Blood and Tissue Donation by LGBTQ+ Individuals
43,200 people need life-saving blood transfusions every day in America. There is a significant shortage of blood, tissue, and organ donations that results in deaths each day. Unfortunately, antiquated policies stigmatizing the LGBTQ+ community in the United States are partially responsible for this shortage.
The Original “Gay Blood Ban”
For 33 years, starting with the dawn of the AIDS epidemic, there was a lifetime ban on blood donations by gay and bisexual men. Men who had ever had sex with another man were banned from donating blood not just for a period of time, but their entire lives. Tissue donation was less restrictive. There was no lifetime ban. Men who had had sex with another man in the five years prior to the time of offering to donate were ineligible.
These restrictions were written around the same time that transmission of HIV began to be criminalized. Numerous states continue to maintain these criminal laws, which are intended to punish HIV-positive individuals for allegedly exposing others to the virus even if precautions are taken to avoid it. In many of these jurisdictions, someone who donates HIV-infected blood, tissue or organs can still be criminally prosecuted.
During the early days of the AIDS epidemic, HIV testing was slower and less accurate, and officials were concerned that someone could be infected without showing up as HIV positive on a blood test. However, at this point, tests can detect the presence of HIV in as few as nine days after infection.
The Revised Guidelines
In May 2023, the Food and Drug Administration (FDA) finalized a recommendation that donor eligibility be assessed on an individual risk basis instead of using time-based deferrals specific to men who have sex with men (MSM). Under a 2015 policy, gay and bisexual men were required to affirm that they had not had sex with other men for three months, and sexually active gay and bisexual men could not donate. This meant that sexually active gay or bisexual men who were married or in a monogamous relationship could not donate. This is no longer the case under the FDA's 2023 recommendation. Under the new policy, donors are evaluated using individual risk-based questions that are the same regardless of the donor's sexual orientation, gender, or sex.
The new recommendations allow more gay and bisexual men the opportunity to donate blood, including those individuals in monogamous relationships. Prospective donors who report specific conditions that could make HIV detection less certain, such as having a new sexual partner in the past three months (there is a window period for detection of HIV by nucleic acid testing), will be deferred under the new policy. People taking medications to treat or prevent HIV infection will also be deferred due to concerns about delayed detection and the differences between sexual transmission and transfusion transmission.
Blood and Tissue Donations by Transgender Individuals
How does the policy affect the transgender community? Historically, the FDA had an incoherent policy in which the sex of a donor was determined at birth for purposes of establishing eligibility to donate. However, in a section of the policy guidelines issued at the end of 2015 entitled “Nonbinding Recommendations,” the FDA recommended to donation facilities that male and female gender be self-identified and self-reported. This is a recommendation, but because it is “nonbinding,” it is not clear that all donation facilities will appropriately implement the recommendation. Facilities can choose to adopt more “stringent” donation guidelines if they wish. Further, those who were previously identified according to their assigned birth gender will continue to be deferred if they meet other current criteria for donor deferral.
