AABB24: A Closer Look at Blood Donation Eligibility Throughout the World

In the past few years, multiple countries have changed their blood donation eligibility criteria and adopted protocols based on individual donor assessments (IDA). The United States implemented such a policy last year. 

At the Sunday afternoon session titled “Beyond Gender-Based Sexual Activity Blood Safety Rules: Outcomes and Next Steps,” leaders from Australia, Canada and the United Kingdom spoke about their countries’ recent history with donor eligibility protocols and the ongoing work to make blood donation more inclusive.

Katy Davison, MSc, principal scientist of epidemiology at Blood Safety, UK Health Security Agency, spoke about the UK’s “For the Assessment of Individual Risk” FAIR Committee, which was tasked with developing recommendations for new donor eligibility criteria in the UK. After conducting research and data analysis, assessing risk models, and meeting with key stakeholders, the committee recommended a more individualized approach to donor selection policy. The recommendations were accepted by UK health authorities and the new policy was implemented in June 2021.

Mindy Goldman, MD, FRCPC, medical director of Canadian Blood Services, discussed how Canada implemented IDA protocols in September 2022. Similar to the UK approach, Goldman said Canada made this decision after thoroughly assessing data and involving key stakeholders. Goldman also stressed that the new policies are more inclusive and allow more people to donate. “We are committed to increasing donor diversity and inclusiveness while maintaining safety and adequacy,” she said. She added that the new policies also helped to decrease stigma. “Asking male donors about sex with other males is perceived as discriminatory and stigmatizing,” she said. “Also, asking all donors the same sexual risk questions allows transgender donors to self-identify in their affirmed gender.”

Goldman said that follow-up studies assessing blood safety following the implementation of new protocols has demonstrated that the risk of transfusion-transmitted infections has not changed. “HIV rates [in donated blood] have remained low and stable,” she said. She added that the UK has seen a slight increase in the number of eligible donors who identify as gay or bisexual. Additionally, only about 0.1% of donors are currently being deferred under the new protocols.

Joanne Pink, MD, FRCPA, FRACP, chief medical officer at Australian Red Cross Lifeblood, spoke about the Australian experience. Pink noted that Australia is somewhat unique in that it collects more plasma donations than blood. Furthermore, its protocols for plasma donation eligibility are different than those for blood donation eligibility. Health leaders in Australia have developed a “Plasma Pathway,” which would allow everyone – including gay and bisexual men, and those taking PrEP – to donate plasma for fractionation without any deferral period. Pink said the implementation for this protocol is expected before the end of 2024.

For blood collection, Australia is currently in the process of developing a proposal for implementing  protocols, similar to those in Canada, the UK and the US, to expand blood donation eligibility criteria and use an IDA-based approach to determine deferrals.