• Is the NBTS stigmatising blood donors from LGBTQI community?
• The available data/facilities/guidelines prevent accepting such individuals as blood donors

Blood donation is a critical and life-saving process that plays a crucial role in healthcare systems worldwide. Every day, countless lives are saved thanks to the generosity of volunteer blood donors. To ensure the safety and well-being of both blood donors and recipients, blood donation safety measures are of utmost importance. These safety protocols are designed to minimise the risk of infections, complications and adverse reactions during and after the donation process.

The issue of the potential stigmatisation of lesbian, gay, bisexual, transgender, queer and questioning, and intersex (LGBTQI) individuals by the National Blood Transfusion Service (NBTS) raises important questions about equality and inclusivity in blood donation practices. It is crucial to examine whether the NBTS unintentionally perpetuates stigmatisation against LGBTQI individuals in the context of blood donation.

To clarify these doubts The Daily Morning interviewed the Director of the NBTS, Dr. Lakshman Edirisinghe.

Following are excerpts from the interview: 

What are the essential requirements for individuals to be eligible as blood donors?

The primary goal of the NBTS is to ensure the provision of safe blood and blood products to patients in Sri Lanka. Due to the potential transmission of infectious diseases through blood, certain criteria must be met by potential donors in order to be considered eligible for blood donation. Hence, donors with a history of transfusion transmissible infections or engaging in behaviours that may lead to such infections are not permitted to donate. Additionally, if donating blood would jeopardise the donor's health, they will also be ineligible.

Before being accepted as a donor, individuals undergo comprehensive donor counseling and examination conducted by a trained medical officer from the NBTS, following the guidelines laid down by the NBTS.

The basic criteria for a healthy donor include, being between 18 and 60 years of age (first time donors should be under 55), having a weight exceeding 50 kilograms, maintaining a haemoglobin level above 12.5 grams per decilitre (g/dL), and being free from any risky behaviours that could potentially result in transfusion transmissible infections.

What are the diseases and behaviours that may render a potential blood donor ineligible for donating blood?

Potential donors who have a previous history of Hepatitis B or C, human immunodeficiency virus (HIV), or Syphilis are deferred from donating blood. Additionally, individuals with behaviours that increase the likelihood of acquiring these diseases are also disqualified from donating. Apart from these specific diseases, there are numerous other infectious and non-infectious conditions that may prevent a donor from giving blood. If the donation from a particular donor is deemed to pose a significant risk to the recipient, it will not be carried out. Furthermore, if donating blood worsens an existing medical condition in the donor, they will also be deferred from donating. All of these regulations and prerequisites are established so as to ensure the well-being of both the donor and the recipient.

What are examples of these risky behaviours?

The aforementioned risky behaviours include intravenous drug use, engaging in sexual activities with multiple partners, males having homosexual partners, and participating in sexual acts for monetary gain. These behaviours have been associated with an increased risk of transmitting certain diseases, such as HIV.

Is it not possible to remove and defer donors with these diseases after testing the donated blood?

Although testing donated blood is an essential step in ensuring its safety, there is a period called the "window period" during which a pathogen may not be detectable through diagnostic tests. This means that even if a donor carries a disease, it may not be identified by tests immediately. During this window period, the donor can still transmit the infection to others, including the recipient of the blood. To mitigate this risk, it is crucial to conduct thorough donor counselling sessions with trained medical officers from the NBTS. If counselling is not conducted or is inadequate, there is a potential for diseases such as HIV, or Hepatitis B or C to be transmitted to patients. Therefore, while not all donors with risky behaviours may have these specific diseases, the likelihood of them carrying such diseases is higher than normal.

In accordance with guidelines from the World Health Organisation (WHO), the aim is to meet the need for blood and blood products using donors who do not have a history of risky behaviours. This approach ensures that only safe and healthy donors who meet the established criteria are accepted, minimising the risk to patients' lives and upholding their human rights.

Is it true that certain individuals can donate blood without an issue in foreign countries but they are unable to do so in Sri Lanka?

The acceptance or rejection of blood donations is based on guidelines established by a technical committee composed of consultant transfusion physicians from the College of Transfusion Physicians. These guidelines consider factors such as screening and testing capacities, disease prevalence, infectivity through blood, the relationship between risk behaviours and disease transmission, and other relevant scientific and technical data specific to the country, in this case, Sri Lanka. It is important to note that these factors can vary from country to country.

As a result, the donor counselling related guidelines differ among countries and can vary significantly. For example, if a donor travels to a malaria endemic country and returns to Sri Lanka, they must wait for three years before being eligible to donate blood. This decision is based on the fact that malaria has been eradicated in Sri Lanka, and the only potential transmission risk is through blood donated by individuals who have travelled from malaria endemic regions. In contrast, in the United Kingdom, the waiting period after returning from a malaria endemic country is only one year. Similarly, in Sri Lanka, individuals with a history of epilepsy are not allowed to donate blood, whereas in certain countries, they may be eligible to donate after a certain period of time.

It is important to highlight that the WHO recommends collecting blood from donors with the lowest risk of transfusion transmissible Infections. In some countries with insufficient blood supplies, there may be instances where donors with risk behaviours are accepted to meet the demand. However, Sri Lanka has an adequate supply of voluntary donors with low risk, who donate regularly, allowing us to meet our blood supply related requirements without any issues.

Is this the reason why individuals with a history of homosexual behaviours are not allowed to donate?

Yes. Currently, individuals with a history of homosexual behaviours are not eligible to donate blood. This restriction is based on national statistics that indicate a higher risk of diseases, such as HIV, among male homosexual individuals. The data and facilities available in our country along with the current guidelines, prevent us from accepting these individuals as blood donors. However, it is important to note that these guidelines may change in the future if statistics and disease spread patterns change as well. At present, the demand for blood in Sri Lanka can be met adequately by healthy donors who do not engage in such high risk behaviours.

It is important to emphasise that this decision is not based on any discriminatory factors such as race, religion, caste, sex, or sexuality. Our sole objective is to adhere to the technical guidelines in place in order to ensure the safety of blood and blood products for patients in need. We treat all our donors with equal respect and fairness, irrespective of their sexuality or any other personal characteristic.

Conclusion

In recent years, there have been efforts to reassess and revise the eligibility criteria of blood donors in order to ensure that they are based on scientific evidence, individual risk assessment, and the most up to date medical knowledge. Organisations such as the American Red Cross and the Australian Red Cross Lifeblood have implemented changes to their blood donation policies, moving towards more individualised risk assessment regardless of sexual orientation. These changes aim to address stigmatisation and promote inclusivity while maintaining the safety of the donated blood supply. However, it is important to note that the practices may vary depending on the country and the specific resources and guidelines in place.

(The writer is a Medical Officer of the Health Ministry)