Creating a Fair and Equitable Blood Donation System: An Evidence-Based Policy Change

Guest blog by Professor Eamonn Ferguson, Professor of Health Psychology.

Any patient needing blood or blood components (and is willing to accept them) will receive them.  Blood and its components are used for 22 different treatments, and without the continual supply of blood, modern health services could not operate effectively. Indeed, in the UK 5,000 donations are needed daily to meet this clinical need. This critical need is met by the generosity of a small number of blood donors, with approximately 3-4% of the eligible population donating blood at any one time. To better understand donor motivations and develop evidence-based interventions we, at the University of Nottingham, have been involved in blood donor behavioural research for over 25 years.

We were very proud, recently, to be part of the FAIR (For the Assessment of Individual Risk) project, whose remit was the examine the evidence and collect new data to implement a change to UK blood donor selection that is based on sexual behaviour of all potential donors. Based on our evidence-based recommendations this policy change was officially accepted by the Department of Health and Social Care .

Before this change, men-who-have sex-with-men (MSM) were deferred from donating blood unless they had abstained from sex for 3-months . While the UK was the 1st country to move to a 3-month deferral it was seen as only an initial step towards greater equality with a more individualized approach based on the sexual behaviour of all potential donors called for. As such, the FAIR steering group was set up. This group comprised a wide range of stakeholders including epidemiologists, behavioural scientists, MSM groups, lobbying groups, donors representatives, patient representatives, clinical and operational staff from all four UK blood services. The remit of FAIR was to examine the evidence to evaluate any risk to the safety of the blood supply from a change to an individualized approach, identify the key questions to ask donors to implement such a policy and make recommendations to government.

To implement an evidence-based policy change the FAIR group considered a combination of epidemiological and behavioural science evidence. The behavioural science work was conducted by a team at the Univerity of Nottingham School of Psychology and Funded by the UKFORUM (the consortium of UK Blood Transfusion Services) and headed up by Professor Eamonn Ferguson and Dr Claire Lawrence (now of Lawrence PsychAdvisory) with Dr Naomi Pierce (now at Birmingham City University) and Erin Dawe-Lane (now at Kings College London). We used a mixed-methods approach collecting new data via a series of large scale surveys of the general public and UK Blood donors and focus groups and interviews with MSM, donors, donor staff, and patients.

We explored the frequency of a series of sexual behaviours in the general public and for each sexual behaviour its perceived recall accuracy, its acceptability, its potential to deter donors, and the reliability of its reporting. Perceived risk was also examined in terms of risk to the safety of the blood supply from an individualized policy and perceived risk of acquiring a sexually transmitted infection. The epidemiology team was headed Dr Su Brailford (Chair of the FAIR Steering group), with  Katy Davison, Claire Reyolds and Joe Flannagan from NHS Blood and Transplant and Public Health England, who considered evidence on the objective risk of blood bourne infection risk from different sexual behaviours, infection rates in the UK and the sexual behaviour of blood donors.

Thus, the FAIR project was a unique collaboration of epidemiological and behavioural sciences. These approaches were complementary and the evidence triangulated to give strong correspondence in terms of the best questions to ask to screen on the grounds of sexual behaviour that are gender-neutral. The questions, that form the basis of the new policy, were reliable, associated with a higher risk of infection (objective and subjective) and acceptable. The policy change was perceived as fair, equitable, needed, unlikely to increase the risk to patients and one that was seen to be likely to encourage more donors.

This evidence and recommendations were presented to the Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO) for evaluation and based on that received Governmental approval and accepted by the Department of Health and Social Care.

The change relaxing the rules will allow MSM who have had the same partner for three months or more to give blood. This a major step forward to creating a fair and equitable blood donor system for all, with the UK transfusion services leading the world in this area by being the first country in the world to take a purely individualized approach. This shows powerfully how evidence-based policy that combines evidence from different disciplines can help support positive changes for the wider community, and we are very proud of this achievement and our involvement in it.


Professor Eamonn Ferguson, who led the research

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