Yes, you heard that right. Why would anyone have an issue with it? If that's what you’re wondering right now, it isn’t just because of the social stigma surrounding the trans community, but also cause science plays a big role in blood donation. The pandemic has revealed the scope of plasma therapy and its role as a potential cure, and the need for blood donors is on the rise. So can transgenders join the bandwagon? The answer isn't so simple.
Blood donation requires the donor to satisfy a number of different criteria. Fulfilling these criteria become even more complicated when transgenders are involved since more factors come into play such as the individual’s sexual activity and gender identity. To get into the specifics of why the transgender community can or cannot donate blood, it would only be fit to understand how the process works.
Blood donation process
The process of blood donation requires the donor's blood to go through a screening for infectious diseases before being separated into its components: red cells, the platelets and plasma. Depending on what the recipient requires, that component will be transfused. In order for there to be a set standard of norms regarding blood donation, the World Health Organisation has come up with a set of conditions, which one needs to meet, in order to donate blood. According to the W.H.O guidelines, in order to be a donor, there are age, weight, health standards that need to be met. Among these, however, ‘at risk’ sexual activity is the most important, and often the most controversial, since the definition is more or less open to interpretation.
The guidelines say that if one is engaged in ‘at risk’ sexual activity in the past 12 months, they are not allowed to be donors; the term ‘at risk’ comprises of individuals who have multiple sexual partners, engage in unprotected sexual intercourse or those who may have a sexually transmitted disease. According to the FDA guidelines, a man who has had his gender reassigned as a woman who, as a man, had not had high-risk sexual activity, can be accepted. The condition being if, as a woman, they have a sexual relationship with a man.
Once you manage to get past all the above-mentioned checkpoints, there’s the debate of the composition of the blood of transgenders.
The science of transgender blood
Whilst sexual identity cannot deter transgenders from donating blood, there are certain scientific differences between male and female blood such as the presence of certain hormones, that can.
Once a trans goes through gender reassignment surgery, the hormone levels are manipulated as per the sex that the person wants to change into. Thus, when a woman becomes a man through gender reassignment, they receive high levels of the male hormone testosterone. If this woman, now a man (with high levels of testosterone in their blood) donates blood to a woman, the receiver’s blood hormone levels would be affected. Similarly, when a trans man becomes a woman, they receive the female hormone oestrogen. Thus, if this man, who is now a woman (and has high levels of oestrogen in his blood), donates blood to a man, this would affect the receivers blood hormone levels.
A ban on transgender blood donors
Two trans women sued one of the world's largest blood companies, Florida-based CSL Plasma, for refusing to allow them to donate. The company in its defence said they were just following the FDA regulations, which is “Designating donors by sex at birth."
In other words, the FDA doesn't recognize trans people, who identify with a gender different from the one assigned to them at birth. This has caused a lot of confusion for companies, which have reacted with blanket bans on trans women.
The FDA also bans men who have sex with men from donating blood. The agency considers trans women to be men, and thus they are also banned if they have sex with men. Some companies interpret this to ban gay men and transgender women from donating for life, even if they're not sexually active. (The ban doesn't apply to trans men who have sex with men since they're considered heterosexual women by the FDA.) However, many companies argue that just like anyone else, trans women can be straight, gay, bisexual, asexual, etc. They don't all have a preference for men.
The science of transgender blood and the many criteria it has to satisfy before it can be used in blood donation does justify why this issue is so debatable. However, the world-over, transgenders are now coming forward as blood donors, and countries too are becoming more sensitised to this.
The world is progressing
In January 2020, a group of transgenders in Bengal created history by breaking the National AIDS Control Organisation (NACO) guidelines that said that people who are donors shouldn’t be those who are ‘at risk’, which includes transgenders. “This NACO guideline is very discriminatory in nature. How can all those belonging to the transgender community be clubbed as ‘at risk’ category, at one go? By donating blood we will make a statement that NACO needs to review its guideline” said Ranjita Sinha of the Association of Transgenders in Bengal.
Canada in 2016, added national criteria specific to trans blood donors. This essentially would mean that there would be no uncertainty about the screening process and how it would apply to trans people. The Irish Blood Transfusion Service (IBTS) has said it is working on a long-term IT solution for recording a trans person’s preferred gender.
The battle is a long one, but nations seem to be doing their bit to push for a revolution of sorts, and move past barriers that prevent the trans community from partaking in the noble cause of blood donation.