Prioritising health equity alongside donation safety – Authors' reply

We thank Warren B Fingrut for his interest in our Review1Worel N Aljurf M Anthias C et al.Suitability of haematopoietic cell donors: updated consensus recommendations from the WBMT standing committee on donor issues.Lancet Haematol. 2022; 9: e605-e614Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar and for highlighting the important issue of health equity alongside donation safety. The authors concur on the paramount importance of ensuring that both donor wellbeing and product safety remain central to the process of haematopoietic stem-cell donation. A major component includes minimising the risk of blood-borne infectious disease transmission from product to recipient using donor health screening questionnaires that are largely synchronous with and adapted from established guidelines for blood transfusion donation. Fingrut has pointed out the need to re-evaluate some donor questions, so that all potential donors are treated equally on the basis of individual risk factors and without regard to their sexual orientation or gender identity. This approach was powerfully highlighted by the American Medical Association (AMA) in January, 2022, when it called on the US Food and Drug Administration (FDA) to remove its discriminatory ban that prevents many gay and bisexual men from becoming blood donors.2Harmon GE The FDA must lift its discriminatory blood-donor policy.https://www.ama-assn.org/about/leadership/fda-must-lift-its-discriminatory-blood-donor-policyDate: Jan 26, 2022Date accessed: September 4, 2022Google Scholar The AMA argues that the current 3-month deferral period for gay and bisexual men singles out blood donors on the basis of their inherent attributes rather than risk factors. As a result of the HIV/AIDS crisis, the FDA established a lifetime ban on donations by men who have sex with men in 1985. This ban was subsequently modified to a 1-year deferral in 2015 and finally shortened to 90 days in 2020. This timeline not only illustrates the need for regular re-evaluation of such potentially contentious criteria, but the importance of ensuring that safety is not compromised. Such re-evaluation must be based on scientifically sound and objective findings. One effort is the Assessing Donor Variability And New Concepts in Eligibility (ADVANCE) study, which is being conducted by US blood centres—including the American Red Cross—with the hope that the results, when available, will help to shape future FDA donor-eligibility requirements.3FAIR steering groupBlood donor selection policy: More people now able to give blood.https://www.blood.co.uk/news-and-campaigns/news-and-statements/fair-steering-group/Date: May 11, 2021Date accessed: September 4, 2022Google Scholar The AMA have also proposed a change to the restrictions on donation of human cells and tissues by men who have sex with men. Other countries have already made changes informed by evidence-based reviews. The UK announced a landmark change to blood donation eligibility rules in 2021 and abolished its restriction from voluntary blood donation for any man who had sex with a man in the last 3 months. The new criteria will now allow men who have sex with men in a monogamous relationship to donate blood and is a historic move to make blood donation more inclusive, while maintaining blood safety. Additionally, the question of if “you or your partner has had sexual contact in Sub-Saharan Africa” has been removed. The changes follow an evidence-based review into individualised criteria by the For the Assessment of Individualised Risk steering group (known as FAIR) led by the UK National Health Service's Blood and Transplant service.3FAIR steering groupBlood donor selection policy: More people now able to give blood.https://www.blood.co.uk/news-and-campaigns/news-and-statements/fair-steering-group/Date: May 11, 2021Date accessed: September 4, 2022Google Scholar We authors acknowledge that such evidence-based reviews are urgently needed in the field of haematopoietic stem-cell donation. The aim for a more inclusive, unrelated donor registry will benefit this field enormously, because it has long been recognised that minority ethnic groups are under-represented in unrelated registries and have an a increased attrition rate caused by various factors.4Fingrut W DeGurse N Hrycyshyn A et al.Towards a more inclusive unrelated donor registry.Bone Marrow Transplant. 2022; 57: 688-690Crossref PubMed Scopus (5) Google Scholar All of these features lead to a reduced probability of finding a suitable match for patients belonging to minority ethnic groups, affecting equitable access to haematopoietic stem-cell transplantation.5Anthias C Shaw BE Bruce JG et al.Role of race/ethnicity in donor decisions about unrelated hematopoietic progenitor cell donation: exploring reasons for higher attrition among racial/ethnic minorities.Biol Blood Marrow Transplant. 2020; 26: 593-599Summary Full Text Full Text PDF PubMed Scopus (15) Google Scholar This Review by the donor issues committee of the Worldwide Network for Blood and Marrow Transplantation (WBMT) aims to provide recommendations that will be useful and implemented internationally.1Worel N Aljurf M Anthias C et al.Suitability of haematopoietic cell donors: updated consensus recommendations from the WBMT standing committee on donor issues.Lancet Haematol. 2022; 9: e605-e614Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar We authors recognise the worldwide diversity of political systems, religious beliefs, and societal differences and that continuing re-evaluation—together with evidence-based findings—are necessary to guarantee that guidelines are clear, prevent misinterpretation, and do not allow for discrimination. The stance of the Worldwide Network for Blood and Marrow Transplantation is clear: equal respect of all individuals, including all patients and donors. NW has received speaker fees, travel support, and research grants from Sanofi Genzyme, Therakos Mallinckrodt, Szabo Scandic, Kite Gilead, and Novartis. All other authors declare no competing interests. Suitability of haematopoietic cell donors: updated consensus recommendations from the WBMT standing committee on donor issuesThe contribution of related donors to the globally rising number of allogeneic haematopoietic stem cell transplantations (HSCT) remains increasingly important, particularly because of the growing use of haploidentical HSCT. Compared with the strict recommendations on the suitability for unrelated donors, criteria for related donors allow for more discretion and vary between centres. In 2015, the donor outcome committee of the Worldwide Network for Blood and Marrow Transplantation (WBMT) proposed consensus recommendations of suitability criteria for paediatric and adult related donors. Full-Text PDF