In August 2016, we added national criteria for trans blood donors. These criteria will standardize the screening process for trans donors across the country and allow for their eligibility assessment to be the same no matter where they donate.
In November 2016, we updated our computer system so that donated blood components can be properly processed to reduce the risk of transfusion-related acute lung injury (TRALI).
In November and December, we hosted in-depth and solution-focused consultations with thought leaders in the trans and gender non-binary community to determine how we can screen donors in a way that is as respectful as possible, without putting recipients at risk.
Over the last few years, a small but increasing number of potential donors have identified as trans. These donors were not screened using national and standardized criteria. As a result, trans donors faced great uncertainty whenever they came to a clinic to donate.
We recognize that being turned away from a blood donor clinic can leave a donor feeling hurt and rejected. This is especially true of blood donation because it is a purely altruistic gift.
There is, however, no international consensus on blood donation criteria for trans individuals. Many blood collection organizations appear to have a blanket deferral for trans individuals, or have not publicly shared their criteria. While practice varies in the U.S., several large blood collection agencies currently use sex assigned at birth to determine eligibility of trans donors.
There is little information available on the safety of subgroups of trans individuals and blood donation.
Canadian Blood Services is dedicated to providing the safest possible blood to transfusion recipients. Donor criteria that affect recipient safety are based on the best available scientific evidence. And, these criteria must be approved by Health Canada, our regulator.
Two main safety concerns apply to trans donors:
Risk of TRALI
TRALI is a rare but potentially fatal complication that can occur in recipients after transfusion. Donors who have had a past pregnancy, including miscarriages and abortions, are more likely to have antibodies present in the liquid portion of their blood (plasma) that may cause TRALI in a recipient. To reduce this risk, we process blood donations from all donors coded as female in our computer system differently from donations from donors coded as male. The plasma from female donors is used to produce products such as immune globulin, instead of being transfused directly to patients.
Risk of transmission of HIV
There is very little information available on the risk of HIV in trans individuals in Canada, as they are not included in a separate risk category by the Public Health Agency of Canada in their annual reports of HIV and AIDS in Canada. However, in a review of available studies, the prevalence of HIV in trans females in five high-income countries, including the U.S., was 22 per cent. In another review, focusing only on U.S. studies, 28 per cent of trans females were HIV-positive. For this reason, we must place trans female donors who have a male sexual partner in a high-risk category. As a result, a trans female donor will be ineligible to donate blood for one year since her last sexual contact with a male sexual partner. As with all of our donors, eligibility is not based on an individual risk assessment, but rather on assigning donors to a risk category.
Blood donation eligibility criteria
Donors who have not had lower gender affirming surgery:
Donors will be asked questions based on their sex assigned at birth. They will be eligible to donate or be deferred based on these criteria. For example, trans females will be asked if they have had had sex with a man in the last 12 months. If the response is yes, they will be deferred for one year after their last sexual contact with a man.
Donors who have had lower gender affirming surgery:
Donors will be deferred from donating blood for one year after their surgery. After that year, donors will be screened in their affirmed gender.
Frequently Asked Questions
Unfortunately, there have been few studies on the trans population in Canada. The CDC’s “HIV Among Transgender People” (April 2016), which summarizes information from the U.S. and European countries, states that studies reveal HIV prevalence rates of 22 per cent to 28 per cent among trans women in the U.S. and other high-income countries. The fact sheet, “What are transgender men’s HIV prevention needs?”, prepared by experts from the Ontario Gay Men’s Sexual Health Alliance, and “What are transgender women’s HIV prevention needs?”, prepared by experts from the University of Minnesota, provide recent, clear summaries of what is known about HIV risk in these population groups.
How do the criteria compare to the U.S.?
To our knowledge, there are no uniform criteria in place in the U.S. However, based on our correspondence with medical directors at several large U.S. blood collection organizations, many are currently using sex assigned at birth to determine donor eligibility. Their concerns are similar to Canadian Blood Services’ in terms of the risks of TRALI and HIV, particularly for trans females.
What consultations have taken place within the LGBTQ community?
We were fortunate to receive input from the LGBTQ community before submitting our application to Health Canada to change the blood donation eligibility criteria for men who have sex with men (MSM) and for trans individuals in March 2016. We consulted widely and in a variety of ways, including webinars, phone conversations and face-to-face meetings.
Although the focus of discussion was the donation criteria for MSM, the participants from LGBTQ organizations were also provided with the proposed screening process for trans donors described above. All of our consultations have included LGBTQ representatives as well as representatives of patient groups who receive large amounts of blood products.
We have heard from some people in the trans and gender non-binary community that our screening processes should change. We would also like to do better. We are committed to working with the trans and gender non-binary community to improve how we interact with donors. This is why we are holding a consultation meeting in Toronto and in Vancouver in November and December of this year.
Here is a partial list of organizations that have contributed to our discussions and with which we will continue our work on our criteria:
- Aplastic Anemia Myelodysplasia Association of Canada
- Calgary Pride
- Canadian AIDS Society
- Canadian Centre for Diversity and Inclusion
- Canadian Centre for Gender and Sexual Diversity
- Canadian Federation of Nurses Unions
- Canadian Federation of Students
- Canadian Hemophilia Society
- Canadian Immunodeficiencies Patient Organization
- Canadian Immunodeficiency Society
- Community-Based Research Centre for Gay Men’s Health
- Community champions — ally clinic recruiters and promoters
- Dalhousie University Blood Club
- Edmonton Pride
- EGALE Canada Human Rights Trust
- Fierté Canada Pride
- G.L.O.W. (Gays and Lesbians of Waterloo)
- GBS-CIDP Foundation International (Guillain-Barré Syndrome/chronic inflammatory demyelinating polyneuropathy)
- HAE Canada (hereditary angioedema)
- International blood collection organizations
- Kidney Foundation of Canada
- Members of Canadian Blood Services’ National Liaison Committee
- Volunteers from Canadian Blood Services’ netCAD (Network Centre for Applied Development)
- Nova Scotia Rainbow Action Project
- Options for Sexual Health
- Pride Halifax