Blood donor referral

Blood donor referral

Vamvakas EC. Scientific background on the risk engendered by reducing the lifetime blood donation deferral period for men who have sex with men. Transfus Med Rev. 2009 Apr;23(2):85-102.

The lifetime deferral for men who have sex with men has not been harmonized with the 12-month deferral for similar-risk activities through heterosexual contacts. This occurs primarily because of fears of increased transfusion transmission of known sexually and transfusion-transmitted viruses for which donor blood is (eg, HIV) or is not (eg, human herpesvirus 8 [HHV-8]) tested and also of fears of novel agents that may share the epidemiology and long asymptomatic phase of HIV. A 12-month men who have sex with men deferral could result in release of 1 HIV-infectious donation every 11 years in the United States. This risk is smaller than the risk from allowing the continued use of pooled whole blood-derived platelets (release of 1 infectious platelet dose every 1.67 years), a risk that is considered “tolerable.” Provided that measures to reduce the number of allogeneic-donor exposures to novel pathogens (which may be vector- or food-borne rather than sexually transmitted) are implemented, and the deferral for similar-risk activities through heterosexual contacts is extended to 5 years, a 5-year men who have sex with men deferral could be justified because of the interval between emergence of a novel pathogen and introduction of measures to protect the blood supply. Also, provided that measures to protect the blood supply from HHV-8 are implemented, a lifetime men who have sex with men deferral could be justified because of the uncertainty about the clinical consequences of transfusion transmission of HHV-8. Because such alternate measures, which would have had a greater impact on safety than the men who have sex with men deferral, have not been implemented to demonstrate a consistent approach to safety, maintenance of the current men who have sex with men deferral appears to be selectively precautionary and cannot be justified.

Editors’ note: Arguments have been advanced to harmonise the deferral periods for men who have sex with men with those for heterosexuals with similar-risk activities. Argentina, Brazil, Japan, Hungary, New Zealand, Russia, and South Africa have substituted a 1-, 5-, or 10-year deferral for the lifetime deferral of men who have sex with men. The USA, Canada, and the 19-nation European Blood Alliance maintain their current positions. This article argues cogently for a scientifically based, consistent approach to blood safety. It highlights the ramifications for blood safety of inconsistencies in national policies, arguing that the men who have sex with men lifetime deferral is selectively precautionary. More can be achieved by interventions to protect the blood supply against HHV-8 and by prohibiting the use of pooled whole blood-derived platelets. On balance, arguments can be made that extending the heterosexual deferral from 1 year to 5 years and harmonising the men who have sex with men deferral to 5 years would reasonably protect against an ‘HIV-like’ agent that could emerge in the future.