Some Thoughts About Orlando
OneBlood in Orlando, ABC members from Florida to Hawaii and from Texas to Alaska extend condolences to all touched by the horror of the attack at Pulse last Sunday. We owe thanks to the blood donors whose willingness to extend their arms before, during, and after these events saved and will continue to support the lives of the victims. These words are a faint reflection of what is in our hearts, but if the survivors and their families and friends can know that it's from our hearts that we speak, that will be enough.
There are uniquely difficult circumstances associated with this attack on a gathering place for our LGBT friends. We are hearing expressions of the irony that allows gay men to become the targets of this horror, and then refuses them the solace of the most powerfully symbolic act of kindness available-giving blood. Members of the LGBT community have expressed a longstanding sense of discrimination against gay men with the historic lifetime deferral of men who have sex with men (MSM). We are said to act without medical and scientific justification. This is not hard to understand. However, that sentiment discounts the incredible precautionism and complexity that characterizes policies around transfusion safety that the American public demands and the Food and Drug Administration requires. Nothing we do can be seen as decreasing transfusion safety. First steps, the permanent deferral is being replaced with a one-year deferral following almost 15 years of our advocacy for change and based on data collected by the blood community. Data from ongoing blood community research initiatives will inform future revisions.
An alternative to deferral based on sexual identity-sensitive tests backed by explicit sexual behavioral screening and shorter deferral times-is proposed in the absence of an experience adequate to assure the FDA the result will be stable or improved transfusion safety. The emerging experience with behavioral screening, as opposed to sexual orientation, comes from environments far different from U.S. donor rooms and may not be generalizable. Short deferrals moving closer to the window periods seen with contemporary tests need validation from the study of large numbers of donors (millions) and are difficult to do. We are responding with limited resources to many issues of donor and recipient safety-donor reactions, donor iron depletion, and mitigating risk from non-infectious transfusion complications that are orders of magnitude more frequent than the current risk from HIV-we need to engage our stakeholders in evaluating novel approaches and to arrive at the most effective ways to select safe donors.
These are difficult issues, and no single answer satisfies us all. At the end of the day, the blood community can only ask for understanding and engagement. Those of you who cannot donate under current regulations will recognize that every qualified donor you find and send to your local blood center provides the same gift of life that saved lives on June 12, 2016.