January is National Blood Donor Month in the U.S., coinciding with the time of year that often packs a one-two punch of blood supply shortages and reduced donations due to the busyness of the holiday season, the unpredictability of weather, and the height of cold, flu, and coronavirus season. For over half a century, beginning with President Richard Nixon’s proclamation in January 1970, National Blood Donor Month has honored voluntary donors and brought awareness to maintaining an adequate nationwide blood inventory. It is also intended to encourage more people to roll up their sleeves to give blood at a time of year when the lifesaving resource is most needed. However, there were times when entire demographic groups were banned from donating.
Race and Blood Donation
The first blood bank was founded in Chicago in 1937 by Dr. Bernard Fantus to safely store blood for just a few days, either for self-transfusions or to be used by others. However, Fantus’ early bank did not have standardized methods of collecting, testing, or handling donations.
In 1939, Charles Drew, a Black medical student, conducted his doctoral research on how to store blood for a more extended timeframe so it could be available as needed. He also focused on the necessity of recruiting donors, screening them for suitability, and training staff in safe and effective collection methods. He was instrumental in developing a program dubbed “Blood for Britain,” which collected and shipped donated American blood to British soldiers coming under German fire in Europe in 1939-40. This research and experience laid the foundation for launching a nationwide blood banking pilot program in the U.S. through the Red Cross – the National Blood Donor Service, which officially began in November 1941. Because of his advances in both the science and logistics of blood donation, Drew is credited as being “The Father of the Blood Bank.”
Nevertheless, the blood banking system pioneered by a Black man first precluded those of his race from donating, then later segregated their donations from the general population. The Red Cross pilot project initially excluded Black donors; however, within one month of the U.S. entering World War II with the bombing of Pearl Harbor, the ban on Black blood donations was lifted. Donated blood, though, was segregated based on race to “accommodate cultural norms of the time,” resulting in boycotts of the Red Cross and blood donation. Drew vehemently opposed both the ban on Black blood donations and the practice of donated blood segregation, stating in a 1944 acceptance speech of the NAACP Spingarn Medal, “It is fundamentally wrong for any great nation to willfully discriminate against such a large group of its people. . . . It is unfortunate that such a worthwhile and scientific bit of work should have been hampered by such stupidity.” In 1948, the American Red Cross stopped requiring segregation of blood donations.
Race-Specific Blood Needs
There are instances, however, in which the ethnicity of a blood donor does matter. It has been scientifically proven that blood can be racially specific, which can be a matter of life or death to recipients with rare blood types in need of blood transfusions. According to the Association for the Advancement of Blood & Biotherapies (AABB), two inherited blood disorders disproportionately affect people of color:
Thalassemia is a disease that reduces the hemoglobin level, the component of blood that allows red blood cells to carry oxygen throughout the body. Thalassemia accounts for 4.4 out of every 10,000 live births worldwide, predominantly among South Asians, and is becoming more prevalent in the U.S. as immigration increases.
Sickle cell disease causes red blood cells to form into the shape of the letter “C,” become sticky, and block blood flow through the vessels. The painful condition affects approximately 100,000 people in the U.S., including one of every 365 Black Americans. There is a difference between sickle cell trait and sickle cell disease. Having sickle cell trait is not a mild form of sickle cell disease. It simply means a person carries a gene that can be passed to their children. For a child to be born with sickle cell disease, the child must inherit at least one abnormal gene from both parents.
Individuals with thalassemia and sickle cell disease must manage their conditions with lifelong transfusions of precisely matched blood donated from individuals with similar ancestry. Unfortunately, there are often more ethnic minority patients who need blood than there are ethnic minority donors. According to the National Institutes of Health (NIH), Black Americans comprise 13% of the U.S. population but less than 3% of blood donors.
LQBTQ + and Blood Donation
In June 1981, the Centers for Disease Control and Prevention (CDC) published an article in its Morbidity and Mortality Weekly Report describing 5 cases of a rare lung infection in young, previously healthy gay men in Los Angeles. That article marked the first official reporting of the Acquired Immunodeficiency Syndrome (AIDS) epidemic. By the end of that year, there were 337 reported AIDS cases in the United States, of which 130 had already died. Research in the following years showed that blood transfusions could spread the infection from donor to recipient. By January 1985, the CDC advised that a newly identified human immunodeficiency virus (HIV) was the cause of AIDS and issued provisional guidelines for blood screening, which began in March of that year. The Food and Drug Administration (FDA) – the blood donation regulatory agency – imposed a lifetime ban on men who have sex with men (MSM), ruling that “men cannot give blood if they have had sex with another man at least once since 1977.”
FDA broadens the donor pool by relaxing restrictions
In the 40 years that have passed since AIDS came on the scene as a public health crisis, great strides have been made in controlling the disease, including the development of accurate testing and effective treatment and prevention methods. As advances have occurred, the FDA has periodically revisited its stance, revoking in 2015 the lifetime ban on MSM to allow blood donation by MSM who self-reported being abstinent for an entire year. When the COVID-19 pandemic severely decreased the number of blood donors, the FDA once again revisited its stance in 2020, this time reducing the period of sexual abstinence of MSM to a period of three months.
A significant change, more inclusive of LGBTQ+ donors, came with the FDA’s August 2023 final guidance, eliminating the eligibility criteria based on sexual orientation. These changes are the result of an evolving understanding of HIV transmission through evidence-based research and continued advancements in blood screening techniques supported by data collected through the Department of Health and Human Services Transfusion Transmitted Infections Monitoring System (TTIMS) and the FDA-funded Assessing Donor Variability and New Concepts in Eligibility (ADVANCE) study which examined the rates of HIV risk factors and infection, as well as the use of medications to treat or prevent HIV infection among MSM study participants.
The new guidance focuses on individual risk rather than groupwide restrictions. Every potential donor is presented with the same gender-neutral screening questions regardless of sexual orientation. According to a Harvard Medical School article, the questionnaire asks whether, in the past three months, a potential donor has:
- had a new sexual partner and engaged in anal sex;
- had more than one sexual partner and engaged in anal sex;
- taken medicines to prevent HIV infection (pre-exposure prophylaxis, or PrEP);
- exchanged sex for pay or drugs, or used nonprescription injection drugs;
- had sex with someone who has previously tested positive for HIV infection;
- had sex with someone who traded sex for pay or drugs; or
- had sex with someone who used nonprescription injection drugs.
- Answering no to all of the questions: Suggests a person has a low risk of HIV infection. Blood donation may proceed; no waiting period is necessary.
- Answering yes to any of the questions: Raises concern a potential donor might have a recently acquired HIV infection. Defer giving blood for at least three months.
How You Can Help
Every two seconds, someone in the U.S. needs blood. Blood donation saves lives.
Please consider giving blood. The need is critical, and your donation is important. Even if you are deferred as a donor, you can still help by volunteering to organize or work at a blood drive. Find your nearest blood donation center here.