Donor deferral should be regarded as a public health issue, not an issue of social policy, fairness or equality, although deferrals must be justified, fair and proportional to risk. The position of the WFH is that decisions on donor deferral, including deferral of men who have sex with men (MSM), should always be based on data and scientific evidence and not on considerations of social policy or politics.
The safety of recipients of blood transfusions and blood components must always be the primary concern. Decisions on deferral of donors should be made nationally, bearing in mind the prevalence of sexually transmitted infections and transfusion transmitted infections in each country. In considering any change to deferral policy, countries should carry out a risk assessment based on the scientific evidence available and the epidemiology of the country. This includes an examination of whether any change in policy will result in an increased risk to blood recipients and a decision on the degree of risk tolerance, bearing in mind that the risk is borne by recipients and not by donors. The level of donor compliance with any deferral policy should also be examined when this is possible to estimate. Providing safe blood and blood components for patients in need of transfusion is the objective of blood transfusion services. Patient health should always be the driving force in any decision on donor deferral.
In general, many individuals are deferred as blood donors based on their medical history, travel history, and health status. There are also deferrals of several broad categories of people based on statistical and epidemiological observations of increased risk of their having a transmissible infection. These include MSM, injection (IV) drug users, people who have lived in countries where malaria is endemic, people with hemophilia and their partners, and individuals residing in the UK from 1980 to 1996 due to the risk of vCJD. Similar to the other groups, the UK residents are not individually assessed for dietary exposure to beef but are all deferred. By deferring all persons in a risk category, the overall risk is decreased. Opposition to lifetime deferrals for MSM has been led by organizations working on civil rights and health issues for gay men who believe the policy is discriminatory and thus a civil rights issue. They question the correctness of categorically deferring an entire group of people and propose basing any donor deferral decision on individual assessment of high risk behaviors. The deferral of MSM donors has been legally challenged in Canada, Australia and Finland, and the legality of the deferral was upheld in each case.
The WFH views the issue of blood donation by MSM as a risk management issue which should be dealt with in the same way as any other existing or proposed donor deferral policy for blood or plasma donors. There are two broad categories of risk to patients receiving blood transfusions that need to be taken into account when considering a possible change in donor deferral criteria. These are first, the possibility of increasing the risk of transmission of known infectious agents such as HIV or Hepatitis B or C and second, the risk of transmission of new, as yet unknown and therefore undetectable, infectious agents. Whenever any new infectious agent is discovered, health authorities must reevaluate deferral policies in the context of that new risk. New agents with the potential to be transmitted via blood transfusion are not infrequent. In recent years, they have included West Nile Virus, Hepatitis E, Chagas, and Leishmania, all of which have been transmitted by blood, and H1N1, H5N1, SARS and MERS, which have not yet been shown to be transmitted by blood.
Lifetime deferral of MSM donors was introduced in the 1980s as a result of the widespread transmission of HIV through blood transfusion. The lifetime MSM deferrals in the USA and the Netherlands are currently under review, with the probability of reduction to a 1-year deferral. A one-year deferral of MSM donors is currently in place in the UK (except Northern Ireland), Finland Australia and New Zealand. Canada has a 5-year deferral. In Spain and Italy, there is no deferral period, and donors are individually assessed based on their sexual history. A lifetime deferral remains in place in Germany, Norway, France, Denmark and Ireland.