Canadian Blood Services
Canadian Blood Services is a non-profit charitable organization that is independent from the Canadian government. The Canadian Blood Services was established as Canada's blood authority in all provinces and territories except for Quebec in 1998. The federal, provincial and territorial governments created the Canadian Blood Services through a memorandum of understanding. Canadian Blood Services is funded mainly through the provincial and territorial governments.
Canadian Blood Services is a health-care system that is part of Canada's broader network of systems, and it is currently the only organization that is funded by Canada's provincial and territorial governments for manufacturing biological products. In addition to providing blood and blood products, the organization also provides transfusion and stem cell registry services on behalf of all provincial and territorial governments besides Quebec. All provinces and territories are able to access the national transplant registry for inter-provincial organ sharing and related programs.
It has a unique relationship with Héma-Québec, the provincial blood system operator that provides products to patients and manages Quebec's stem cell donor registry. The two organizations work closely to share blood products in times of need and collaborate regularly to share information, insights and data.
There are several reasons why individuals can be deferred from donating blood, including intravenous drug use, living in the UK for certain periods of time, coming from an HIV-endemic country, and engaging in activities that confer a high risk of HIV.
Canadian Blood Services has been criticized for moving away from an unpaid voluntary donor model towards a commercial model based on monetary incentives for donation.
Blood testing
Canadian Blood Services has a multi-tiered system to measure the safety of their blood supply. Before donating, donors are first screened for their health.The screening process for prospective donors includes:
- Making sure the donor is healthy by asking if they have the flu, sore throat, fever or infection
- What medications the donor is taking
- If they have had a vaccination within the last three months
- Questions about their medical history
- Questions about their travel history
- Questions about their lifestyle
Blood donation from men who have had sex with men
Policies that banned gay men from donating blood and tissues were first introduced around the world in the mid-1980s. These policies were introduced after the emergence of several reported cases of severe immune deficiency among gay men in the United States at the end of 1981. In June 1982, an increase in the cases of immune deficiency was reported among several groups of gay men in Southern California. This led many to believe that the cause of the immune deficiency was linked to the sexual transmission of infections agents. Furthermore, because many thought that the immune deficiency was only prevalent among gay men, the disease was initially called Gay-Related Immune Deficiency. Hence, in the mid-1980s, the predecessor of the Canadian Blood Services—the Canadian Red Cross Blood Transfusion Service—introduced a blood donor restriction on men who have had sex with men as of 1977, on the grounds of protecting the blood supply from HIV infection.In 2006, Canadian Blood Services began conducting a thorough review of the blood donor restrictions on MSM; however, in 2007, the board of directors concluded that the restrictions were to be maintained. Upon this conclusion, Canadian Blood Services was encouraged to continue gathering more information on the subject. In 2010, the Ontario Superior Court—in response to the Charter of Rights and Freedoms challenge which was launched in 2002—ruled that the deferral criteria for MSM were not discriminatory as they were based on health and safety considerations. In 2011, the Canadian Blood Services' board of directors approved plans to remove the permanent deferral for MSM, and instead, agreed towards a defined term of not more than 10 years but less than five years since last sexual contact.
On May 22, 2013, Canadian Blood Services announced that the deferral period as prescribed and enforced by Health Canada for MSM would be decreased from a ban for "even once since 1977" to "five years from last MSM activity" by the summer of 2013. The new policy came into effect on July 22, 2013. In June 2016, Canadian Blood services announced that Health Canada had approved its request to shorten the MSM ban from five years to one year, with this policy change to take effect on August 15, 2016. In 2019, Canadian Blood Services amended their policy again, after Health Canada had approved their request to reduce the waiting period for MSM donors from one year to three months. Canadian Blood Services plans to remove the ban by the end of 2021.
In April 2022, the Canadian Blood Services announced that by September 30, 2022, the 3-month deferral period would be scrapped and replaced with a policy inquiring if donors engage in any higher-risk sexual behaviours, regardless of sexuality. Monogamous individuals would be able to donate blood without any waiting period whatsoever. The UK has a similar blood donation rules implemented in 2021.
On September 11, 2022, this new sexual behaviour-based screening was implemented for all donors, regardless of gender or sexual orientation. The previous questions regarding MSM were replaced by two new questions. The first asks whether the donor had a new sexual partner in the last 3 months, and the second, whether they had more than one sexual partner in the same period. If the answer is yes to any of the two questions, then there is a follow-up that asks whether they had anal sex in the same period. If they have, then a 3-month deferral period is required.
MSM policy reasoning
Canadian Blood Services aims to keep their policies as minimally restrictive while also keeping their blood supply safe. Data from HIV in Canada-Surveillance Report in 2017 stated that MSM adults are the largest portion of new HIV infection in Canada at 46.4%. Eligibility is determined by the most current evidence-based research available. Canadian Blood Services stated that the 3-month waiting period existed because HIV is not detectable shortly after infection with their current testing technologies.MSM policy criticism
Many critics say that Canadian Blood Services should be using a screening model that evaluates risky behaviour that may result in HIV, not based on an individual's sexuality. If a gay man is having unprotected anal sex in a committed monogamous relationship, they are less likely to be HIV positive than a man with secondary sex partners. All donations go through HIV testing and the approximate nine-day window where HIV goes undetected is the same for a gay man and a heterosexual man.MSM policy change
In September 2022, the Canadian Blood Services renounced their previous policies on MSM, opting instead for a gender and sexual orientation-neutral questionnaire that only asks if the donor had anal sex with new or multiple partners in the previous 3 months. Canadian Blood Services stated that the long period for the implementation of the new sexual behaviour-based screening was due to a strict evidence-gathering process that was later delivered to Health Canada for approval. Canadian Blood Services also justified the new focus on anal sex with new or multiple partners by stating these sexual behaviours statistically increase the chance of HIV transmission per sex act, compared to vaginal and oral sex.MSM Research Grant Program
The Canadian Blood Services, in partnership with Héma-Québec, manages the MSM Research Grant Program. This program is funded by contributions from Health Canada, which has made a $3-million investment in the research program. The objective of the MSM Research Grant Program is to generate a body of evidence-based research to help develop and inform alternative screening approaches for blood or plasma donors, thereby helping to ensure a more inclusive donor screening process for the Canadian blood system. The MSM Research Grant program is anticipated to help evolve and inform the current eligibility criteria for MSM, while maintaining and ensuring the safety of the Canadian blood supply. As of November 2018, the MSM Research Grant Program funds a total of 15 research projects.Blood donation from trans individuals
Previously, there was ambiguity regarding the screening process for trans donors before the national criteria were implemented. On August 15, 2016, Canadian Blood Services' new eligibility criteria for transgender people came into effect. According to these criteria:- Donors who have had lower gender affirming surgery will be deferred from donating blood for three months after their surgery. They will then be screened in their affirmed gender after three months.
- Donors who have not had lower gender affirming surgery will be asked questions based on their sex assigned at birth and will be eligible to donate or be deferred based on these criteria.
- Risk of Transfusion-related acute lung injury, particularly from trans men. It is more likely for donors who have had pregnancies in the past to have antibodies present in their blood plasma that can cause TRALI in a recipient, which is rare but potentially fatal. In order to reduce this risk, instead of transfusing plasma protein from donors at risk for TRALI directly to patients, their plasma are used to produce plasma protein products.
- Trans individuals in Canada are not included in a separate risk category in the HIV and AIDS annual reports by the Public Health Agency of Canada. Therefore, trans women donors who have not had lower gender affirming surgery are placed in a higher-risk category if they have had a male sexual partner.