It cannot be underestimated simply how vital blood is for efficient healthcare provision. Of the quite a few therapies individuals depend on for his or her wellbeing, blood is essential for as many as 22 totally different therapies, together with surgical procedure, child-birth, emergencies, end-of-life care, and coverings for varied illnesses.
To satisfy this want, 5,000 day by day donations are wanted from blood donors within the UK. The goal is achieved by means of a small variety of beneficiant blood donors (roughly 3-4% of the eligible inhabitants donates blood at anyone time).
However in addition to retaining current common donors, there’s an ongoing have to recruit new ones. Evaluation means that there might be potential shortfalls in blood due to growing demand from an ageing inhabitants and a discount within the variety of younger donors.
Increasing the variety of potential blood donors to teams who’ve traditionally been deferred – equivalent to males who’ve intercourse with males (MSM) – is not going to solely create a fairer and extra inclusive blood donation system but additionally assist to handle demand.
The present place: who can provide blood?
In an vital transfer away from the present three-month deferral on MSM giving blood, new guidelines attributable to come into play this summer season will enable MSM who’ve had the identical companion for 3 months or extra to offer blood. MSM are at present deferred from donating blood until they’ve abstained from intercourse for 3 months (down from 12 months in 2017
Whereas the UK transfusion providers had been the primary on the planet to maneuver to a three-month deferral from 12 months, the principles have traditionally been perceived as unfair. Folks have argued that it’s the behaviours that folks interact in, no matter gender and sexuality, that needs to be the main target of choices to defer potential donors.
Although the preliminary rest of guidelines, to a three-month deferral, was a giant step ahead, the Division of Well being and Social Care requested but extra progress: a range strategy based mostly on the sexual behaviour of donors (reasonably than the intercourse of their companion). As such, the FAIR (For the Evaluation of Particular person Threat) steering group was arrange by the UKFORUM (which represents the 4 UK transfusion providers).
With a give attention to people’ sexual behaviour, the group’s intention was to evaluate dangers to the protection of the blood provide. It was additionally tasked with figuring out key inquiries to ask donors with the intention of creating suggestions to the federal government about altering the principles on blood donation.
System based mostly on behaviour, not sexuality
To offer proof for a possible transfer to guidelines based mostly on assessing sexual behaviour, the FAIR group checked out a mix of epidemiological and behavioural proof. Epidemiologists suggested on the target danger of an infection for various sexual behaviours whereas behavioural scientists offered recommendation on the perceived danger of various sexual behaviours, the frequency of these behaviours and the way acceptable individuals would possibly discover every query on their sexual behaviour.
The epidemiology group was comprised of Dr Su Brailsford (chair of the FAIR Steering group), Katy Davison, Claire Reynolds and Joe Flannagan from NHS Blood and Transplant and Public Well being England. Collectively, they thought-about proof on the target danger of blood-borne an infection from totally different sexual behaviours, an infection charges within the UK and the sexual behaviour of blood donors.
The behavioural science work was led by the group on the Faculty of Psychology, College of Nottingham: myself, Dr Claire Lawrence (now at Lawrence PsychAdvisory), Dr Naomi Pierce and Erin Dawe-Lane (now at Kings School London).
We explored how typically individuals reported participating in a sequence of sexual behaviours, how precisely individuals felt they and others might recall their sexual behaviour, how acceptable it will be for individuals to be requested questions on sexual behaviour, and if asking about sexual behaviour might doubtlessly deter donors.
We additionally checked out whether or not sexual behaviours are reported reliably normally, and perceptions of danger to affected person security when donors are chosen based mostly on sexual behaviour. These questions had been thought-about among the many non-donors, blood donors, MSM, donor employees and sufferers.
By gathering this knowledge, we had been capable of establish a set of gender-neutral questions that had been perceived as acceptable to ask, unlikely to discourage donors, and had been related to each the next goal and subjective danger of an infection.
These questions on sexual behaviour will likely be requested of each particular person volunteering to offer blood when the brand new guidelines come into power in the summertime of 2021. Individuals within the analysis additionally thought-about the proposed modifications to be truthful, thought they had been wanted and had been a possible method to encourage extra new donors. They had been thought-about unlikely to extend danger to sufferers.
Proof and suggestions for a brand new strategy had been offered to the federal government’s Advisory Committee on the Security of Blood, Tissues and Organs (SaBTO) for analysis on October 2020. They had been subsequently accepted by the Division of Well being and Social Care in December 2020.
UK transfusion providers are world-leading in being the primary to take an strategy based mostly on the sexual behaviour of all donors. Different international locations together with the US, Canada and New Zealand are additionally contemplating the same shift of their guidelines.
Enjoyable the principles is a serious step ahead in direction of creating a good blood donor system for all and we’re very pleased with this achievement and our involvement in it. The ability of the FAIR mission to supply proof to help this landmark change lay partly in combining epidemiology, behavioural science and interesting wider stakeholder teams. Different international locations that want to help related change may additionally now undertake such an strategy.
Eamonn Ferguson receives funding from UKFORUM, NHSBT, Versus Arthritis, BBSRC, Pfizer