Kurt Mitman | There won't be blood
Sorry to be Kurt | Why the FDA should revise its policy regarding who is eligible to donate blood
February 15, 2013, 1:11 am·
Sorry to be Kurt
Walking down Locust Walk last week and earlier this week, I was solicited several times by brothers from Zeta Beta Tau and Sigma Delta Tau to donate blood for their annual blood drive.
To escape the pestering, I told them that I was ineligible to donate and continued on my way.
I remember the first (and only) time that I’ve gone to donate blood. It was in the aftermath of 9/11. It was the patriotic thing to do — united we stand in line to donate blood.
After a long wait, I finally made it inside the donation location. I was given a questionnaire to determine if I was eligible to donate. It turned out that I was ineligible to donate based on travel, because I had lived in the European Union and because I had had sexual contact with another male (surprising, because I’m a registered organ donor).
I can understand the concerns regarding malaria and Creutzfeldt-Jakob Disease — more commonly referred to as Mad Cow Disease. Blood donations are not tested for malaria, and there is no test for CJD.
The lifetime ban on males that have had any sexual contact with another male (MSM) since 1977 seemed a little extreme to me.
The Food and Drug Administration sets United States policy regarding blood donation. It develops guidelines that are aimed at protecting the nation’s blood supply.
On the FDA website, they present facts to make their case: MSM have an HIV prevalence that is 60 times that of the general population, 800 times higher than that of first time blood donors and 8000 times higher than that of repeat blood donors.
Of great concern to the FDA is that it is challenging to detect HIV shortly after infection because levels of the virus in the blood are very low. As such, during this “window period,” there is a possibility that blood screening procedures would not detect HIV and that the donated blood would infect future potential recipients.
Since MSM have a higher rate of HIV infection, the logic goes, allowing them to donate would significantly increase the probability of infected blood making it into our blood supply.
How does this compare to non-MSM who engage in high risk sexual behavior?
If you’ve had unprotected sex with someone who has HIV or AIDS, is a sex worker or an intravenous drug user, you are only deferred for one year since the contact. If you have contracted syphilis or gonorrhea, you again are deferred for 12 months (if you have chlamydia, you’re free to donate right away).
The rationale, again, is that after 12 months have passed, the screening technology is very effective at detecting the virus.
So how do the 12 months relate to the “window period” for detecting HIV? Based on current screening technology, the window period for HIV is approximately nine days. So, it would seem consistent with current guidelines that any male who hadn’t had sexual contact with another male for the past 12 months should be allowed to donate blood.
That is exactly the joint position taken by the American Red Cross, the American Association of Blood Banks and America’s Blood Centers in 2010.
While that would certainly be a good first step, it probably wouldn’t greatly affect the number of people who are ineligible to donate — since you can imagine a significant fraction of MSM will have had sex with a male in the last 12 months.
It is important to note that it isn’t the relative proportion of people infected with HIV in the two populations that is the relevant measure. It’s the relative proportion of people with possibly undetectable HIV that is relevant for blood donation.
Since only those infected in the past nine days have undetectable cases, the risk is much lower than the FDA claims.
The FDA has yet to create a donor questionnaire that can reliably identify MSMs who don’t have a substantially increased rate of HIV infection compared to the general population.
There’s always a pressing need for blood, and excluding millions of potential donors who can be safely screened unnecessarily endangers the lives of those who are saved by blood transfusions.