Blood (11 page)

Even in the time of the Second World War, American physicians understood that the body of a sick or wounded person receiving plasma or other blood products would not distinguish between the blood of a black or a white donor. The blood exclusion decision had nothing to do with science, and everything to do with society and politics.

WE LOVE OUR NEIGHBOUR
so much that we are willing to give up our blood for a person, three streets or three thousand kilometres away, whom we will never meet or know. And yet we would much rather give, believing that we are healthy, than be put in a position of receiving. As blood transfusion science has revolutionized the ability of humans to give to each other, it has also raised our fears of each other. Could this donor make me ill? Might that blood bag be the cause of my death? We know that people who give their blood are likely to save someone's life — maybe our own — but we also fear that the same gift that moves straight into our own veins and arteries might carry a virus or disease that could kill or cripple us. One has only to look at the various exclusionary policies to see how concerned authorities are with preserving the safety of the blood supply.

Tainted blood, however, is an entirely different matter. In the 1980s, the tainted blood scandal that affected several countries entirely altered our collective psyche. Blood was no longer simply the pure gift that could save lives. In the minds of citizens across the world, it became a product that could kill. And kill it did. In Canada, some two thousand people acquired
HIV
and about thirty thousand people contracted hepatitis C after receiving tainted blood transfusions and tainted blood products to treat hemophilia. Some eight thousand people are expected to die as a result of having received bad blood in Canada over the course of a decade.

In
Factor 8
, named after a clotting factor given to hemophiliacs, American documentary filmmaker Kelly Duda chronicles the blood harvesting scandal in an Arkansas prison and the blood's subsequent sale into Canada. Some of the tainted blood products entered the blood supply in Canada and other countries after Arkansas prison inmates — some of whom had unprotected sex in prison, shared needles for drug use, and contracted
AIDS
— were paid between $7 and $10 for each unit of blood they donated, which they collected themselves in inmate-run blood drives. The Arkansas Department of Correction used private organizations to sell the prisoners' blood at great profit to Connaught Laboratories in Canada, which used the imported plasma to create a blood-clotting factor later sold to the Canadian Red Cross Society.

The tainted blood scandal led to the creation of the Horace Krever's Commission of Inquiry on the Blood System in Canada, which reported its findings to the government of Canada in 1997. The Krever report noted that until Connaught Laboratories was informed in 1983 that the blood plasma it had been importing from the United States was tainted, the Canadian company “had not been aware of the fact that it had been processing plasma collected from prison inmates. The shipping papers accompanying the plasma had not revealed that the centre was located in a prison. They had simply referred to the source as the ‘
ADC
Plasma Center, Grady, Arkansas,' without any indication that ‘
ADC
' stood for ‘Arkansas Department of Correction.'”

The Krever report recommended that new blood collection agencies be created in Canada to replace the Red Cross. As a result, Canadian Blood Services now collects blood in English Canada, and Héma-Québec collects it in Québec. The commission also recommended that the government compensate victims of the scandal. Federal and provincial governments in Canada have paid out billions of dollars of compensation, and civil litigation has been massive. Nearly $5 billion has been paid in compensation and to settle class-action lawsuits. Among its many other recommendations, the commission also said that, barring exceptional circumstances, donors of blood and plasma should not be paid, and that Canada needed far more stringent policies related to blood collection and blood safety.

Canada was not the only country affected by the tainted blood scandal. In what was surely the most catastrophic public health scandal of the century, people in the United States, France, the U.K., Ireland, Japan, and other countries were also contaminated with tainted blood. The global scandal spread just as the
AIDS
epidemic began to unfold in the world. Indeed, in 1981 — by which time tainted blood was already entering the market —
HIV
had not yet been identified as the virus that led to
AIDS
.

It took years to bring the contaminated blood supply under control, but one result was the implementation of a new rule in 1983 — in Canada and elsewhere around the same time — banning blood donations from gay men.
Experts tend to agree that it was a necessary step at the time.
AIDS
was highly prevalent in the gay community, and little was known about the disease, the virus that led to it, or how to contain it. Some three decades have passed since then, and science has evolved hugely, but the politics of blood donation have barely progressed.

In Canada, you cannot donate blood if you are a man who has had sex with another man (which classifies you as an “
MSM
”), unless you have been celibate for five years. This, ostensibly, is to prevent the
HIV
virus from entering the blood supply. However, each blood donation is tested for
HIV
, hepatitis C, and other viruses. There is a window of time — approximately two weeks — in which a donor might have acquired a virus, without that same virus showing up in a blood test. This is given as a reason for excluding
MSM
donations, even though heterosexual donors may also provide blood-carrying viruses that will not necessarily show up in tests.

The arbitrary, subjective nature of the rules barring or impeding blood donations from males who have had sex with males becomes very clear when one looks at the divergent policies from country to country. In Israel, France, Greece, and the United States, gay men are not allowed to donate blood. Canada recently eliminated its lifelong prohibition, and ruled that gay men who have been celibate for five years will be eligible to donate. New Zealand also sticks to five years. In the U.K., Sweden, and Japan, gay men can donate blood if they have been celibate for one year.

Gay rights activists and many others argue that the exclusionary rules are based on fear of homosexuality, rather than on science. They say that a promiscuous heterosexual who does not practise safe sex will pose a much greater risk for the transmission of
HIV
than a gay male who is faithful to one partner and who uses a condom.

Indeed, Spain and Italy do not bar blood donations from men who have had sex with men, but ask donors instead how many sexual partners they have had in the past six months. If the answer is one, they may donate. If it is more, then the donation is deferred. Mexico has also moved to allow gay men to donate blood.

Testing for viruses and pathogens in blood is far more sophisticated today than it was in 1983, when we did not yet have a test for the
AIDS
virus, and when the tainted blood scandal erupted in Canada and many other nations. We have more sophisticated means at our disposal for selecting donors judiciously: testing their blood, asking questions to eliminate those with risky behaviours, and so forth. But much like the decisions to prevent American blacks from donating blood destined for use by white U.S. troops during World War II. I would argue that the blanket ban on blood donations from sexually active gay men in Canada, the United States, France, the U.K., Japan, and many other countries is no longer based on science, but rather on lingering public bias that considers homosexuality inherently wrong and unsafe.

When it was announced in May 2013 that Canadian Blood Services and Héma-Québec would begin to accept
donations from gay men who had been celibate for five years, nobody pretended that it would increase the quantity of blood donated, and nobody offered a rigorous scientific argument explaining the magic number of five years. It is time to stop creating rules that give credence to antiquated thinking about the inherent dangers of gay sex. A promiscuous heterosexual who does not practise safe sex is likely to pose more risks to the safe blood supply than a gay male in a long-term monogamous relationship. Federal health officials should give serious thought to a new policy that would take every reasonable step to ensure the safety of our blood supply, while not alienating and insulting potential gay donors. Rather than rejecting the safety of any blood donated by a gay male, people running blood clinics could give gays the same opportunities offered to heterosexuals. They should be asked clear questions about risky sexual behaviours. They should be screened out if their answers are unsatisfactory. Their blood should be tested, very carefully.

To refuse to allow blood donations from sexually active gay men has several negative consequences. It perpetuates stereotypes against homosexuality and robs the blood supply of vital donations. It runs the risk of discouraging heterosexuals who are sympathetic to gays from donating. It creates a system in which people who are desperate to donate might lie about their sexual orientation as a sort of act of political resistance. Indeed, in 2010 Canadian Blood Services won a lawsuit against a gay man named Kyle Freeman, who lied about his sexual orientation and donated blood several times between 1990 and 2002 as a protest against what he felt was an unfair exclusion. Although Freeman took blood donation rules into his own hands, others have opted for more concrete and open protests by staging campus demonstrations against blood drives.

Durhane Wong-Rieger, a former board member of Canadian Blood Services who has spent some twenty years working in areas related to blood policy, has decried the five-year deferral period. She says it perpetuates negative stereotypes about gay people and the safety of their blood — and has nothing to do with scientific evidence. From the standpoint of a recipient's health, the difference in risk between blood donated by a man who has had sex with a man and another donor is “absolutely infinitesimal,” she said in a radio interview in May 2013. “The greater risk will be that someone who needs blood will not be able to have access to it,” because of insufficient supply.

The American Red Cross could have taken a stand during World War II, by arguing that there was no reason to impede blacks from donating blood to white military personnel. Perhaps this would have helped the United States tackle serious problems of segregation and racial discrimination in an era when these issues were crippling the country. Today, federal officials in Canada, as well as Canadian Blood Services and the American Red Cross — where a lifetime deferral for men who have sex with men is still in effect — could show the same leadership with regard to blood from gay donors.

In June 2013, the American Medical Association (
AMA
) voted to oppose the ban by the U.S. Food and Drug Administration, which refuses blood donations from gay men. “The lifetime ban on blood donation for men who have sex with men is discriminatory and not based on sound science,”
AMA
board member William Kobler said in a statement. The
AMA
argued that decisions to ban blood donations should be based on individual risk and not on sexual orientation alone. In July 2013, Arthur Caplan, who leads the Division of Medical Ethics at the New York University Langone Medical Center, also argued in favour of eliminating “an outdated, non-scientific regulation that bans [blood donations by] anyone who has had sex ‘even once' with another man since 1977. Although many people died in the 1980s after they received blood donations that were infected with the
HIV
virus, much improved
HIV
testing has made the ban on gay blood donors obsolete,” Caplan wrote. “The Food and Drug Administration acknowledges that
HIV
tests are highly accurate, with the risk from a unit of blood reduced to about one per 2-million units in the U.S. The worry is from the risk during the ‘window period' which occurs very early after being infected with
HIV
when even current testing methods can't detect antibodies. But the Red Cross, America's Blood Centers and the
AABB
(a blood donation advocacy group) all support throwing out the ban.”

Restrictions on who should donate should be based on science, on tests, and on meaningful questions designed to avoid donations from people who engage in risky behaviour. Even in an era of advanced medicine, when nucleic acid tests can reveal whether a donor has been exposed to
HIV
or hepatitis C before antibodies even show up in the blood, we rely on the honour system. When people give their blood so that others may regain their health, we still count on donors to tell us the truth about the most intimate parts of their lives.

In the world of blood donation, the safety of the blood supply depends on two key factors, which must be combined to maximize the benefits of synergy. We must use the best science in our laboratories, and we must ask many questions. As always, we will have to make wise decisions about blood donations. As for whether we deem it wise to accept the offer of blood, it will come down to three questions: How badly do we need it? What are the benefits? And what are the risks?

JUST AS WE COUNT
ON
the truthfulness and honour of blood donors, we also require it of the famous athletes whom we so revere, and from whom we draw hope and inspiration. Any superstar athlete who claims that his or her blood is clean, when it is not, runs the risk of creating a mighty scandal. At the intersection of honour and blood, we hold people to account. And so we should. If someone lies about blood being donated, people could die. If someone lies about racing clean on a bicycle or on the track, people will be shocked to the core. It is a matter fundamental to our sense of right and wrong.