The Effects of Disqualification: Society’s Role in the Blood Donation System

Donoghue300v3Description: Is donating blood a right or a privilege? Although blood donation might appear to be a somewhat simple process, only 38% of the United States population actually qualifies to participate. This project will explore the fairness of the qualifications that ban millions of Americans from donating blood by focusing on one of the most controversial regulations in the donation system today. This regulation protects recipients from HIV by prohibiting all men who have had sex with men, even once since 1977, from donating. Since the blood donation system has become increasingly safe for recipients due to medical advances in recent years, it is important to take into consideration the donor’s perspective and well-being. By examining the social and psychological effects that disqualification may have on a donor as well as the appropriate risk that all associated parties must accept, this project will assess the fairness of these regulations.

Introduction

Every two seconds, a patient somewhere in the United States needs a blood donation (“Blood Facts and Statistics”).  These recipients vary in age, gender, weight, experiences, and many other characteristics; however, they all have one thing in common – they must rely on a blood donor’s goodness to save their lives.  Similar to recipients, donors come in all different shapes and sizes, but unlike recipients, donors are subject to strict qualification standards.  Although there is a constant need for blood donors, only thirty-eight percent of the United States population is eligible to donate (“Blood Facts and Statistics”).  The strict guidelines regarding the blood donation system affect many individuals, both donors who are willing to give a part of themselves to benefit another human being, and recipients who are in need of a donation, every day.

The current qualifications, particularly those banning all men who have had sex with men (MSM) citing risk of HIV transmission, raise various ethical questions relating to both fairness and safety.  In terms of fairness, members of certain minorities are permitted to donate, while members of other minorities are not, even though they offer similar risk to the recipient.  This indirectly values certain individuals over others and defines a person’s identity by certain decisions they have made throughout their lifetime, such as choosing to have sex with a man.  Safety is an important issue, particularly in the medical community and blood donation system.  All parties associated with the donation system are expected to accept an appropriate risk, which is usually determined by researchers and scientists, because mathematically, risk could never be completely eliminated.  However, societal norms play a large role in the decision-making process as well.  In addition to helping to determine appropriate risk, societal norms affect individuals who desire to donate but do not qualify to give blood.  These ineligible individuals may be faced with negative social and psychological effects, due to their inability to become donors.  It is important to consider the importance of these regulations both inside and outside the system.  Negative social effects may result from the singling out of minorities for risk of HIV.  This can create negative social stigmas or connotations for these individuals in situations unrelated to blood donation.  Many members of society look to organizations such as the American Red Cross, the largest United States blood supplier to date, for medical statistics and research.  The statements published by these prevalent organizations are generally accepted as accurate, simply because they originate from trusted sources.  However, in a changing society, it is important to recognize the need to reevaluate regulations that have been in place for many years.

This paper examines the current regulations relating to HIV risk in the blood donation system.  It assesses the fairness of these regulations, as well as the safety of both donors and recipients alike.  Safety will be considered by observing statistics relating to risk factor and by determining an “acceptable appropriate risk.”  Lastly, it will observe the effects that unfair guidelines could have on donors, focusing mostly on social and psychological effects.  There are many types of unfair qualifications, but in terms of this paper, an unfair qualification is one that does not effectively benefit both the donor and the recipient in the best way possible.  It is important to consider multiple different perspectives when determining whether a qualification is fair.

Factual Background on Blood Donation

The most common type of donation in the United States is the donation of whole blood.  However, there are several other types of donations, including platelet, plasma, and double red cell donations.  Whole blood donation is the simplest type of donation, in which approximately one pint of an eligible donor’s blood is given (“Types of Donations”).  The donation itself takes around ten minutes, but the entire process requires about an hour of the donor’s time.  The donor then must wait fifty-six days before being eligible to donate blood again (“Blood Facts and Statistics”).  These donations usually take place at blood drives, donation centers, or other American Red Cross approved locations.  Many times, they are made in public settings, such as workplaces, schools, college campuses, or religious organizations.  The regulations discussed in this paper relate to anonymous donations, in which the donor does not direct their blood to a specific patient or place their donation into a bank for their own personal use in the future.  There are over nine million donors each year, but there is still a constant need for both donations and new donors.  This is partially due to the fact that the majority of donations are made by experienced donors who return to make donations regularly (“Blood Facts and Statistics”).

The qualifications placed on blood donation are organized into categories based on risk.  For example, individuals who weigh less than one hundred and ten pounds are not permitted to donate, because it is considered to be unhealthy for their bodies (“Eligibility Requirements”).  This paper focuses on the lifelong ban on MSM, intravenous drug users, and individuals who have taken money in return for sex, for risk of HIV transmission to the recipient.  While these groups receive lifetime deferrals, individuals who have come in close contact with a member of one of the groups receive a one-year deferral period (“Eligibility Requirements”).  This is considered to be acceptable because a person with HIV would most likely have experienced severe symptoms of the disease by this time, leading them to visit a doctor or get tested.

Before being transferred to a blood bank, all donated blood must pass through an extensive testing period for various harmful infections or diseases that could be transmitted to the recipient (“Blood Facts and Statistics”).  One of the most notable and important tests is the one for HIV, which is also known as human immunodeficiency virus.  HIV usually develops in three stages.  The first stage, acute infection, lasts between two and four weeks.  The second stage, clinical latency, is a period of dormancy in which the virus reproduces at an extremely slow rate.  The last stage, commonly referred to as AIDS, describes the period of time when the patient’s immune system reaches heightened levels of damage from the virus.  HIV never leaves a patient’s system and remains either active or dormant for the rest of his or her life.  There is no cure for this virus, but current treatment options allow for infected patients to live relatively normal lives with nearly normal life expectancy.  Advanced tests are able to detect HIV in a person’s system within days of infection.  However, some rare cases may take up to six months to become prevalent enough in the patient’s system to be detectable (“About HIV/AIDS”).  The current risk of HIV transmission from a donor to recipient through a blood transfusion is estimated to be approximately one in two million (“Blood Testing”).

The Centers for Disease Control and Prevention collect data relating to HIV diagnoses in the United States.  These statistics give researchers and scientists a basic idea of what groups of people are at increased risk of contracting HIV.  These findings are then used to determine which individuals should be considered eligible to donate.  Often times, cases are separated by transmission category, which place each individual case into a group that best represents what action most likely caused the transmission of the disease.  By transmission category, 63% of HIV diagnoses in 2010 were from the MSM community.  Additionally, 25% of diagnoses were from heterosexual contact, 8% of diagnoses were from intravenous drug uses, and 4% were from other categories (“HIV/AIDS Statistics Center”).  A similar study recorded these same HIV diagnoses across racial categories.  Blacks, who account for approximately 12% of the United States population, represented over 44% of HIV diagnoses.  In addition, Whites accounted for 31% and Hispanics accounted for 21% of diagnoses (“HIV/AIDS Statistics Center”).  Although MSM is one noteworthy group of individuals that have a high risk of HIV, there are several other groups at increased risk as well.  For example, Black heterosexual women, Black heterosexual men, and White heterosexual women have high risks of contracting HIV as well (“HIV/AIDS U.S. Statistics”).  MSM and Black heterosexual women are two examples of over-represented populations, because the number of diagnoses in this year was particularly high in comparison to the number of people who fall into this group.

Fairness

The ethical issue of fairness relates to commonly-used definitions of identity, as well as the valuing of members of certain minorities over others.  When assessing whether or not any given blood donation qualification is fair, it is important to question several different aspects of the rule, especially by looking at all associated parties’ perspectives.  For example, should individuals be grouped into broad categories based on identity or specific behaviors?  Additionally, should these same individuals be grouped based on risk of contracting any given disease, especially if the lifting of this ban would affect the risk factor on a miniscule level?

The current regulations group individuals from all different backgrounds, life stories, and experiences into relatively specific categories, based on certain behaviors.  All MSM, whether they identify with being homosexual, bisexual, or heterosexual, are permanently banned from the blood donation system.  Taking money in return for sex and using intravenous drugs are behaviors listed with the MSM qualification, because they also relate to risk of HIV transmission to the recipient (“Eligibility Requirements”).  Because the technical language does not use the term “homosexual” or “bisexual,” it desensitizes the action by referring to it as a behavior instead of an identity; this may be at odds with the views of many men, who see their sexual decision-making to be an integral part of their identities.  The term “MSM” refers to all men who have had sex with men, but not necessarily “homosexual men.”  Despite this definition, the majority of men who identify as being homosexual would fall into the category of MSM, therefore making this qualification more about the type of person and not the risk associated with the action.  Additionally, homosexual contact is no different from heterosexual contact in terms of risk of disease transmission.  However, HIV is more prevalent among the homosexual community, leading to the assumption that gay men are more prone to contracting HIV.  An example of this social norm outside of the blood donation system would be in a college admission’s office.  It is unethical for a college to deny admission to a student based on their sexual orientation.  Discriminating against MSM in this setting, whether it is based on the action itself or the identity of the candidate, would be considered wrong.  Rules against discrimination of homosexuals and bisexuals in situations like these were put in place to prevent systematic bias in society.  This raises the question of what makes the blood donation system exempt from these societal norms.  If college admissions offices are prone to systematic bias, then it could be assumed that blood donation systems would be as well.

Although this example is different from blood donation because there is no public health concern, it points out a relatively obvious assumption that people might accept without thinking about the consequences.  It is not right to discriminate against someone based on their identity.  The present discrimination against all homosexual and bisexual men in the donation system greatly affects this population by isolating members of society who identify with this group.  However, many people in the United States have already accepted the system of categorizing individuals based on behavior and personal choices.  For example, many car insurance companies charge customers more money for drivers under the age of twenty-five.  This is because young drivers are at higher risk of getting involved in car accidents than older, more experienced drivers.  In this case, the insurance rate is affected by a candidate’s age, which is a part of their identity at that point in time.  A person’s identity does not necessarily stay the same throughout the entirety of their life.  Although this young driver will eventually turn twenty-six and no longer face this bias, it is the concept of discrimination against an individual based on an uncontrollable factor that is notable for this situation.  Even though people have grown to accept this in certain settings, it is not necessarily ethical.  Although you can control your risk of getting into a car accident by driving safely, you cannot control your age.  Similarly, individuals can control risk of contracting HIV by practicing safe sex, but they are unable to control their sexual identity. Changes in societal norms and regulations are made every day, including rules governing discrimination and exclusion of individuals based on their identity.

The current regulations also group individuals based on their risk of contracting HIV.  It is unethical to single out an entire group of individuals based on increased risk factors that only some members of this group carry.  In this situation, it is assumed that any man who has ever had sex with another man is automatically at higher risk of contracting HIV than any heterosexual man or woman.  However, monogamous couples theoretically carry the same exact risk as all other monogamous couples, regardless of sexual orientation (Crary).  Therefore, there is a broad range of risk factors within the MSM category.

Members of certain minorities are permitted to donate blood in the United States despite having high risks of HIV infection, while members of other minorities are permanently banned.  This raises the question of whether or not society as a whole indirectly favors certain minorities, as well as certain social issues, over others.  For example, HIV is especially prevalent among Blacks, particularly heterosexual women (“HIV/AIDS U.S. Statistics”).  This group of individuals receives no type of deferral in regards to the blood donation system and is permitted to donate blood at any point in time.  Some might argue that the exclusion of heterosexual Black women from the blood donation system would be both racist and sexist, even though it would ultimately lower the risk of HIV transmission to the recipient.  Racism and sexism are two major issues that American society has worked to address and overcome in recent years.  Although they still exist, many people would have strong negative reactions to the disqualification of any given race or gender from an organization as widespread as the blood donation system.  Society has grown increasingly tolerant of homosexuality, especially in the United States.  However, despite recent changes, heterosexism is still a major social issue that is widely discussed throughout the United States today.  The system itself keeps gay and bisexual men out of the pool of donors, indirectly forcing recipients to refuse the blood of a homosexual man.  A person who is unwilling to receive a blood transfusion from someone who is Black would be considered racist and prejudiced by most Americans.  However, refusing the blood of a homosexual man has been a part of the United States’ blood donation system since the HIV epidemic.  This implies that it is wrong to deny a Black person’s blood, but it is acceptable to deny a homosexual’s blood.

The donation ban for MSM essentially treats an individual who is willing to donate their time and a part of themselves to benefit another living human as a product.  This is because researchers look at a pool of possible donors and remove any groups of people who might be considered to be “too risky.”  In this situation, they are making the blood as marketable as possible, by removing the risk in areas where it would be convenient to do so.  The placement of these individuals into broad groups based on identity or risk is unethical, especially when these categories are being used to determine an individual’s eligibility to take part in an activity.

Safety

The blood donation system was initially put in place for the sole benefit of the recipients.  The recipient is rightfully the ultimate priority in any type of donation, because, although donation is voluntary, need is involuntary (Ogilvie, Brooks, and AuBuchon 1).  In other words, while donors have the capacity to choose whether or not they wish to participate, recipients generally have little to no choice.  The concept of safety is usually first associated with physical well-being, focusing mostly on the prevention of physical harm to a person’s body.  However, the term “safety” can be used to describe mental health in addition to physical health.  Negative social or psychological effects that a person might experience fall into the category of mental health problems. Therefore, when considering safety, it is also important to think about an individual’s mental health.  Since the risk of a recipient experiencing physical harm from a blood transfusion has been virtually eliminated, it is reasonable to take into consideration the mental wellbeing of donors because they are an integral part of the blood donation system as well.

Lifting the ban on MSM would benefit many different stakeholders in this situation, including donors and recipients.  Recipients would benefit in the long-run, because more units of blood would be available for patients in need.  The need for blood is constant in medicine today, so any additional blood donations could greatly impact a recipient’s life.  Blood is in such high demand because it can only be transfused from a donor to a recipient; it cannot be artificially manufactured in a laboratory.  Also, over forty-one thousand units of blood are used daily for both emergency patients, such as victims of car accidents, and terminally ill recipients, such as cancer patients (“Blood Facts and Statistics”).  From the donor’s perspective, a prospective donor who has HIV may be properly diagnosed if their blood is tested for use in the blood donation system.  This person might not have known about their condition if had they not donated their blood and submitted it for testing.  An accurate diagnosis is particularly important because adequate treatment and medication for HIV patients is necessary for infected patients to survive (“About HIV/AIDS”).  While mental health is important, physical health will always take priority.  People who are not allowed to donate are not at risk for serious health issues or death.  However, recent studies suggest that mental health is of similar or even equal importance to physical health because poor mental health can often lead to poor physical health and harm (“Importance of Mental Health”).  It is also important to examine social and psychological effects on a disqualified donor because they allow for a more detailed depiction of the donor’s perspective.

I. Appropriate Risk

When choosing to participate in the blood donation system, all associated parties must understand and accept that there is risk involved in donating or receiving blood.  Over the years, the medical community has improved the testing process to such a degree that the risk of contracting HIV through a blood transfusion is less than one in two million (“Blood Testing”).  To put this into perspective, the odds of being killed by lightning are approximately one in 126,158; so any given individual is almost sixteen times more likely to be killed by lightning than contracting HIV through a transfusion (“Odds of Dying From”).  Although most people would like to have no risk at all, especially when people’s lives are at stake, risk can never be eliminated altogether.  Therefore, the medical community must establish an acceptable threshold of appropriate risk.

The current risk associated with blood donation is already miniscule; yet, it would shrink even more if additional minorities at high risk of HIV were excluded, such as heterosexual African American women.  So would we find it appropriate to take these measures, just to reduce risk even further?  Both the medical community and society needs to find an appropriate place to draw the line.  An acceptable appropriate risk would keep both the donors’ and recipients’ best interests in mind.  Additionally, it should not exclude any minorities unnecessarily.  In fact, it may be beneficial to accept a miniscule amount of risk in order to avoid discrimination against minorities in our society.  A study by the GMHC (Gay Men’s Health Crisis) in 2006 indicated that changing the lifetime ban on MSM to a one-year deferral period would increase the risk to recipients by one in forty-six million cases, which is equivalent to approximately one new case every thirty-three years (“Frequently Asked Questions”).  With an entirely new pool of donors and more blood units in the system, this miniscule increase in risk would benefit so many recipients who might not have received blood otherwise.

If the gap in priority between donors and recipients were to be decreased, both parties would greatly benefit.  The mental health of donors, who might have previously faced negative social or psychological effects from disqualification, would be protected.  Indirectly, more recipients would benefit from this change because more units of blood would be available for those who are in need.  By taking into account the ethical principle of utilitarianism, or the greatest good for the greatest number, the lifting of the MSM ban would be favorable.  Many individuals, both donors and recipients, would either directly or indirectly experience the positive effects that this change would entail.

II. Social Effects

There are many social effects that could potentially have a negative impact on prospective donors, particularly those who are excluded from participating in the blood donation system.  These individuals may come face-to-face with uncomfortable situations, in which they may feel pressured to share something about themselves that they might not have shared otherwise.  Ineligible people might fear being looked at differently by their peers or being discriminated against in the workplace, due to their sexual orientation or identity.  While there are countless different possible negative effects, it is important to focus on a few in particular that could be extremely detrimental or harmful.

Even though disqualification from donating blood should be a private matter, it can be difficult to keep this information confidential at a blood drive in a public setting, such as a school, workplace, religious function, or college campus.  It may also be difficult for a person to explain to their peers the reason why they are unable to donate.  This places disqualified donors, as well as those around them, in an uncomfortable situation.  Therefore, privacy and confidentiality should be an integral part of keeping the blood donation process as fair as possible.

A far more harmful possible outcome is disapproval of or discrimination against in a person’s place of work, school, or community (Van den Burg and Magnussen).  There are many religions that do not condone homosexuality.  At a blood drive held at a religious function, a homosexual or bisexual member of the community might not feel comfortable sharing this information with other members of the community.  They may fear being looked at differently or being disapproved of in an otherwise safe setting.  In terms of discrimination, disqualification in a workplace has the potential to negatively affect a donor’s performance at their job as well as some social aspects of their everyday life.  Many members of the LGBT community are not protected from discrimination in the workplace based on sexual orientation or identity by federal or state law.  Only twenty-one states have laws banning the discrimination of a worker based on sexual orientation.  An even smaller number of states prohibit the discrimination of a worker based on sexual identity.  Sexual orientation describes an individual’s personality traits or qualities, while sexual identity describes how an individual views himself or herself.  There are currently no federal laws protecting the rights of homosexual or bisexual individuals in the workforce (O’Keefe and Cillizza).  A prospective donor who fails to qualify for a blood donation at the workplace might fear losing his or her job or being denied a promotion if their coworkers or boss knew about their sexual orientation.  This could cause feelings of stress or anxiety for an individual in this situation.  Someone who does not receive a permanent deferral but chooses not to donate for some other reason may be faced with similar social effects.  For example, people around them might make assumptions about their lifestyle or identity, simply because they are not donating in a situation where others around them are doing so.

One way to examine the social effects that unfair qualifications could have on prospective donors is by looking at historical events that parallel this situation.  In February, 1990, the Food and Drug Administration issued an exclusion on all Haitian immigrants in the United States from the blood donation system, due to risk of HIV transmission (“Safer Blood, Fairer Policy”).  This was put in place during a time where many Americans did not fully understand causes of HIV/AIDS or the means of transmission from one infected person to another.  The decision to exclude Haitian immigrants was met with great opposition, because the majority of the excluded Haitians did not actually have HIV.  In New York City, there were only 550 Haitian-related HIV cases among the city’s total of 24,383 (Lambert).  Haitians were discriminated against and isolated due to the negative publicity that they received.  The Executive Director of the Haitian Centers Council in Brooklyn stated that, “In a public school in Brooklyn, after a ten-year-old Haitian girl used a telephone, they sprayed it.” (Lambert)  Statements like these partnered with new scientific findings on HIV resulted in a lifting of the Haitian ban from the blood donation system because it was considered to be unethical.  We can learn from past changes and mistakes in history.  The lifting of the Haitian ban may eventually pave a path for the lifting of another ban, such as MSM, that would be deemed unethical, similar to how other historical events led to changes in policy.

The major social effects that disqualification in a public setting can impose on prospective donors help demonstrate that these regulations are unethical.  Disqualified donors are placed in uncomfortable situations, in which they are given the option to either untruthfully donate anyway or reveal something to their peers that they might not have chosen to reveal otherwise.  It is unfair to put a person who is willing to give a part of himself to benefit another person in a situation such as this one.

III. Psychological Effects

Prospective donors who do not qualify can be negatively affected psychologically as well.  The reactions to disqualification can be observed by examining the possible psychological mindsets of prospective donors.  Disqualifying donors may face exclusion or feelings of unworthiness, leading up to stress or poor mental health.  There are four basic psychological mindsets that encompass most of the motivations for people to donate.  These can be found in the research of psychologists and bioethicists who study donation, such as Ingrid Velhuizen.  There are other theories on this topic, but these four ideas summarize one basic view of the donation system.

1. Attitude describes the logical, need-based motivation for prospective donors, such as the knowledge that donating blood is useful to others.

2. Self-Efficacy describes a person’s willingness to donate because they are able to do so.

3. Moral Norm describes a person that feels responsible to donate for various reasons, such as having a sick family member or coming in contact with someone who has needed a blood donation in the past.

4. Subjective Norm, which relates the most to this topic, states that the donor has chosen to donate because others think that it is important for them to do so (Veldhuizen).  This mindset is key to understanding the social pressures that many people face today, either directly or indirectly.  One common form of this pressure comes from one person verbally informing a prospective donor that they should donate.  However, a less common form of this pressure comes from a prospective donor being aware of others around them who are donating and feeling pressured to do the same.

Many people view blood donation as a relatively common and simple task.  In fact, organizations, such as American Red Cross, market donating as an easy and fulfilling activity, in order to attract more donors.  Even those who do not donate regularly or at all may still be of the opinion that donation itself would be somewhat easy.  However, many people are unable to participate in this “simple” task, due to deferrals of some sort.  Since blood drives are often held in public settings, such as workplaces, schools, religious functions, or other organizations, people may feel pressured to donate (Veldhuizen).  Peer pressure from friends, family members, and coworkers can often contribute to a person feeling a strong obligation to donate.  This psychological mindset, referred to as the subjective norm, subtly plays an important role in the disqualification of donors by making prospective donors feel that they should donate.  Because of this peer pressure, someone who is unable to participate in this activity due to a deferral might feel excluded from an activity.  They might also feel guilty saying that they will not donate when others think that they should.

Additionally, the exclusion of large groups of people based on risk of contracting a disease can lead to negative connotations or social stigmas against individuals belonging to these groups inside and outside the blood donation system (Galarneau).  Someone who feels devalued by the blood donation system may also be devalued by other members of society, simply because they are viewed as unworthy of something like blood donation.  Another example of exclusion in this situation can be found at a blood drive on a college campus.  Often times, blood drives are supported financially by student-run organizations or student activity boards.  A student who is ineligible to participate might feel as though this money is not being used for the benefit of all students in the community (Galarneau).

Unfortunately, society has grown to accept the fact that not every person is able to be involved in every organization, especially in schools.  For example, student-funding often goes to sports teams that not all students have the opportunity to participate in.  However, this case is different from a blood drive because individuals not directly involved with a sports team may still take advantage of the activities in other ways.  Students can attend sporting events or take part in pep rallies on campus, if they would like to get involved.  Blood drives differ in this way because there are very few opportunities available for disqualified persons to take part in.  Additionally, the members of the community who are chosen to participate in sports are included based on talent or ability.  It would be unfair to keep a player off a sports team based on their sexual orientation.  Blood drives are exclusive in ways that sports teams are not.  Colleges are the foundation of young adults in the United States, many of whom are vocally supportive of homosexuality.  Some colleges that fund blood drives excluding MSM are faced with protests and disapproval from large portions of the student body (Darling).

Those who receive deferrals from blood donation may feel unwanted by both the system as well as the recipients.  The blood donation system automatically keeps these individuals out and, therefore, recipients indirectly do not receive something valuable that a prospective donor is willing to offer them.  A deferred candidate may feel as though their blood is less worthy than another candidate’s blood.  In addition, someone who is allowed to donate may be viewed as more desirable in the eyes of the system or the recipients in comparison to a person who is deferred from donating.  After taking into consideration the vast array of possible negative psychological effects that disqualification can have on prospective donors, it is reasonable to bring about awareness of this situation that could eventually result in a change or lifting of unethical guidelines.

Conclusion

In terms of fairness, the current regulations placing lifetime bans on homosexual and bisexual men are both outdated and unfair.  It is unethical to classify an entire broad group of people into one specific category, especially when those categories are being used to determine someone’s eligibility to take part in an activity.  Even though the wording of the regulations does not specifically single out homosexuals, it is implied because often times a person’s sexuality is part of his or her identity.  Grouping individuals based on risk factor of contracting any given disease is also unfair, because it does not take into consideration exceptions to statistics, such as monogamous gay couples.  Statistics apply to large groups of people, but may not necessarily apply to one individual, or even the majority of individuals, within that group.

While it is acceptable to favor the recipient’s well-being over the donor’s well-being in a situation such as this one, the donor’s best interests should still be kept in mind.  A lifting of the MSM ban not only benefits the donors, but the recipients as well.  Donors would be shielded from unnecessary social or psychological harm; recipients would be shielded from potential physical harm that might have otherwise occurred due to a lack of usable blood donations.  Additionally, members of the community who have HIV may be properly diagnosed and treated if their blood is tested for HIV.  The increase in risk would be minimal compared to the miniscule risk that recipients already accept and face every day.

The negative social effects that disqualification in a public setting could potentially have on a prospective donor include, but are not limited to, discrimination in the workplace and disapproval from members of a community.  These issues could be detrimental to a person’s lifestyle and have the potential to greatly affect their everyday life.  Additionally, there are psychological effects that could affect a prospective donor’s mental health.  Although mental health is generally considered to be of less importance than physical health in many cases, it does still play a role in a person’s lifestyle and quality of life.  Poor mental health or excessive stress can also lead to physical health problems (“Importance of Mental Health”).

Instead of grouping MSM into one large category under HIV risk, it might be appropriate to state that any individual, regardless of gender or sexual orientation, that has had unprotected sex within a certain period of time is not allowed to donate.  This regulation refrains from singling out one gender or favoring heterosexuality.  It could also be beneficial because it removes candidates who are automatically at an escalated risk of contracting HIV, without making any possibly harmful generalizations about certain groups of people.  Additionally, changes could be made to blood drives or blood donation organizations to lessen the potential social harm.  For example, if disqualification was handled in a more discrete manner, fewer individuals would face negative social effects.

It is important to have guidelines, especially because recipients should remain the ultimate priority; but these guidelines should not objectify the donors, cause them any social or psychological harm, or violate certain intrinsic values.  Willing donors should not be turned away from donating blood based on their identity or their risk of contracting any given disease.  It is unethical to classify these individuals based on an action that can be directly linked to their identity, such as homosexuality and MSM, especially when determining that person’s eligibility for an activity.  The potential benefits to both the donors and the recipients of changing these regulations greatly outweigh the potential harm to recipients.

By Amanda Donoghue

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One Response to The Effects of Disqualification: Society’s Role in the Blood Donation System

  1. Amanda Donoghue says:

    What is your reaction to the current blood donor qualifications discussed in this paper? Do you have any suggestions based on the factors that you believe should be used?

    How do you think “acceptable appropriate risk” should be determined when it comes to the safety of the recipient?

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