The blood service should ask donors about practice, not just partners

Richard Titmuss’s seminal study of blood donation systems, The Gift Relationship, concludes that the central question for ensuring the safety of the blood supply is, “What particular set of conditions and arrangements permits and encourages maximum truthfulness on the part of donors?” (see BMJ 2011;342:d2078, doi:10.1136/bmj.d2078).

Notwithstanding advances in the epidemiological modelling of risk and the screening of blood, truth telling and trust remain pivotal. Screening is imperfect, and laboratory facilities are overstretched. So the UK National Blood Service uses a “donor health check” questionnaire to identify would-be donors whose “lifestyle and medical history” puts them at greater risk of having contracted a transfusion transmittable viral infection (www.blood.co.uk/can-i-give-blood/donor-health-check). This triage of potential donors is designed to limit the volume of infected blood entering this fallible system.

Donors are trusted to answer a range of questions, including whether they have recently had a tattoo, travelled from a region of high HIV prevalence, or had sex with someone known to have HIV. They are also asked, “Are you a man who has ever had oral or anal sex, whether or not a condom was used, with another man [hereafter MSM]?” Answering “yes” to these questions currently results in a six month, 12 month, or lifetime deferral.

Permanent deferral of MSM is controversial, and the government has just announced a change …