Blood screening rules

August 24th, 2008

I’ve been an infrequent blood donor for years.

The needle scared me off until empty pockets in Greece in 1976 overcame that fear. In Athens twice I earned what I recall as the equivalent of 12 pounds sterling per extraction. The attendant joked with us that Greeks held parties to get high on hippies’ blood.

From then on I donated here though I still don’t look at the needle.

Then in the early 1990s I was engaged as a lawyer by the Ministry of Health on the restructuring of blood transfusion services. It followed a Hepatitis C scandal.

A French Minister was convicted for allowing risky blood to be used. In New Zealand culpability was never clarified. Some of it occurred on H Clark’s watch as Minister of Health though neither she nor any other Minister may have known enough to be in the gun. Haemophiliacs mainly paid the tragic price for casualness about blood borne diseases.

My job was to develop the legal structure for a new nationally coordinated service, and to negotiate contracts with CSL of Australia and other foreign suppliers. As lawyers do, I learned a lot along the way about blood services, products and risks.

Our ability to draw from a purely donated domestic supply is a powerful protection for New Zealanders.

I vividly remember one of the most qualified directors reminding a meeting that blood transfusions were inherently dangerous, and we should design the service to use as little as possible. "There is so much we still do not know about what is transmitted, and latencies" he said, before mad cow disease turned the British beef industry upside down.

A month ago I was told my last donation would be used only for plasma, not red cell transfusion, because in my household there’d been a severe stomach upset a week earlier.

So i was specially interested when people at the Rainbow forum last week asked candidates to stop blood services from distinguishing between gay donors and others.

I respect their wish to give blood. Our voluntary system depends on altruism. But it appears this issue is now used by some gay activists to sniff out those they call "homophobes".

I did not then realise the significance of the probing. Now I know the background.

The New Zealand Blood Service is now proposing to move further away from the total "no thank you" policy recently reaffirmed by the UK and the US. I hope it is driven purely by NZBS views of best practice for patients, and not by fear of seeming unfashionable. It is not a good sign that NZBS’ introduction makes more of the involvement of a QC than the medical authority of the authors.

The AIDS Foundation in a handy paper has described the new policies as likely to "…position New Zealand as having one of the least restrictive [donor] deferral criteria in the world…"

It appeared that was not enough for many at the Forum, and the candidates seemed happy to encourage them.

My approach was simple. In blood safety matters the interests of the innocent recipients come first, second and third. And without perfect knowledge and perfect screening tests safety is governed by probability assessments. A wish to donate blood is not a right. If we have enough blood from lower risk people then do not take any from higher risk donors.

Screening tests will not necessarily pick up blood infection in a latency period after infection but before the sufferer is aware.

Some who’ve been in the UK during the incubation period for mad cow disease have grizzled about rejection as donors.

Tough – the interests of helpless sick people must come ahead of any donor’s desire to feel virtuous.

So I was amazed when the ACT, Green and Labour candidates all assured the Rainbow forum of support for eliminating the "discrimination".

The Labour candidate was effusive, though to be fair it was hard at the end to know exactly what he’d said.

Nevertheless he was not pressed for clarification. The audience must have been content.

Filed under Health, Wellington Central

Comments

Tough – the interests of helpless sick people must come ahead of any donor’s desire to feel virtuous.

Stephen, I wonder if your above comment will also make you a homophobe in the eyes of the lunatic fringe of the homosexual and political movement.

I hope that others who read your post take note of what NZ Blood Services have to say in their review. Over 1000 Canadians became infected with HIV due to pressure from the homosexual lobby. A reduction from 10 to 5 years does not seem unreasonable but if there is political pressure to change further to make some zealots feel good it should strongly be resisted.

The reason ACT is polling badly is due to a large extent to the party being taken over libertarian ideologues. They should make up their mind whether their economic policies or their loopy libertarian ideas to have priority.

The fact that 2% of the population account for 82% of HIV infection acquired in New Zealand should show that homosexual should not be offering advise on sexual health matters.

[…] suggested that I hold forth my opinion of the proposed new deferral periods for Blood Donors that Stephen Franks has recently blogged about. A deferral period is how long you have to wait between doing something […]

Just to clarify, are you saying that gay people shouldn’t be able to give blood in case they have some sort of “gay” disease? Do you realise that straight people can get HIV and that every blood sample taken is screened for it?

Stephen, I find your homophobic rant difficult to read, it literally sickens me to know that people with views like this are standing for a party that wants the treasury benches.

One of the first welcomes we received as expats in The Philippines was offers to ‘pair up’ with other expats with equivalent blood groups. Each ‘on call’ for the other/s. Nothing to do with HIV – or homophobic – rather the predominant asian blood group was O+ so the other blood groups (B, AB, any negatives) were very hard to match locally.
Only hospitalised once – fortunately no blood required.
Maybe NZers who are concerned have to start thinking about pairing up if the need arises?
John Milne

From what I’m told the NZBS recommendations are sensible. The AIDS Foundation paper seems to support them.

That’s good enough for me.

When I heard the discussion at the Rainbow dinner I had not seen those. I assumed that the proposed policy must be offensive. So when I web searched I was stunned by both the complaints at the Rainbow dinner, and even more by the Labour candidate’s support for them.

They seem to me to put more weight on symbolic winning and losing than on the risks, however small, to the sick people who rely on us putting their interests first.

I’m sorry that you feel there has been a rant.

I couldn’t help but noticed that nobody’s mentioned the prevalance of aids amongst the gay population. I take it you have just assumed that homosexuality = more aids. So I did a quick google.

http://www.moh.govt.nz/moh.nsf/ea6005dc347e7bd44c2566a40079ae6f/2e8f02f2e62d7c96cc256c380019b060?OpenDocument

Since 1996, heterosexual sex accounted for 44% of HIV transmission while (male) homosexual sex accounted for 49%. 5% is statistically insignificant, especially when one takes into account the extra awareness and precautions that take place now compared to a decade ago.

At best, this blog is uninformed.
At worse, it’s a poor cover for Mr. Frank’s intolerance towards homosexuality.

Err, my bad. I had 6 hours sleep and I guess it shows. Logic ftl today. It would be statistically insignificant if 49% of the population = homosexual men, which it isn’t.

A much more thought out response follows 😛

Disclaimer: Being the idealistic little shit that I am, I strongly believe in personal freedoms and as little governmental fiddling as possible. As such the idea of blocking the many from participating in something because of the condition of the few is inherently abhorrent to me.

Mr. Franks, what you are suggesting is basically discrimination. Now, before you shout accusations of PC and put quotes around the word “discrimination” to make it sound like I have a hidden agenda, hear me out.

The chance of either a straight man or a gay man having HIV is ridiculously small. One has a greater chance than the other (as my blunder above points out) but overall the chance is still very, very tiny. This chance is then reduced again by several orders of magnitude by disease testing as part of screening. I put it to you that the difference is not enough to exclude an entire group of people from being able to save lives. After all, even if one HIV-infected person’s blood (who could be heterosexual for all you know) makes it into the bloodstream of a patient, think of how many other lives are saved by the addition of homosexual blood to the pool.

But if you can’t agree with that, if you still don’t think the risk of HIV is worth saving many more lives, then I have a suggestion you should take to heart: ban *all* heterosexuals and homosexual men from donating blood and instead only allow homosexual women to donate. They’re even cleaner still and you have already established that you think the reduction in donations is worth the reduced chance of HIV making it to patients.

Putting all that aside, it’s easy to draw parallels between banning homosexual men from donating blood because they’re more likely to have HIV, and say, hypothetically banning maori from donating to charity because their money is more likely to have come from illegal sources. One’s obviously wrong because we were brought up with sensitivity towards racial profiling and discrimination. The other is a lot more difficult a subject for the older generations to tackle. It’s taken a long time for homosexual folk to get to the level of acceptance and respect they enjoy now and the last thing they need is a step backwards, however small.

Now that’s a rant.

David, why do you not contact John Key and tell him if he wants the homosexual vote he should tell Stephen to apologise for offending homosexuals who are prepared to put the public at risk to make themselves feel good. Let us know his reply. If he does not support Stephen on this one there is no hope for National.

I do not know if you are a homosexual or some libertarian nutcase from ACT but you should do your homework before you rant. Heterosexual people get HIV also. That is obvious but you fail to take into account their rate of infection is far, far lower. Having said that the figure for them is far too high, but this is because government have listened far too much to militant homosexual lobby groups such as NZ AIDS Foundation.

Sensible steps to reduce the incidence of HIV would be to

Stop anyone who is HIV+ from immigrating

Make HIV a notifiable disease and implement contact tracing

Stop the AIDS Foundation from misleading the public about the reliability of condoms

Inform the public that promiscuity combined with sodomy is one of the reasons for the high incidence of HIV

The AIDS Foundation opposes all these measures. That is why the rate of HIV amongst homosexuals is many times higher than for heterosexuals. I think the ratio of 40 is very conservative.

The quote below is from the AIDS Foundation web site.

Keeping sex safe has nothing to do with who you have sex with, how often you do it or how many people you have sex with.

Keeping safe is as simple as not sharing cum or other body fluids: use a condom and water based lube every time you fuck.

http://www.nzaf.org.nz/articles.php?id=155

While this government funded lobby group act so irresponsibly they should have no say in matters relating to general public health.

We need to discirminate between sensible precautions and discrimination.

I’m one of those not able to doante blood in case I’m a mad cow. I don’t remember eating much meat when I was in Britain – we survived on tinned tomatoes but it’s possible I did consume some beef, and I accept the NZBS needs to take a precautionary approach.

The thing is, homepaddock, the same argument cannot be applied for HIV.

Creutzfeldt-Jakob disease cannot be detected in blood samples, through which it can be transmitted.

That is quite different to HIV, which is easily detected in blood samples, and every blood product taken and used in New Zealand is screened for HIV multiple times.

Unless Mr. Franks knows of some mystery “gay disease” that no one else knows about (and given his views on nuclear power and marrying ones’ dog, I would not be surprised) , I don’t see why gay people shouldn’t be able to donate blood. If they have the misfortune of having HIV, their blood will not be used.

For the benefit of Chuck Bird and others I feel it is worthwhile clarifying my viewpoint as the ACT candidate who appeared.

I did say I feel the discrimination is reprehensible and I stand by that. I clearly stated that if the fear of transmittable diseases is higher from gay men, then the answer to this is not prohibition but better screening. Five years is prohibition.

The idea that it takes five years for the HIV/AIDS virus to appear in tests after contraction is not supported by facts. In reality it is more like 3 months.

When we are constantly advised by the NZBS that blood shortages exist, I would have thought the generous donations of some in our community would not be overlooked.

I reiterate my statement I made that night, that if I were lying on the operating table requiring a blood transfusion to survive, I would be grateful to the donor. Irrespective of who they chose to have sex with.

Would those who oppose my view, such as Chuck Bird, care to state where they stand on the other issues discussed such as single sex adoption? I have a feeling that their position will point to an underlying agenda against equal treatment by the state for those whom they don’t support. Come on – flush yourselves out.

Tom, David

I urge a read of the AIDS Foundation paper even if you do not want to read the NZBS papes. Apparently the likelihood of HIV in the blood of an active MSM is 40 times higher than otherwise.

The risks of unwanted organisms is even higher for needle sharing addicts, and in most countries they will be permanently screened out, no matter how long ago they ceased to use needles.

Those risks would not preclude donating if supplies were critically short, though testing is not fooproof. When I was involved as a lawyer a problem of relying on testing was that results were delayed, and whole batches of product had to be dumped on a positive, because of mixing or inadvertent infection risks.

But if there are enough alternative donations, no risk need be taken. For example, I’d have no objection if my blood was discarded or I was told I need not bother, if there was a surplus from healthy younger people who have not travelled (overseas exposure increases the risk, albeit minutely).

Without shortages Tom your postulated tension between exclusion and life saving is invalid. What you call “homosexual blood in the pool” (or any individual donor’s blood) is lifesaving only if without it the pool would be inadequate. Unless things have changed recently that is unlikely.

Blood Brothers/Macdoctor Moments (above) puts it as follows “… there was nothing in the Blood Service recommendations about need. Are we very short of donors? Do we have adequate supplies of blood? These are actually the most important questions to answer. If we have an adequate supply (barring massive disaster or sudden localised need), then there is no need to accept blood that has any risk at all of carrying HIV – the deferral period for those at risk should then be indefinite (for ever – we don’t need the blood).”

I don’t agree with his last line. I value broad community inclusion. I’d rather ensure that donating reinforces the sense of community, and our care for the stranger we may never meet, than rely exclusively on the most cost/efficient sources. For example collecting and processing could probably be done more cheaply if collection was confined to Auckland for the whole country (assuming the donor pool was adequate) but the service, correctly in my view, sees value in reinforcing the sense of reciprocity that helps maintain the giving from the 4% of the population who give

I’d rather they took blood infrequently from a wide pool even if they quietly dump or turn into plasma powder for sale or gift to countries without enough, what they get from the higher risk groups.

David, it would be good if you could clarify some matters. It would be better still if you could stick to the fact and avoid the childish name calling.

I agree that Creutzfeldt-Jakob disease cannot be detected in blood samples. However, neither is HIV during the window period. The window period has reduced but is still there. What that means is that if some one got infected the night before they donate blood the HIV virus will not be detected by testing.

The second concern is that no test is 100% accurate. There can also be administration errors even if the blood tests positive.

Homosexuals, prostitutes, IV drug users and people who have lived in high prevalence countries are at far higher risk of being HIV+ than the rest of the population.

Are you suggesting that people in the above categories should be allowed to donate blood without restriction?

Mike, I would be happy to tell you my position on various issues on another thread. If we got into the issue of homosexuals adopting children we would get way off the topic.

No system is infallible. Patients die because doctors prescribe wrong drugs or chemists get the dosage wrong.

Can you tell me what is the probability of someone receiving bad blood due an administration or testing error? Is it 1 in billion or 1 in a thousand? I do not know. However, I suspect those NZ Blood Services who are reviewing criteria would have lot better idea than you or I. If you had even scanned their report it would be clear that they looked at blood services in many other countries.

Have you got any evidence that the experts at NZ Blood Services have other motives than keeping blood recipients as safe as possible?

Do you also think that prostitutes and IV drug users should be able to donate blood after three months of not being at risk?

Your three month criterion does not take account that some of these people’s memories might not be the best.

Can you name another country with a three month criterion?

I am advocating taking the advice of experts and caution. You are advocating a radical change that goes against the advice of experts at the NZ Blood Services.

How much if any have you read of their report? If you have not read it you are acting irresponsibly as a political candidate advocating a policy that could put blood recipients lives a risk to gain political support.

Stephen,

Blood is always in demand it seems. A year hasn’t gone by where they’ve approached schools, businesses, ads etc advertising their need for blood donations. It’s a redundant, if fair, point.

But what about the rest of my unaddressed post? In the above hypothetical situation where the blood is flowing freely, you imply that we should then start screening out homosexual men. But in this case, why stop there? Shouldn’t your stance be that we screen out heterosexuals as well and accept only from the purest sources: prepubescants and homosexual women?

You also didn’t address the underlying discrimination inherent in such decisions of exclusion. I’d like to hear your response on how this is any different to banning Muslims from obtaining pilot’s licenses.

Tom

Tom: Could I just point out to you that the HIV rate amongst homosexual men is forty times greater than the rate amongst heterosexual men. This is a significantly higher risk.

Your suggestion that all heterosexual men be eliminated as well as homosexual is fatuous. This would eliminate nearly half of the available donor pool. The NZ blood service policy is designed to minimize risk, not eliminate it entirely.

The blood service uses the HIV screening test, not the very expensive (but more accurate) western blot test. The screening test is not sensitive enough at 3 months and is still a little risky at 6 months. This is why Australia currently set their deferral period for male to male sexual activity to 1 year.

Apparently the blood service is looking at the level of increased risk involved in resetting to a 1 year deferral but have currently opted for a conservative 5 years. Bear in mind that most countries do not take blood from gay men at all. As you correctly point out the actual HIV rate in NZ is relatively low in world terms. I, personally, think that a 1 year deferral is perfectly adequate (and is in keeping with the deferral for a heterosexual male who has sex with a prostitute or a woman who has sex with a bisexual man.

It’s worth observing that HIV/AIDS is the most politicised disease in the history of mankind. So it comes as no surprise that certain homophile assertions here support this point.

This is also reflected in the idea that gays claim HIV/AIDS is an ‘equal opportunity disease’. In truth and fact, it discriminates in their favour with deadly effect.

I repeat but 2 of the 10 recommendations of the American Food and Drug Administration as to why blood from homosexuals should be barred.

(a) Men who have had sex with men since 1977 have an HIV prevalence (the total number of cases of a disease that are present in a population at a specific point in time) 60 times higher than the general population, 800 times higher than first time blood donors and 8000 times higher than repeat blood donors (American Red Cross). Even taking into account that 75% of HIV infected men who have sex with men already know they are HIV positive and would be unlikely to donate blood, the HIV prevalence in potential donors with history of male sex with males is 200 times higher than first time blood donors and 2000 times higher than repeat blood donors.

(b) Men who have sex with men also have an increased risk of having other infections that can be transmitted to others by blood transfusion. For example, infection with the Hepatitis B virus is about 5-6 times more common and Hepatitis C virus infections are about 2 times more common in men who have sex with other men than in the general population. Additionally, men who have sex with men have an increased incidence and prevalence of Human Herpes Virus-8 (HHV-8). HHV-8 causes a cancer called Kaposi’s sarcoma in immunocompromised individuals.

40 times next-to-nothing is still next-to-nothing. That was one of my points.

Banning homosexual men and post-pubsecent heterosexuals from donating blood is ridiculous, yes. But it would bring up overall blood donor quality. I was using the ridiculousness of it to attack the idea of restricting it at all (my second point), seeing as I’ve never heard of us ever having enough donor blood. Ten HIV infected patients beats 100 dead patients imo.

Still waiting on the third point to be addressed. I can make more cool analogies if needed… it’d be like banning men from driving ambulances because they’re more likely to have an accident.

Tom

I’m afraid your thinking is ‘next-to-nothing’.

Is that why you refer to yourself as an ‘idealistic little shit’?

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