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Eligibility criteria for trans individuals

In August 2016, we added national criteria for trans blood donors. These criteria standardize the screening process for trans donors across the country. They also 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 2016, 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. In May 2017, we sharedthe summary report of what we heard from participants at those consultations.

Background

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.

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.  This risk was addressed when we made changes to our computer system in November 2016.

 

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 women 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 women were HIV-positive. For this reason, we must place trans women donors who have a male sexual partner in a high-risk category. As a result, a trans woman 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 broad 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 women 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 

What evidence are the criteria based on?

Unfortunately, there have been few studies on the trans population in Canada. The Centres for Disease Control and Prevention’s (CDC) “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, particularly for trans men, and HIV, particularly for trans women.
 

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 held a consultation meeting in Vancouver (November 2016) and another in Toronto (December 2016). In February 2017, we shared the summary report of those consultations with the participants.

Here is a partial list of organizations that have contributed to our discussions and with which we will continue to engage.  

  • Aplastic Anemia Myelodysplasia Association of Canada
  • 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 participants
  • EGALE Canada Human Rights Trust
  • Fierté Canada Pride conference participants
  • GBS-CIDP Foundation International (Guillain-Barré Syndrome/chronic inflammatory demyelinating polyneuropathy)
  • HAE Canada (hereditary angioedema)
  • International blood collection organizations
  • Members of Canadian Blood Services’ National Liaison Committee
  • Members of Canadian Blood Services’ Regional Liaison Committees
  • Volunteers and donors from Canadian Blood Services’ netCAD (Network Centre for Applied Development)
  • Nova Scotia Rainbow Action Project
  • Options for Sexual Health
  • Halifax Pride participants
  • Pride Toronto (and WorldPride) participants
  • tri-City Pride participants
  • Vancouver Pride participants
  • Pride Winnipeg participants