Potential blood donation changes for MSM

Filip Vukasin

23/02/2023 4:40:12 PM

A shift to indivdual risk assessments has been floated, as has allowing men who have sex with men to donate plasma.

A nurse preparing a patient to give blood.
Only 3% of Australians donate blood each year.

Last week, Greens Senator Janet Rice asked Professor John Skerritt of the Therapeutic Goods Administration (TGA) why men who have sex with men (MSM) still face barriers to blood donation.
Currently, there is a three-month abstinence period requirement for MSM who wish to donate, meaning even if they only engage in oral sex, they are unable to donate. The current approach is part of a population-based risk assessment, as opposed to an individual risk assessment.
Professor Skerritt reportedly replied that the Australian Red Cross Lifeblood is reluctant to move to an individual risk assessment because it would involve asking donors about anal sex.
‘And they’re actually worried that in an Australian context there would be a number of people offended by that question, and it would negatively affect the number of donations,’ Professor Skerritt said.
Vice President of Just Equal, Rodney Croome, has been lobbying for the removal of barriers to MSM blood donations and told newsGP other countries have not seen a drop in blood donations after changing to individual risk assessments.
‘In the UK and other countries that have dropped the gay blood ban, a new policy of individual risk assessment has been adopted,’ he said.
‘This policy asks all donors, gay and straight, whether they have had anal sex with a new partner in the last three months.
‘The Australian Red Cross Lifeblood Service is concerned this question could defer existing heterosexual donors who have had anal sex with a new partner or deter those existing heterosexual donors who find it offensive.
‘However, a recent study by the Canadian Blood Service across all its blood collection centres found that less than 1% of existing donors would be put off by a question about anal sex, a percentage more than made up for by safe gay men who could donate under an individual risk assessment policy.
‘This is borne out by the experience in countries like the UK that have individual risk assessment. They have not experienced a drop in donations or a decrease in the safety of the blood supply.’
Mr Croome says that the blood supply would be safer under a policy of individual risk assessment because it would screen out those heterosexual people who are at risk.
‘At the moment in Australia, the focus on gay men means some at-risk heterosexuals are waved through,’ he said.
He says many gay men are frustrated with the current ban because they know they are safe to give blood and want to help save lives.
‘Many see it as a form of discrimination that is no longer relevant and feel it stigmatises gay men as a threat to public health,’ Mr Croome said.
Dr George Forgan-Smith, a Melbourne GP with interest in LGBTQIA+ health, told newsGP he understands the frustration with the barriers to blood donation.
‘I was the recipient of 10 units of blood last year that saved my life, and I cannot reciprocate by donating blood,’ he said.
‘It is an assessment based on statistics and risk. Unfortunately, population-based risk assessments never feel fair.
‘In the setting of blood donation, it may feel accusatory, and we are talking about people who have been recipients of homophobia.’
He sees the merit in individual risk assessments.
‘There are gay men who don’t engage in anal sex, and yes it can be uncomfortable to ask those questions about sexual health, but people should become accustomed to it,’ he said.
‘The risk of HIV is significantly higher through blood transfusion, many times higher than through sexual transmission.’
Mr Croome says the rationale for the current MSM ban is that there can be a window period for those people who are recently infected where the infection does not show up in standard tests. This window period can vary from a few days to a few weeks.
‘The reason this is no longer relevant is that the rate of new infections among gay men is declining rapidly,’ he said.
‘According to research from around the world, the likelihood of a gay man being infected with HIV and passing it on through blood donation during the window period is negligible.
‘If we add to this a regime of individual risk assessment where gay and straight donors are screened out if they have had anal sex with a new sexual partner in the last three months, the risk is even lower.’
According to the Kirby Institute, in 2021 there were 333 new HIV cases in Australia strictly through male-to-male sex.
A spokesperson from Australian Red Cross Lifeblood told newsGP the not-for-profit organisation is investigating an individual risk assessment model.
‘We have launched a research program to look at individual assessments and are working with the Kirby institute,’ they said.
‘But we will be focused first on the plasma pathway which would allow more people to become donors. Australia would be the first country in the world to introduce a plasma pathway like this.’
The plasma pathway would enable anyone to donate plasma, without the need to ask sexual health questions, thereby allowing currently prohibited MSM donors to play their part.
‘This would remove all sexual questions for donating plasma, such as having a new partner or being on PrEP, so that anyone would be able to donate plasma,’ the spokesperson said.
‘There were 30,000 people on PrEP in Australia last year and they wouldn’t be able to donate under an individual risk assessment. They would under the plasma pathway.’
Professor Skerritt echoed this possible change in the Senate inquiry, when he said, ‘we’ve also been discussing the potential of removing all controls on plasma donations, irrespective of sexual history’.
The Lifeblood spokesperson said the change to plasma donation is safe.
‘Lifeblood performs rigorous testing for a range of infections for both plasma and blood donations,’ they said.
‘Plasma donations, however, also undergo further processing in state-of-the-art facilities under stringent, controlled conditions. Each step of the manufacturing process is validated and contributes to the safety of plasma products.
‘These additional processing steps include, for example, viral filters as precision sieves to remove viruses and other methods to inactivate or kill viruses, thereby effectively reducing the risk of an infection such as HIV being passed on to a patient.’
According to the Department of Health and Aged Care, a single blood donation can save up to three lives, and one in three people will need blood or blood products in their lifetime.
The current level of demand requires more than 29,000 donations each week, yet only 3% of Australians (one in 30) donate blood in any given year.
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