Assessing alternative donor screening questions in current donors

This project sought to contribute to an evidence-based and incremental approach to evolution of more inclusive donor policies for gay, bisexual, and other men who have sex with men (gbMSM) and trans populations. The removal of the men-who-have-sex-with-men (MSM) screening questions and implementation of individual sexual behaviour-based questions required understanding their potential impact on current donors, their acceptance and understanding of these questions, and their own eligibility, to inform feasibility considerations and next steps. 

This study—completed in three phases—provided recommendations to the blood operators regarding evidence-based optimal approaches to asking sex and gender questions and questions related to sexual risk behaviours. Following the successful implementation of a change to SBBS at Canadian Blood Services in 2022, a third phase of this study was created to complete further quantitative surveying of donors at three Canadian Blood Services sites.  

Phase one results indicated that sexual behaviour-based screening (SBBS) questions were not expected to be more uncomfortable than the existing screening questions. Phase two studied three different conditions using random assignment of participants to ask potential SBBS questions. Its results confirmed that most donors felt comfortable and that adding a short explanation for why the questions are being asked might decrease some discomfort with the screening questions.  

Results of the third phase aligned with the findings of earlier phases: that both new and returning blood donors largely felt comfortable with the new sexual behaviour-based screening questions. They also investigated the how factors such as self-reported attitudes, social norms and perceived behavioural control—factors that were found to be predictive of intentions to donate within the next 6 months—influenced subsequent donation behaviour within that timeframe. For new donors in particular, the day-of experience while donating was found to significantly influence their return for subsequent blood donation. 

Findings from the third phase of this study provide valuable insights for blood operators to understand factors that influence new and returning blood donors’ decisions about returning for subsequent donation(s). The identified predictors of donors’ positive intention/sureness to donate included attitudes, norms, and perceived behavioural control. Findings also identified that for new donors in particular, the donation day experience is a significant factor in their completion of subsequent donations. These results may be mobilized to support blood operators’ donor retention strategies and may provide valuable insights for donor-facing staff. 

Fisher W, Kohut T, Haw J. Experience of blood donation and return for subsequent donation among new and repeat donors. Transfusion. 2025. https://doi.org/10.1111/trf.70019  

Woo H, Fisher W, Kohut T, & Haw J. Qualitative analysis of Canadian blood and plasma donors’ views on expanding donor screening eligibility for gay, bisexual, and other men who have sex with men. Transfusion. 2024.64(1): 85-92. https://doi.org/10.1111/trf.17606  

Fisher W, Kohut T, Woo H, and Haw J. Alternatives to blood donor deferral of gay, bisexual, and other men who have sex with men: Acceptability of screening the sexual risk behavior of all donors. Transfusion. 2023. 53(3): 531-540. https://doi.org/10.1111/trf.17241.      

Haw J, Woo H, Kohut T, and Fisher W. Sexual risk behavior questions: Understanding and mitigating donor discomfort. Transfusion. 2022. 62(2): 355-364. https://doi.org/10.1111/trf.16755. 
*This article was featured in America’s Blood Centers (ABC) Newsletter; and one of Wiley’s most cited articles 2022-2023. 

Haw J, Woo H, Kohut T, and Fisher W. Optimizing donor screening and eligibility for gbMSM and trans donors: Assessing current donors’ perceptions of alternative screening questions. Transfusion Medicine Reviews. 2022. 36(1): 66-67.  https://doi.org/10.1016/j.tmrv.2021.10.005

Results from these studies informed a submission to Health Canada by Canadian Blood Services to remove the MSM deferral criteria and implement SBBS questions as part of donor eligibility screening in September 2022. More about the implementation of these questions, including the May 2024 apology issued by Canadian Blood Services acknowledging harms caused by the previous deferral criteria can be found on blood.ca.  

From this specific project, multiple publications and internal and external knowledge mobilization activities continue to share the learnings with blood operators, clinicians, researchers, and donor centre staff.