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Landmark change to blood donation criteria

Men who have sex with men in a long-term relationship will be able to donate blood in England following changes to blood donation criteria.

  • New criteria focuses on individual behaviours, and lifts a blanket deferral for men who have had sex with men in the last 3 months
  • Policy is based on findings from the ‘FAIR’ report
  • Changes will have no impact on the safety of blood donated in the UK

Men who have sex with men in a long-term relationship will be able to donate blood in England following changes to blood donation criteria announced yesterday by Health and Social Care Secretary Matt Hancock. The move, which will also be implemented in each of the devolved administrations, sees the UK become one of the first countries in the world to adopt a more individualised risk-based approach to donor selection criteria.

Following recommendations from the Advisory Committee for the Safety of Blood Tissues and Organs (SaBTO), donors who have had one sexual partner and who have been with their sexual partner for more than 3 months, will be eligible to donate regardless of their gender, the gender of their partner, or the type of sex they have.

The ‘For Assessment of Individualised Risk’ (FAIR) steering group, a collaboration of UK blood services and LGBT charities led by NHSBT and established in 2019, conducted extensive research into the risks associated with more individualised blood donor selection policy. Their report, published yesterday, proposed a move away from a blanket 3-month deferral for men who have had sex with men, and instead to identifying a wider range of ‘highest risk behaviours’ which applies to all donors, regardless of sexuality.

This change will be implemented by Summer 2021.

Health and Social Care Secretary Matt Hancock yesterday said:

This landmark change to blood donation is safe and it will allow many more people, who have previously been excluded by donor selection criteria, to take the opportunity to help save lives.

This is a positive step and recognises individuals for the actions they take, rather than their sexual preference.

Minister for Blood Donation Lord Bethell yesterday said:

By closely examining the latest evidence relating to blood donation and sexual behaviour, we have been able to bring forward more inclusive policy to allow people to safely donate blood to save lives.

I am grateful to the members of the FAIR steering group, including LGBT charities, for the work they have done over the last 18 months to enable us to bring this policy, which many have called for, to fruition.

In a further step forward for equality in blood donation, under the new selection process, all donors will complete the same donor health check prior to donation, regardless of gender or sexuality, recognising that all donors, including heterosexual men and women, have potential to carry infections.

Anyone who has had the same sexual partner in the last 3 months will be eligible to donate and men who have sex with men will no longer be asked to declare if they have had sex with another man or their sexuality, making blood donation gender neutral and more inclusive.

Su Brailsford, Associate Medical Director at NHS Blood and Transplant and chair of FAIR yesterday said:

Patients rely on the generosity of donors for their lifesaving blood and so we welcome the decision to accept the FAIR recommendations in full. We are proud to have the safest blood supply in the world and I’m pleased to have concluded that these new changes to donor selection will keep blood just as safe.

This is just the beginning. We will keep collaborating with LGBT representatives, patients and donors so when we make these changes our process for getting accurate donor information about sexual behaviours is inclusive and done well. FAIR has also made a recommendation to government that further evidence-based reviews are needed for other deferrals such as how we determine risk based on travel.

New donor criteria will also defer those who have engaged in chem sex, defined as a drug taken immediately before or during sex to enhance sexual interaction, in the last 3 months or been treated for syphilis in the last 12 months.

The Chair of SaBTO Professor James Neuberger yesterday said:

As SaBTO Chair, I welcome the announcement made by ministers to update the donor selection criteria. SaBTO members during the last meeting unanimously agreed that changes proposed by the FAIR steering group would not negatively impact on the safety of blood supply so it’s good to see the government taking positive steps towards equality, informed by evidence.

Eamonn Ferguson, Professor of Health Psychology at University of Nottingham, yesterday said:

The FAIR project was novel in that it triangulated epidemiological and behavioural science research to identify the best combination of a question to use for the policy change. The behavioural research contributed by exploring the appropriateness, perceived recall accuracy, reliability and potential for self-deferral of these questions, as well as identifying a subset of questions that reliably predicted self-report sexual risk taking.

This was achieved using a variety of psychometric analyses of donor and non-donor surveys, and interview with donor staff, donors, non-donors, MSM and patients. The results from these analyses triangulated with the epidemiological evidence and provided additional insights into ways to implement the policy changes.

Dr Michael Brady, Medical Director at Terrence Higgins Trust, yesterday said:

Our first priority must be to ensure the safety of the blood supply in the UK. We welcome the move to a more individualised risk assessment approach to blood donation. The UK is leading the way in ensuring that blood donation is more inclusive and now will allow many more gay, bisexual and other men who have sex with men to donate blood.

There is certainly more work to do and we will continue to work to ensure that our blood donation service is inclusive, evidence based and both maximises the numbers who can donate while ensuring our blood supply is safe.

Ethan Spibey, founder of FreedomToDonate, yesterday said:

We have campaigned for over 6 years for the restrictions on men who have sex with men (MSM) donating blood to be updated and warmly welcome this announcement.

This means the UK has one of the world’s most progressive blood donation policies and more people than ever will be able to safely donate for those who need it. The work of the FAIR steering group shows that simply being a MSM is not a good enough reason to exclude someone from donating blood.

We’ve made great progress and look forward to continuing to work with the government and others to ensure as many people who could safely donate blood can do so.

Nancy Kelley (she/her), Chief Executive, Stonewall, yesterday said:

We want to see a blood donation system that allows the greatest number of people to donate safely. This change will help ensure more gay and bi men can donate blood, and represents an important first step towards a donation selection policy entirely based on an individualised assessment of risk. We will continue to work with government to build on this progress and ensure that more people, including LGBT+ people, can donate blood safely in the future.

While we welcome today’s news, we know much more still needs to be done to tackle the challenges that lead to gay and bi men, along with other groups of people including black African communities, sex workers, and trans communities, being at higher risk of acquiring HIV and other STIs. The recommendations of the HIV Commission set out a clear roadmap for achieving the UK government’s commitment to ending new HIV infections by 2030, and we will continue to work with the government and other charities to make this a reality.

Deborah Gold, Chief Executive at National AIDS Trust, yesterday said:

We welcome this step towards a fairer system of individualised, evidence-based assessment of risk for people who choose to donate blood. It’s important that the government now builds on this to address the remaining inequalities in blood donation policies, such as restrictions for people who have ever injected drugs. In doing so it should prioritise protecting the safety of the blood supply while maximising the potential for people to give blood.

We now need to see action on the endemic health inequalities that lead to the disproportionate impact of HIV on some groups including gay and bisexual men and people from black African communities. This includes the government meeting its commitment to end new HIV transmissions by 2030 and implementing the findings of the HIV Commission, which set out how this can be achieved.

Background information

The FAIR steering group concluded this updated method of selection criteria will maintain the world-leading safe supply of blood in the UK.

Blood donation guidelines are set by DHSC and based on recommendations from SaBTO, which advises health ministers in all 4 UK nations, the UK blood services, and the NHS more widely on the most appropriate ways to ensure the safety of blood, cells, tissues and organs for transfusion or transplantation.

In the UK there’s less than one-in-a-million chance of an unsuitable blood donation being used in patient care.

Following implementation, monitoring by the UK blood services will ensure new donor selection criteria do not have any unforeseen consequence, any changes in acute and chronic infections in new and regular donors are recorded and the development of methods to monitor overall deferral.

A post-implementation survey to obtain feedback from donors on the proposed change in pre-donation questions will also be developed.

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