The 5-year deferral period – a vestige of the past

GroupPhotoMaxime Billick, Jeremy Cygler, Gabriel Devlin and Bellal Jubran are all third year medical students at McGill University

 

We are four fresh and eager medical students just beginning clerkship, but we can already attest to the importance of blood in medicine. We use blood to bring back patients from the brink of death in the operating room. We use it to treat patients with sickle cell disease on the medical wards. We use it to advance scientific knowledge in the research lab. Yet the policies that govern how we collect donated blood remain woefully antiquated.

In 1983, the Canadian Red Cross instituted a lifetime blood donation ban for any man who had engaged in sexual contact with another man. In 2013, this was modified to a five-year deferral since the last sexual encounter. These policies were put in place in the 1980s by the Canadian Red Cross (predecessor to the Canadian Blood Services and HĂ©ma-Quebec) to protect the population during the rise of the HIV epidemic. At the time HIV was largely unknown, testing methods were poor, and the medical and general population were in a state of veritable panic. Since then, the context for HIV and affected populations has changed substantially. Current testing methods used to screen for HIV in blood products have sensitivities and specificities upwards of 99%. The risk of an infected blood product entering the blood pool is now so small that it cannot be measured directly but must instead be extrapolated from mathematical models. However, Canadian blood donation policy remains antiquated. Men who have sex with men (MSM) are still unnecessarily excluded from donating blood and are not permitted to do so within five years of sexual contact, despite a strong body of evidence illustrating that a one-year deferral policy is equally safe. Countries worldwide have adopted one-year deferral periods; they include the UK, Australia, Japan and Brazil. A study conducted in Australia showed that this change in policy was not associated with an increased risk of HIV infection from blood products. Closer to home, after a comprehensive review of existing evidence - both published and unpublished - the FDA stated that the United States would be adopting a one-year deferral period as well.

When originally implemented in 1983, the ban on blood donations for MSM was an understandable reaction to an emerging epidemic and a lack of effective screening tools and treatment. However, these barriers no longer apply. Antiquated and unfounded, these policies merely fuel the marginalization of MSM. HIV now affects an increasingly heterogeneous population, yet in the public eye it is still construed as a disease of gay and bisexual men.

As future physicians, we would never want to put our patients in harm's way. Current policies are simply not based on best available evidence. Changing to a one-year deferral period, with the eventual goal of moving to individual risk assessment, would reflect evidence-based practice, increase the dwindling blood supply in Canada, and begin to dismantle the remnants of institutionalized stigma against MSM within the healthcare community.

Together we wrote a position paper advocating for the implementation of a one-year deferral policy in Canada. After presenting the paper to the Canadian Federation of Medical Students (CFMS), it was endorsed and now represents the official stance of all 8000 medical students in this country. Significant change, however, will require a much stronger coalition, and we now seek the support of the Canadian population at large. Scientific and societal change occur in tandem and are deeply intertwined. The scientific evidence on this issue is clear, but true policy reform requires community action. We ask that you join us in this movement as we continue to advocate. We look forward to the day when we can proudly donate blood in Canada.

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