FDA Accepts Blood Donations From Men Who Have Had Male-on-Male Sex: Thoughts of a Mormon Bloodbanker

On December 23, 2014, the FDA released a statement saying that they have changed the deferral men who have had sexual intercourse with men from indefinite deferral to one-year deferral. The AABB and the American Red Cross have approved the change, and (since I have many hemophiliac friends and they kind of do have a dog in this fight), the Hemophilia Federation of America, after being asked their opinion by the FDA, has endorsed the change.   Here are my thoughts as a Mormon, certified Blood banker.

First, as a Mormon.  This paragraph is short, because it doesn't actually matter.  My religion has nothing to do with this issue, but I know that it will come up if I don't address it. So, let me say this:  The Mormon church does not believe in discriminating against any group.  True, we do not agree with homosexual behaviors.  True, we believe that marriage is between a man and a woman.  However, we have also gone on record against discrimination in workplace, rental agreements and the like.  Just because we don't agree with their behavior, doesn't mean that we should try to make their lives difficult.  They should be able to live their lives, no matter what we feel about their sexual actions.  That being said, when considering them for blood donation, the only opinions that matter are my scientific opinions.  Are they safe donors?  If no, then I am bound to reject them.  If yes, then I am bound to accept them.  My feelings about them religiously are irrelevant.

All that being said, this same thing applies to any blood-banker who believes that gay marriage should be allowed.  Your feelings about them as people are irrelevant. The only thing that matters is the safety of their blood.

As a certified blood banker, I don't have an issue with accepting the blood of men who have had male-on-male sexual intercourse.. However, I also don't have a problem with them continuing to refuse donations from gay men, so long as they're consistent about it. Someone who experimented with male-on-male sex once in the 70s is banned from donation for life right now, but having sex with a prostitute is fine so long as it was more a year ago? Rights of no group is more important than safety of a patient. So, as long as they're consistent about the risks, I have no problem. This means if they were to continue to make them an indefinite deferral, people who have had sex with prostitutes are off the list entirely. But, this change does make it so now we have to consider IV drug users.  If gay men are changed to one-year deferral, then technically we should probably consider IV drug users going to one-year deferral--unless we can document that, with today's populations, the risk of a homosexual being HIV-positive is statistically lower than that of a drug user. If you can, then I'm all for leaving it that way.

All that also being said, take all of the homosexual males on earth, and all of the heterosexual males on earth, and the chances of a homosexual being HIV positive (even if they are not aware of it) are astronomically higher. But we are always playing that game with donors, and it's been long enough since the uncontrolled spread of HIV, that with other questions and the molecular screening, it's kind of silly to not accept blood from gay men.  The percentage of gay men that are HIV positive is much lower today than it was twenty years ago. And you also have to consider this question:  those that are HIV-positive are older.  And homosexuals, just like heterosexuals, tend to have intercourse with people in their same age category. Meaning that the younger slice of the homosexual population are much safer as donors than the older.  But that might be a more complicated question on the questionnaire than it's worth. 

But the donor questionnaire is kind of out-of-date in general.  There are a lot of questions on the donor questionnaire that just reek of out-of-date science. For example: Women cannot donate if they have had sex with a hemophiliac in the past twelve months. That line of reasoning is just as flawed as the gay man donation thing. Hemophiliacs who were not alive in the 1980s have no higher risk of HIV than any other American. NONE. And ones that were alive in the 1980s know whether they're HIV-positive or not at this point (why do I say they would all know by now, but not gay men?  They've been repeatedly tested for HIV.  Gays haven't been, necessarily). But we still have the rule. Because Blood Bankers are an excessively cautious people--and they should be. It's really not hard to accidentally kill people with blood banking if you're not careful. And a lot of blood bankers that were working in the 1980s still feel PERSONALLY responsible for the deaths that were caused by dirty blood. And they're not going to let it happen again.

I have heard people say that any rejection was just discrimination with today's science.  But they're wrong. Because ELISA has about 95% reliability. And Western Blot is slightly higher--maybe 98%. To be considered as a donor, you have to be negative on both.  We still have to screen the blood through a questionnaire before testing to ensure safety. I know that they thoroughly screen every donation. That's part of my job. And yet, I still think that blood should be screened by questionnaire--because 2%x5%=0.1%. This means that the blood has a 99.9% chance of being safe.

Sure, the clinical chemist in me says, "98%? 95% I'm cool with that. And put them together, and you go up to 99.9%. Heck, statistically speaking, 95% confidence is acceptable." (I am more of a clinical chemist/clinical hematologist at heart...blood banker by virtue of being a certified medical lab scientist). But not in blood banking. In blood banking, the world is positive and negative and there is no in between. There is no background noise, and there is no "well, it's kind of safe." A unit is either compatible or it is not.  There is no sort-of.  You have to understand that when I talk to some blood-bankers who were working in the 80s (I'm not old enough to be one), they don't just talk about it in the "it was a sad time in my life" way. They are traumatized by it. In their telling of the story (not mine), they murdered 1000s of people, without even knowing it. Granted, this was an emotional response, but not one that was about gays.  It was about HIV.  And even after they could screen the blood, it was years before they were willing to look hemophiliacs in the eye and say, "It's safe. You're safe." And today, I know many hemophiliacs who still don't believe that--they still assume it to be infected. Because they're traumatized, too. And all that is the fault of HIV. Not of gays. But that doesn't mean that they're cool with a mere 99.9%.

That's also why if a donor pops up positive, we have to initiate lookback. That means that if anyone has received that donor's blood in the past YEARS. We now have to assume them to have been exposed and initiate prophylaxis and screening procedures.

True, not only gays, prostitutes and IV drug users get HIV. But a heck of a lot more of them do. So, as long as we're consistent about it, I'm okay with it. It should be "if you have had sex with a member of a high-risk group within x amount of time" and it shouldn't change based on the high-risk group. And yeah, technically that excludes gay men. Because if you are having sex with a gay man, you have had sex with a high-risk group. And that's just how it is. So, if we're willing to say that it's safe to have a donor who slept with a prostitute last week, we can say that it's safe to have a gay donor.

I don't care what the regulation is, so long as it's consistent and safe for patients. And quite frankly, the current molecular screening procedures on their own are not safe enough. As blood bankers, we will always play the statistics game. We are pretty good at it actually. I know blood bankers who can, using statistics, pull a set number of random units out of the fridge and get the exact antigen-phenotype they want in at least one of them. And I'm willing to admit that the gay-HIV-risk statistic needed to be re-evaluated because the population has changed. But, I'm not willing to say that gays should donate based on equality or for fear of discriminating against a group. I would discriminate against myself if it meant a patient was safer.

So, I am happy about this change.  I think that this opens up the possibilities for blood that we need. I do understand that this means that gays who are currently in a sexual relationship are still deferred (because if you are in a sexual relationship, you've probably had intercourse in the last year).  But, until we can adequately document that gays are not a risk-group for HIV (which we currently can't), or we can be sure that sexual contact with a member of an HIV risk-group is not a concern (which we currently can't), that's the way it's going to have to be. 

But, I'm glad that we have some consistency that shows that the deferral is based on science and is not walking on egg-shells for fear of seeming homophobic (like it would be to grant blanket donor acceptance), nor is it based in a prejudice against gays (like it was before).  I'm hoping the change will go over smoothly with doctors, who sometimes don't listen to science over tradition (which is why we still have CMV-negative blood being ordered on non-immunocompromised patients when it's flippin' leukoreduced and we still run bunches of ESRs), but I can dream.  Overall, it's a good thing.  Not often that I'm willing to say this, but, good on you, FDA!