window period. For safety and simplicity, the deferral period is based on the longest window period.
Donors’ experiences matter: Although our operations are built around patient safety, the experiences of our donors matter deeply to us. Through their generosity, blood and plasma donors provide the essential biological material that allows Canadian Blood Services to create medical therapies that patients rely on. We understand that what we say, what we do, and how we do it must inspire people of all ages and from all walks of life to continue to be a part of Canada’s Lifeline. Our commitment to donors is stated on our website. It is informed by this understanding and by our commitment to patient safety.
We truly understand that being turned away from donating blood can leave donors with a sense of frustration and disappointment. We recognize that eligibility criteria for men who have sex with men is a particularly sensitive issue affecting many who have experienced longstanding marginalization and stigma. We also recognize that the incremental changes to donor criteria that still exclude many gay, bisexual and other men who have sex with men have been painful and frustrating for many, and we aim to create a more inclusive system.
Our goal is to stop asking men if they’ve had sex with another man and instead focus on high-risk sexual behaviour among all donors. We are working diligently toward greater inclusivity for donors while maintaining a safe and adequate supply of blood products for the patients we serve. This will be partially achieved by asking all donors about sexual behaviours.
We acknowledge that some of our donor health questions currently and in the past have disproportionately impacted racialized Canadians due to our geography-based policies. As the patterns of disease and our testing platforms evolve, we commit to reviewing and updating our safety procedures.
Our current criteria, which impact gay, bisexual and other men who have sex with men, are based on a broad statistical picture of risk rather than individual risk assessments.
According to data collected by the Public Health Agency of Canada (PHAC), the incidence of HIV and hepatitis C is substantially higher in Canada among men who have sex with men than it is in the rest of the population. According to PHAC, men who have sex with men represent three to four per cent of the Canadian adult male population, but about 40 per cent of all HIV cases in Canada, and 50 per cent of all new HIV infections.
We understand, however, that individuals within a group are not all the same. This is part of the reason why we have proposed to Health Canada a new way of screening donors that looks at the risks of specific sexual behaviours.