The ethics of blood donation are more complicated than you think

One of my commissioning editors on Patreon this month* gave me a fantastic prompt — I’ve talked about blood donation before, but how do I feel about it now? Have my feelings evolved? I told them it was a great question, which it is, but people may not necessarily like my answer, which, in a nutshell, is that I’ve always supported blood donation and I always will, but I’m not a huge fan of how we go about it, and how we talk about it. Reforms to the ways we conceptualise blood donation are critical to make it safer and better for everyone.

First, the obvious stuff: Blood products are used in a range of medical procedures and interventions, and for some people, they are absolutely lifesaving. It’s very important to have a range of blood products available, especially from people with rare blood types, to ensure that those who need blood can have it. That includes emergency situations, but also people who need more long-term care with blood products, such as people who receive clotting factors to manage specific disorders.

That said, there’s a tendency to only donate blood in a crisis, and that often leads to thousands of units just being discarded, because blood does go bad. We need a steady supply of willing blood donors who come in regularly to ensure that the blood supply isn’t interrupted. In a crisis, that steady supply also makes it easier to move units to where they’re needed while waiting for an influx of donors to get through screening.

Bottom line: Yay blood donation!

Now, the tricky stuff.

The first issue is that blood donation is often highly performative and it’s sometimes constructed and presented in a way designed to shame those who do not donate. I certainly pass my share of admonitory billboards and get stacks and stacks of reminders about how I need to help fellow humans by donating to the local blood bank. There seems to be a belief that shaming tactics will work to goad people into doing the right thing.

Only here’s the thing: I can’t donate blood. So when I encounter this messaging time after time after time, it actually makes me feel pretty shitty. It makes me feel like a bad person. It makes me feel inadequate. It makes me feel like I am not contributing to society and I am a garbage human and I should be ashamed of myself — especially since I’ve received blood products in emergency settings and been so incredibly grateful to the kind strangers who donated** blood products to help me survive. Thank you, blood donors!

Lots of people cannot donate blood for a lot of reasons. Our reasons are not your business. But when we’re surrounded by messaging to donate donate donate, it puts a lot of pressure on us. We feel like we have to disclose personal information to excuse ourselves when we are being ordered to donate blood. We feel like shitty people for being excluded from the donor list, even if we actually have blood that you really don’t want us to donate because it could make people very sick. People need to be more conscious of this when they talk about blood donation because your lack of compassion for other human beings makes our lives worse.

On to the second issue: The way that blood donation is administered in the United States is pretty fucked up. First, you have federal regulations limiting who can donate blood, ostensibly to protect the safety of the blood supply, which is a super good thing. I am glad that we screen obvious health risks out at the time of donation, in part because blood is pooled and tested together, so contaminated blood isn’t just about a few bags that can’t be used, but a whole batch. That’s bad! Setting standards is good!

However, a lot of those standards are outdated, discriminatory, and have a tendency to reinforce stigma. I am thinking in particular of the restrictions on blood donation for (cis) men who have sex with (cis) men. While the FDA is currently yet again revisiting the blood ban rule, for the time being, cis dudes who have sexual activity with other cis dudes are not allowed to donate blood for a period of one year since their last sexual contact. Things get even more snarled and hateful when you talk about the trans community, particularly cis men who have sex with trans women. This is absolutely categorically bigoted and not based in science.

There are other restrictions on blood donation that are certainly problematic, though more justifiable. The point is that the feds have outdated and gross restrictions on blood donation. Which doesn’t mean that people should refuse to donate blood in protest (no seriously, please don’t do that). It does mean that we need to talk about the limits on blood donation because there are tons of people eager to donate blood who can’t, and that’s terrible! It’s sad that perfectly good blood is going around circulating in people’s veins when other people could be using it, and it’s infuriating that these bans perpetuate stigma by suggesting that cis dudes who have sex with other cis dudes are some kind of hotbed of infectious disease. We need to talk about this.

There’s also the Red Cross and its hegemonic control over blood donation in the United States. The Red Cross, notably, initially heavily resisted deferrals at the height of the HIV/AIDS crisis that could have saved lives, and is now advocating incredibly hard to keep the same deferrals it didn’t want 30 years ago. Which is gross. Having a centralised, highly organised group that handles blood processing sounds like a good idea, but it can hurt local blood banks. And even if the Red Cross were the 100 percent absolutely best way to donate blood, the agency has serious operational problems including extreme inefficiency and a history of withholding aid to people in areas affected by natural disasters. I’m not a big fan of the ole RC, and if you’re donating blood, consider hitting a local blood bank first. (Think of it as the credit union to the Red Cross’ JPMorgan Chase.)

Bottom line: Got blood to donate, and eligible to donate? Rad! You should think about donating on a schedule that works for you, especially if you have a rare blood type. Got blood that no one wants, whether for a legit or bigoted reason? Don’t feel ashamed about not being able to donate, because there are tons of other great things you can do for your fellow humans, okay?

*Did you know you can help ensure that this ain’t livin’ remains a going concern by supporting me on Patreon, and that one nifty reward is the ability to tell me what to write?

**Just so we’re all clear: Paid blood ‘donation’ is a thing and some people don’t ‘donate’ because they care about humanity but because they want to earn money. (Or with a mixture of both sentiments.) Similarly, blood banks can and do sell blood. This is a business.

Image: Blood Donation, MamaYe Africa, Flickr