“We are desperate for blood donations … but not yours”

“We are desperate for blood donations … but not yours”. Seems an odd statement considering the fact that NHS Blood and Transfusion requires a vast 1.6 million pints of blood each year (Microsoft News. 2016), a feat which needs at least 135,000 new blood donors are needed every year, that’s almost 400 a day, in order to achieve this (Young, S. 2019). However, this was the sentiment of the UK governments rules around blood donation, which banned gay men from donating blood unless they abstained from all types of sex for 3 months (Sturrock, B. R., & Mucklow, S. 2018). Even this was only introduced in 2017: previous to this there was a 12 month ban on gay men following sex, and this all stemmed from a law in 1980 of a lifetime ban of men who have sex with men out of fear of the AID’s crisis (Sturrock, B. R., & Mucklow, S. 2018). Considering it is now 40 years later and the fear of AID’s has been dampened down as it is now common knowledge that not all gay men have AID’s, could the 3 month rule purely grounded in homophobia?

On Monday 14th December 2020 the UK Government announced that as of Summer 2021, the 3 month deferral rule for gay men will no longer apply (Department of Health and Social Care. 2020). Instead, all people will be asked if they have had the same sexual partner (or no sexual partner) for the past 3 months – no one will have to declare their sexuality (Department of Health and Social Care. 2020). This decision follows a report by FAIR (For Assessment of Individualised Risk), which found that sex between two men in a long term monogamous relationship did not increase the risk of blood borne diseases (FAIR group. 2020).

These findings raise a myriad of questions: why was this research not done before? What lead to the ban on sexually active gay men donating blood standing for so long? Why when there is such a dire need for blood has this group of people not been allowed to donate blood when so many are willing? And to get to what I believe is the route of this discussion: why is there still inequalities embedded in our health system and what are we going to do to change this.

A report by Stonewall stated that 1 in 5 LGBT+ people have experienced discrimination because of their LGBT+ identity (Stonewall. 2017). Although this may seem high, if you take into account that all men who have sex with men are discriminated against by the current 3 month rule, this number is most likely a lot higher. Fundamentally I think we need to evaluate what this says about our healthcare system, and wider government, if we have allowed discrimination to be ingrained within it. Even though the new changes are a massive step forward, I strongly believe that we shouldn’t move past this period of discrimination without acknowledging it and pledging to tackle inequalities that we see within our healthcare system throughout our careers within it.

One argument against the changes which I have seen appearing in the last couple days is that it takes away patient autonomy and undermines informed consent. Autonomy is defined as the right that adults with capacity to have to make their own decisions and have these respected (BMA. 2020) and informed consent is when a patient voluntarily consents with all the information they need (NHS. 2019). Although it may be argued that a patient isn’t fully informed if they don’t know who the blood they are receiving is coming from, one of the key principles of NHS Blood and Transfusion is anonymity, for any organ or blood transplant no one knows where it has come from (NHS Blood + Transplant. NA) – why should it be any different because of the donors sexuality?

As healthcare workers who are inherently part of a big healthcare system, I think we have a duty to work in the best interests of all our patients. For me a big part of this is working to tackle and dismantle inequalities we see within the system – if part of the healthcare system you are a part of affects your patient, we should do whatever we can to change this. Whether this is small things like speaking up in favour of making rules more inclusive in conversations, or researching into inequalities within healthcare systems, we have the privilege as healthcare workers to be ‘on the inside’. With this comes the responsibility to use our voices for the good of our patients. Although this rule may have changed, there are still other inequalities within the healthcare system that need tackling.

References:

BMA. 2020. Autonomy or self-determination as a medical student. [Online]. [Accessed 15th December 2020]. Available from: https://www.bma.org.uk/advice-and-support/ethics/medical-students/ethics-toolkit-for-medical-students/autonomy-or-self-determination

Department of Health and Social Care. 2020. Landmark change to blood donation criteria. [Online]. [Accessed 15th December 2020]. Available from: https://www.gov.uk/government/news/landmark-change-to-blood-donation-criteria

FAIR group. 2020. Can donor selection policy move from a population-based donor selection policy to one based on a more individualised risk assessment? Conclusions from the For the Assessment of Individualised Risk (FAIR) group. [Online]. [Accessed 15th December 2020]. Available from: https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/21001/fair_sabto_20201211.pdf

Microsoft News. 2016. The NHS needs 1.6 million pints of blood every year: here’s how you can help. [Online]. [Accessed 15th December 2020]. Available from: https://news.microsoft.com/en-gb/2016/08/16/microsoft-joins-campaign-to-find-200000-new-blood-donors-every-year/

NHS Blood + Transplant. Donor family and recipient contact. [Online]. [Accessed 15th December 2020]. Available from: https://www.odt.nhs.uk/information-for-patients/donor-family-and-recipient-contact/

NHS. 2019. Consent to treatment. [Online]. [Accessed 15th December 2019]. Available from: https://www.nhs.uk/conditions/consent-to-treatment/

Stonewall. 2017. LGBT in Britain – Hate crime and discrimination. [Online]. [Accessed 15th December 2020].

Sturrock, B. R., & Mucklow, S. 2018. What is the evidence for the change in the blood -donation deferral period for high-risk groups and does it go far enough? Clinical medicine (London, England), 18(4), pp304–307.

Young, S. 2019. World Blood Donor Day 2019: How to Donate Blood in the UK. [Online]. [Accessed 15th December 2020]. Available from: https://www.independent.co.uk/life-style/uk-donate-blood-uk-how-where-register-donor-day-a8958316.html