Safety, Acceptance, Fairness & Equality (SAFE project): Acceptable risk and donor selection 

Project Summary


The Canadian blood donation system relies on the participation of volunteer donors. A proposed change to a policy where everyone is eligible to donate blood, and assessed for eligibility based not on their sexuality but on their sexual behaviour (e.g. sexual behavior-based questions) is one that is viewed as more equitable and fairer. However, the acceptability of such a policy change is based on balancing equity and fairness with the perceived risk to the safety of blood the public will accept. This project looked at issues of trust, equality, and acceptable risk in key Canadian stakeholder groups (e.g., patients, LGBTQ+ community members, and the public) and asks: “Do changes in policy lead to people perceiving the level of acceptable risk as being crossed and is this moderated by stakeholder group membership?”

What was done?

A targeted anonymous online survey was conducted between April 2018 and April 2019. Respondents included those recruited through various patient groups (96), various LGBTQ groups (103), professional group (72) and from the general population (Canada = 312, USA = 258). This resulted in a final sample of 841 with 96 patients, 228 self-identifying as LGBTQ+, and 72 self-identifying as professionals. Data were scored and analyzed. Among other measures, the following were assessed: perceived acceptable risk for blood transfusion, moral beliefs in harm, fairness/equity, purity, authority, as well as trust in others in general, trust that people will honestly report their sexual behavior, beliefs in whether or not people can accurately recall their sexual behavior, and willingness to become or remain a blood donor.

What was found?

The findings from the SAFE project show that perceptions of risk change as a function of screening policy (12 months to 3 months to behavioral) but these are all still just below or just above a rating of being of low and acceptable risk. That is, the level of risk always remained as acceptable regardless of the policy considered. Similarly, risk to the safety of patients also varied by policy but again was low, indicating that people do not see safety being compromised by any change in policy and do not see patients being put at risk. Importantly this pattern was the same if you were a patient or not. However, LGBTQ+ people, compared to straight people, perceived the risk of all policies as the lowest, people from non-White communities as higher and low trust in others was also associated with greater perceived risk for all 3 policies. The mechanism by which trust in others influenced increased perceived risk in all policies was identified as low trust in the honesty of others regarding their sexual behavior. Furthermore, people feel that on average people are better than chance (50%) at accurately recalling their sexual behavior but only just (55%, p = .03).

Opportunities for change

The findings suggest that policy changes will likely be accepted. Trust that people can accurately and honestly recall their sexual behavior may influence the effectiveness of any change, especially to a behavioral policy, and would be enhanced by interventions to re-assure people that the accuracy of recall of sexual behavior was being enhanced (e.g., time-line follow-back procedures, use of mobile phones to trace event back over 3 months).

Future considerations

While these results are informative and are the first of their kind to explore how group membership, demography, moral beliefs, and trust influence perceived risk, it has to be acknowledged that the sample analyzed here is a specific and targeted one, and replication in a random sample of the Canadian population would be welcomed. However, a number of the findings reported here on risk have been replicated in the FAIR project in the UK.

Research publications



Findings from this research contributed to the FAIR (For the Assessment of Individualized Risk) report that informed implementation of new individual risk-based behaviour eligibility criteria in the UK in June 2021. FAIR report conclusions were cited in CBS' "Alternative criteria for MSM, Source plasma donation, London and Calgary" submission to HC (implemented in Sept 2021) and will also be used in the upcoming "Risk based sexual behaviour criteria" submission to Health Canada.

Acceptability and feasibility of plasma donation

In a continuation and expansion of her MSM Research Program-funded study, Dr. Joanne Otis (University of Montreal) is looking at how source plasma donation in Montreal might be acceptable and feasible from the point of view of cis and trans gay, bisexual and other men who have sex with men, volunteers from Héma-Québec, current donors, and plasma product recipients.

Plasma Program project; ongoing.

Understanding acceptability

Dr. Daniel Grace (University of Toronto) explored the acceptability of existing and alternative eligibility criteria to gay, bisexual and other men who have sex with men.

Project completed and published.

Mathematical models of risk - plasma

Dr. Antoine Lewin (Héma-Québec) led a mathematical modelling study to understand the risk associated with source plasma donation by gay, bisexual and other men who have sex with men.

Project completed and published.