Last week was an important week for us in blood donation as we implemented the latest changes to the government guidance on donor selection rules on a really important area.
As chief nurse I have been leading the team who have worked for the last three months to make sure that we could safely implement these changes and on Tuesday this week I’m pleased to say that apart from the usual and thankfully small IT glitches, we did it!
The rule changes are around sexual behaviour and now mean that only men who have had anal or oral sex with another man in the past three months (even with a condom) will be asked not to donate. This used to be 12 months.
It’s really important that everyone understands that being gay has never meant that you can’t be a blood donor, this rule has always been and continues to be just about specific activities.
Some of my clinical colleagues were involved in the government group (the Advisory Committee on the Safety of Blood Tissues and Organs SaBTO) that reviews the scientific evidence that supports our guidance in this area.
Over the past year they conducted the review as well as a comprehensive donor survey asking about general health, sexual and social behaviours, and understanding of the donor selection criteria.
Some people will naturally be worried about whether blood transfusions will still be safe, and I hope they will be reassured to know that this review used the very latest scientific evidence to inform the recommendations.
This included more information now available about the risk of acquiring infections that can be passed on in blood, more evidence on how well donors comply with our guidelines and also more evidence that supports the reliability of the blood screening tests we use.
This showed that waiting for three months after the latest sexual contact was sufficient to maintain the safety of the many many units of blood and other products that we supply to patients each year.
The new deferral period is about twice the length of time of the window period for Hepatitis B, window period just means the time between someone acquiring the infection and it showing up in the tests we use. It’s fantastic to be working with people who are so committed to this level of evidence based practice, challenging and changing the standards where it is safe to do so.
This reduced deferral period also now applies to commercial sex workers and people who have sex with partners in groups known to have a high risk of having an infection that could be passed on during sex (high risk partners) e.g. syphilis and hepatitis C infection, so the rules are consistent now for all groups that are deferred due to sexual behaviours.
Unfortunately a four-month deferral period will continue to apply for anyone that has used complementary therapy that involves piercing the skin, e.g. acupuncture, drawing blood e.g. wet cupping or an invasive procedure e.g. colonic irrigation. This is because there is legislation in England that requires us to apply this deferral period, as opposed to the guidance that comes from SaBTO.
Whilst these changes will not affect blood safety, it is crucial that people follow all the rules about blood donation. These are in place to keep blood donors and the patients who receive their blood safe.
Some people do ask us why we have so many rules and ask so many questions. It does seem a bit over the top on the face of it, I agree, but blood donation works on the basis of kindness and mutual trust.
It is vital that all potential and existing donors keep to the blood donor selection rules by giving completely honest answers to all the questions asked confidentially at donation sessions, both for the protection of their own health and that of others.
We really don’t ask any question that is not designed to prevent a patient or a donor from becoming unwell, and we have one of the simplest medical questionnaires in the world – I’ve seen most of them! On session it only takes about four minutes to make sure we have all the answers we need and do the finger prick to test your Hb, so we really do try to keep it quick and simple.
I do often also get asked why we aren’t introducing personalised risk assessments. ‘Wouldn’t that be a fairer system?’ I’m asked.
We are committed to exploring ways to allow more people to donate blood without impacting on blood safety could be introduced. However, there is very little data on effective ways of carrying out more personalised risk assessments in the type of community settings that we often work in.
Work will be required to collect this evidence so we can design suitably effective questions to be designed and tested before they can be routinely introduced. This might well take a few years.
I hope that patients and healthcare professionals alike know that we are more than happy to answer questions or see you on a blood session anytime!
Jane Green is the chief nurse and assistant director of blood donation operations at NHS Blood and Transplant
