Scientific Background on the Risk Engendered by Reducing the Lifetime Blood Donation Deferral Period for Men Who Have Sex With Men

Why Does the Precautionary Principle Suffice for Blood Regulation?

Traditional approaches to blood regulation emphasise the precautionary principle and pursue zero-risk for viral transmission; these traditional approaches have usually followed tragedy, such as the HIV and hepatitis C infections that followed the use of factor VIII concentrates. However, a much more haphazard haemovigilance system operates for general adverse events. Such imprecise assessment of hazards prevents sound benefit-risk assessment, and for blood products this is further confounded by the fact that their efficacy has attracted little systematic study. The ongoing COVID-19 pandemic has now prompted the proposal of a convalescent plasma (CP) blood product. Clearly, mere freedom from infectious agents will not suffice in assessing CP, and an objective measure of efficacy, so as to permit formal benefit-risk analysis, is essential. This is both a scientific and an ethical demand, as has been the case for other experimental COVID-19 treatments. With special reference to COVID-19 CP, the well-recognized adverse events of transfusion-associated lung injury (TRALI) and transfusion-associated circulatory overload (TACO) will be important. Furthermore, not only efficacy but also product quality attributes (e.g., antibody titre) will have to be defined. Both of these are outside the traditional regulatory philosophy for blood products and are needed to truly assess the benefit-risk of this putative therapeutic product.

Righting Anachronistic Exclusions: The Ethics of Blood Donation by MSM

Recently, the FDA announced that it would soon lift the long-standing lifetime ban on blood donation by men who have sex with men (MSM). Re-examining blood donation by MSM, it is clear that there are several ethical goods that must be balanced. Through balancing the primary duty to safety with the imperatives to craft a policy that is formally equal, upholds the public's trust, and is non-discriminatory, an ethical blood donation deferral guideline may be advanced, both for MSM and the population at large.

Should Men who have sex with Men be allowed to donate blood in Israel?

Background

The present permanent deferral policy in Israel for MSM was established in 1977 and was based on the previous (now outdated) USA Food and Drug Administration standards. This study analyses epidemiological data regarding blood donations among MSM, in order to estimate the risk for HIV transfusion transmitted infection (TTI) if the policy is changed to allow at-risk MSM to donate blood.

Methods

An Excel based spreadsheet model integrated demographic, epidemiological data from the HIV National Register, laboratory, blood donation and testing data in order to calculate TTI due to false-negatives in known HIV+ donors, windows period donations, asymptomatic carriers and laboratory misclassification errors. A sensitivity analysis of our estimated TTIs for deferral periods for MSM was performed based on a literature review regarding this overall policy issue worldwide.

Results

MSM in Israel have a considerably higher relative risk (RR) of both prevalence (115) and incidence (143) of being HIV+ than persons without a risk factor. Allowing MSM to donate blood, without any deferral period, will add an additional five HIV TTI cases over the next decade. Imposition of a 1 or 5 years deferral of abstinence will increase the number of HIV TTI cases only by 0.10 and 0.05 cases, respectively.

Conclusion

A 1 year deferral period for blood donations from MSM in Israel is recommended.

Three decades of MSM donor deferral policies. What have we learned?

In the early 1980s, donor deferrals targeting men who have sex with men (MSM) and other high-risk groups were implemented in response to the outbreak of HIV/AIDS. It has now been three decades since the implementation of these deferrals. We review the international experience with developing these policies, which involves combining scientific evidence with ethical and moral concerns and the challenge of moving from precautionary to risk management policies as scientific knowledge and technology evolves. We provide key lessons that can guide blood policymakers as they confront potential new threats to the safety of the blood system and also provide lessons to the wider public health community on how best to incorporate precaution into the policymaking process.

Blood donation and institutional trust: risk, policy rhetoric, and the men who have sex with men lifetime deferral policy in Canada

This article examines the process of rebuilding institutional trust in the Canadian blood system in the aftermath of the tainted blood scandal. Our focus is the policy of lifetime deferral from donating blood for men who have sex with men. Drawing on findings from interviews with representatives of Health Canada's Expert Advisory Committee on Blood Regulation, the National Liaison Committee, Canadian Blood Services, and blood consumer groups, we demonstrate how claims making about rights, discrimination, science, and risk contribute to policy continuity. We also examine the link between policy continuity and the management of reputational risk.