By Melanie Fleming
The Blood Bank of Hawai‘i makes several visits to the University of Hawai‘i campuses to collect blood from student donors. In the beginning of 2010, Lance Sabado, a student of University of Hawai‘i at Mānoa, tried to donate blood at Windward Community College.
“I feel like everybody should help.” Sabado said. “To me, if it’s something that doesn’t affect your health and if anything it helps someone else then it’s something you should do. If it’s not hurting you but helping others than why not?”
While reading the questionnaire that all donors complete before giving blood, he came across a question asking whether he has had sex with another man.
“My initial reaction was, are they serious?” Sabado said. “I didn’t really feel like it mattered. I didn’t think it would affect anything. It shouldn’t really matter because they are going to test the blood,”
Sabado wasn’t told that he was deferred but instead was told that blood samples were going to be taken. He wasn’t made aware of why the question referring to men who have had sex with men was being asked.
“I knew if you were anemic, which made sense to me, that they wouldn’t take blood from you, so that was the only restriction that I was aware of, but beyond that I had no idea that sexuality came into play or sexual preference,” said Sabado.
Following Sabado’s visit to the Blood Bank, a friend unaware of his previous attempt to donate, asked him to donate blood.
“I want to, I do really want to help but I’m not allowed to…because I’m gay,” said Sabado.
A policy enacted by the Food and Drug Administration in 1982 has become a law that requires that men who have had sex with other men after 1977 have a life –long deferral from donating blood, a policy the Blood Bank of Hawai’i the has to follow.
“Their [FDA] deferrals are actually put into the code of federal regulations so they are actually federal law,” said Blood Bank Associate Medical Director Dr. Randy Covin.
The policy was enacted because of inadequate testing for HIV during the AIDS epidemic. According to the FDA, gay men are more likely to contract HIV.
The Blood Bank of Hawaii, a member of America’s Blood Centers, is licensed and regulated by the FDA. The ABC is the nation’s largest network of independent non-profit blood centers that collect 40 percent of the nation’s blood supply.
“We [Blood Bank of Hawaii] need a license from the FDA also to be able to operate, so no donor center ever knowingly breaks federal law or the FDA’s deferral,” said Covin.
Improvements have been made in testing blood for diseases such as HIV, Hepatitis B, Hepatitis C, West Nile Virus and Chagas disease. A Nucleic Acid Test is being used to specifically test for HIV and Hepatitis C.
“It is the most sensitive test that we have,” said Colvin.
Tests are not 100 percent reliable, so other safety precautions are taken. A donor must fill out an extensive history questionnaire. These questions are developed with input from the U.S public health service.
“I knew I was HIV negative. I had gotten tested recently before that,” said Sabado.
A window period is the time between the exposure of a virus and the time it takes for a laboratory test to be able to detect infection in a person’s blood.
“Why we have a lot of those deferrals based on medical history is because we know that tests aren’t perfect.” Covin said. “They are very, very good but they are not perfect. One thing that we worry about is a thing called the window period.”
According to a report in September 2010 by the CDC, men who have sex with men are the only risk group in the U.S. in which the annual number of new HIV infections is increasing. MSM accounts for 53 percent of new HIV infections in the U.S. each year.
Sabado said, “HIV is a universal risk so it shouldn’t matter if one risk group is higher. If you’re testing the blood then it doesn’t matter who is giving the blood.”
There are multiple steps to help keep the blood supply safe. The Blood Bank of Hawai‘i only accepts volunteers and never pays for donors. There is a checklist for past donors to ensure that someone who was deferred has been cleared from their deferral. People are discouraged from using the blood bank to test themselves for HIV. A list of labs where someone can get tested anonymously is provided by the Blood Bank.
Blood is quarantined electronically and stored in a separate place until it is safe to release. Tests are taken and forms are checked before a label is put on it to be released to the hospitals.
“A quarantine release error is when you had something in quarantine because you didn’t want to release it, but somebody accidentally took it and sent it out anyway,” said Covin.
QREs refer to the accidental release of the blood supply before it could be cleared as safe for transfusion. Records of these errors are confidential and handled internally. There is a protocol to be followed; the blood center has to notify the hospitals, do an investigation to find out why it happened and report it to the FDA.
In 2006, America’s Blood Bank, ABS, and the Red Cross filed a joint statement before the Advisory Committee on blood safety and availability regarding the FDA policy.
“The groups that were part of the ABB and the America’s Blood Centers, and the Red Cross as well, they are about another 40 to 45 percent of the blood supply, are constantly asking the FDA to reconsider it.” Covin said. “I wouldn’t be surprised if some point in the future, I just don’t know how long, that something will change, but all I can say right now is that they have at least agreed to look at it which they have never done before.”
The need for blood donors is strong because of the limited storage period, known as shelf life, of the blood. 12 to 16 million units of blood are transfused nationwide every year naturally.
“Red blood cells, we store in the refrigerator. They are only good for up to 42 days and the platelets are only good for five days. And so we always need a constant new supply of blood because it’s only good for so long,” said Covin.
Effective Nov 7, 2011, the U.K. will change its lifelong ban on men who have had sex with men to a deferral of 12 months from the last sexual activity.