Blood donation policy is updated, allowing gay and bisexual men to give

Dr. Robbie Goldstein donated blood two weeks ago for the first time in his life.

On Thursday, Dr. Jesse Ehrenfeld did the same.

Both have devoted their lives to medicine and public service. But until recently Goldstein, the commissioner of the Massachusetts Department of Public Health, and Ehrenfeld, the president of the American Medical Association, were barred from perhaps the simplest way they could help.

They couldn’t donate their own blood.

Both men are gay, and gay men in America have been banned from blood donations since the mid-1980s.

Back then, it made some scientific sense to keep gay men from donating. HIV, the virus that causes AIDS, had entered the blood supply and was passing to people who received transfusions. There was no way back then to rapidly screen donated blood to ensure the virus wasn’t present. The fear of HIV, then a certain death sentence, also affected public policy.

By 2005, the science had been transformed. Testing could rapidly identify HIV in blood with more than 99% certainty. The disease was readily preventable and treatable.

Yet the policy remained unchanged for nearly two decades.

“It’s hurtful when you should be able to do something so selfless and so important and you can’t because of a bad policy decision that is based in old evidence, stigma and discrimination,” Ehrenfeld said.

The back story
In 2015, Goldstein was a first-year infectious disease fellow at Massachusetts General Hospital just finishing a rough week of duty. The patients had been difficult and the care emotionally draining.

Sitting in the room set aside for medical fellows, his mentor Dr. Rochelle Walensky suggested they finish the week by donating blood together. Giving something that benefits someone else and that her own body can regenerate naturally helps her regain a sense of control after particularly stressful times at work.

"It was a startling moment in that dark fellows room to think of how insensitive I had been to the fact that Robbie couldn't give," said Walensky, who spent much of her career focused on HIV before recently completing a two-year stint as director of the Centers for Disease Control and Prevention.

She made him a promise that they would donate blood together some day.

It took eight years to make good on that promise, which finally happened two weeks ago.

The slow pace of policy change
The two, along with a colleague, Dr. Chana Sacks, co-authored a paper in 2016 in the New England Journal of Medicine to raise awareness about the problem.

But it took until Walensky was in federal office, with Goldstein as a key deputy, for them to help push through a regulatory change.

The policy had been profoundly unfair, they and others said, because it singled out gay and bisexual men while ignoring straight men who might be at equal or higher risk for carrying HIV.

On May 11, the Food and Drug Administration officially changed its policy allowing gay and bisexual men to donate blood as long as they have been monogamous for the previous three months.

On Aug. 7, the Red Cross announced it had changed its screening questionnaire, removing questions designed to single out men who have sex with men. Instead of asking about sexual orientation, the Red Cross now asks any would-be donor to wait three months after having had anal sex with a new or multiple sexual partners.

Dr. Amesh Adalja, a spokesperson for the Infectious Disease Society of America, said the policy still doesn't go far enough.

"The guidance and the questions should reflect the state of the art and not be holdovers from an older era where blunt tools were used because they had to be used and now they don't," said Adalja, a senior scholar at the Johns Hopkins Center for Health Security.

Current testing is so precise that the only people who might be missed are people who get infected with HIV while taking PrEP medication. The medication, given to prevent infection and to treat people who are infected, keeps viral loads so low that they may be undetectable by screening, Adalja said. But people with such undetectable viral levels are unable to transmit the virus anyway.

"You don't need to exclude people based on behavior when you have a diagnostic test that obviates those questions," he said.

The impact of the change
The Red Cross' blood supply nationally has fallen by about 25% since early August, with distribution of blood products outpacing donations, according to the Red Cross website. Although donations are typically low this time of year because of late summer vacations, experts say the problem is particularly acute because the work-from-home movement has made office blood drives less effective.

Adding gay and bisexual men to the donor pool is likely to increase the blood supply by about 4%, Ehrenfeld said. With each donation having the potential to save three lives, that increase works out to an extra 544,000 units on top of the typical yearly supply of 13.6 million units collected or potentially more than 1.6 million lives saved.

Ehrenfeld, an anesthesiologist at the Medical College of Wisconsin who uses blood products for his patients every day, said it was particularly tough for him to be prohibited from donating when his own son was born prematurely at 29 weeks.

"You always rely on the kindness of strangers," Ehrenfeld said, noting that blood donations can't be directed to a particular patient. "But to be pulled out (of donating) was a really, really difficult thing to grapple as we were watching our son."

Goldstein also writes regular requests for units of red blood cells or platelets.

"Every time I do it, I realize it's a precious resource and it's giving them life, and it's something I couldn't partake in before," he said on a recent Zoom call with Walensky.

The policy shift, he said, gave him a profound psychological boost.

"For my entire adult life, I'd been told by government that my blood wasn't clean, that my blood wasn't worthy."

Donating, he said, was "a really amazing moment."