Trans individuals
We are committed to working with members of the trans and gender non-binary community to determine how we can screen donors in a way that is as respectful as possible, without putting recipients at risk.
Donors who have had lower gender affirming surgery
will be deferred from donating blood for three months after their surgery. After three months, donors will be screened in their affirmed gender.
For more information and to see if you are eligible to donate, please call 1 888 2 DONATE (1-888-236-6283) to speak directly with a registered nurse. Your call is private, and your personal information is protected.
Donors who have not had lower gender affirming surgery
will be asked questions based on their sex assigned at birth. They will be eligible to donate or be deferred based on these criteria.
For more information and to see if you are eligible to donate, please call 1 888 2 DONATE (1-888-236-6283) to speak directly with a registered nurse. Your call is private, and your personal information is protected.
Screening of trans donors
Two main risk factors are considered as part of the trans donor screening assessment:
Risk of TRALI
TRALI is a rare but potentially fatal complication that can occur in recipients after transfusion. Donors who have had a past pregnancy, including miscarriages and abortions, are more likely to have antibodies present in the liquid portion of their blood (plasma) that may cause TRALI in a recipient. To reduce this risk, we process blood donations from all donors coded as female in our computer system differently from donations from donors coded as male. The plasma from female donors is used to produce products such as immune globulin, instead of being transfused directly to patients.
Risk of transmission of HIV
Trans individuals are not included in a separate risk category by the Public Health Agency of Canada in their annual reports on HIV and AIDS in Canada. For this reason, we must place trans women donors who have not had lower gender affirming surgery and who have a male sexual partner in a higher-risk category.
As with all donors, eligibility is not based on an individual risk assessment, but on whether a donor is in a broad risk category. All donors must meet all eligibility criteria to donate blood for patients with Canadian Blood Services.
We recognize that being turned away from a blood donor clinic can leave a donor feeling hurt and rejected. This is especially true of blood donation because it is a purely altruistic gift.
There is no international consensus on blood donation criteria for trans individuals. Many blood collection organizations appear to have a blanket deferral for trans individuals. Some have not publicly shared their criteria. While practice varies in the U.S., several large blood collection agencies currently use sex assigned at birth to determine eligibility of trans donors.
Canadian Blood Services is dedicated to providing the safest possible blood to transfusion recipients. Donor criteria that affect recipient safety are based on the best available scientific evidence. These criteria must be approved by Health Canada, our regulator.
Frequently asked questions
What evidence are the criteria based on?
Unfortunately, there have been few studies on the trans population in Canada. The Centres for Disease Control and Prevention’s (CDC) “HIV Among Transgender People” (April 2016), which summarizes information from the U.S. and European countries, states that studies reveal HIV prevalence rates of 22 per cent to 28 per cent among trans women in the U.S. and other high-income countries.
How do the criteria compare to the U.S.?
To our knowledge, there are no uniform criteria in place in the U.S. However, based on our correspondence with medical directors at several large U.S. blood collection organizations, many are currently using sex assigned at birth to determine donor eligibility. Their concerns are similar to Canadian Blood Services’ in terms of the risks of TRALI, particularly for trans men, and HIV, particularly for trans women.
How will trans donors who have not had gender affirming surgery be impacted?
Donors who have not had lower gender affirming surgery will be asked questions based on their sex assigned at birth. They will be eligible to donate or be deferred based on these criteria. For example, trans women, who have not had lower gender affirming surgery, will be asked if they have had had sex with a man in the last three months. If the response is yes, they will be deferred for three months after their last sexual contact with a man.
What consultations have taken place within the LGBTQ community?
Over the past several years, we were fortunate to receive input from the LGBTQ community to help inform our application to Health Canada to change the blood donation eligibility criteria for men who have sex with men (MSM). We consulted widely and in a variety of ways, including webinars, phone conversations and face-to-face meetings. Our consultations have included LGBTQ representatives as well as representatives of patient groups who receive large amounts of blood products.
We have heard from some people in the trans and gender non-binary community that our screening processes should change. We would also like to do better. We are committed to working with the trans and gender non-binary community to improve how we interact with donors. Among other regular contact points, we have held face-to-face consultation meetings in Vancouver and in Toronto. To learn more, read the summary report from those consultations.
Our guiding principles for all stakeholder engagement are to:
- Build supportive and constructive relationships with stakeholders.
- Engage stakeholders proactively and explore expectations.
- Inform good decision-making with evidence from different sources.
- Foster transparency in decision-making while respecting privacy and partnerships.