As scores lay injured in Florida hospitals after the Orlando shooting, potential donors inundated blood banks, offering what they could. For some, however, the hourslong wait ended in disappointment. The U.S. Food and Drug Administration has strict guidelines about who can donate blood; among those restricted are people who have had certain diseases, those who have traveled to certain countries and men who have slept with men, or as the FDA refers to them, MSM, within the past year.
An unfortunate paradox comes to mind — that the shooting victims belonged to a community effectively banned from showing its solidarity through blood donation. Although Orlando received more than enough blood, unhappy advocates demanded the ban’s elimination, disparaging what they saw as a discriminatory policy.
HIV tests, though, have always had a flaw: A window exists between the time of initial infection and when the virus can be detected. Scientific advances have shortened this window to about 10 days. But in that period of time, someone could donate infected blood. That’s where two controversial screens — donor deferrals and questionnaires — come in.
Advocates are right to question the policy. It doesn’t make sense to defer a healthy, monogamous homosexual man while allowing a heterosexual man with multiple partners to donate. But it’s the best, if unpopular, balance the FDA can strike at the moment.
Although 4 to 7 percent of the male population is a significant number, that group’s absence from the blood donor pool doesn’t markedly constrict the number of actual donors. The share of the MSM subset (or any other demographic subset) that could and would donate to the blood supply is much lower: Among the 38 percent of the American population eligible to donate, only 10 percent choose to do so, according to the American Association of Blood Banks.
And loosening restrictions on these men is tricky. A blood surveillance survey run from 2011-13 collected data on more than 50 percent of the blood supply. It found that the two leading risk factors for donating HIV-infected blood were sex with an HIV-positive partner and a history of male-to-male sexual contact.
Members of Congress, including Rep. Mike Quigley, D-Ill., have been pressing for changes to the policy. Ideally, their letter to the FDA says, “The FDA questionnaire should reflect risk-based behaviors as opposed to sexual orientation.”
But this requires an evaluation of specific sexual activities that individuals may be reluctant to reveal. When the lifetime deferral was in place, a study found that 2.6 percent of male blood donors had engaged in sex with a man, despite the questionnaire screen. Adding even more intrusive questions about sexual practices for all donors could cause further compliance issues with people who are unwilling to reveal these personal details. And although advocates say ending the ban would increase the blood supply, in-depth interviews about sexual acts could cause regular donors to take a pass on contributing.
Opponents of current blood policy have a right to demand further research, but they do not have the right to demand a decision now. Donating blood is inherently a recipient-centric transaction — all attempts to change blood policy should be made out of concern for the recipient.
Changing this policy will take data, not emotional appeals. It’s not enough to say that allowing this population to donate seems safe theoretically; the FDA needs irrefutable proof. It dragged its feet for 10 years until it got enough data to convince it of a one-year ban. According to Dr. Louis Katz, chief medical officer at America’s Blood Centers, one condition of the change was the establishment of the Transfusion Transmitted Infection Monitoring System. TTIMS monitors a majority of the U.S. blood supply for different transfusion-transmitted infections, including HIV. Katz also noted that the FDA will consider this data in any policy change.
If LGBT supporters want to see a different policy, their elbow grease would be better spent on funding further studies. Analyzing the data will take time and money. In seeking funds, advocates also will be competing to show the importance of their cause in comparison to other issues in blood banking, such as bacterial contamination of platelets and acute lung injuries.
Advocates should continue to advocate, but with the mindset of showing that science is on their side. If their case is as clear-cut as it seems, the only obstacle remaining is to prove it to the FDA.
Kayla Simon is a 2016 graduate of the University of Nebraska at Lincoln and the Tribune’s editorial board intern.
