In order to ensure the safety of the blood supply, potential blood donors in Canada are screened for eligibility prior to making a donation. This process includes answering a series of questions intended to identify those at higher risk of carrying transfusion-transmissible pathogens. Prior to 2013, male donors who had had sex with another man, even once, since 1977 were banned for life from donating blood. From 2013 onward, men who have sex with men (MSM) could donate blood provided that they had not had sex with another man for five years. This policy has been criticized, both before and after the policy change in 2013, as being discriminatory and not based on current scientific knowledge and practices. This paper describes and analyzes the evolution of the MSM blood donation policy in Canada. The analysis shows that Canadian Blood Services, the organization in charge of the blood supply, prioritized blood safety and the perspectives of blood recipients above all others, which led them to take a particularly cautious approach in deciding when and how to change the policy. The analysis also reveals that the policy was finally able to change in 2013 because of the accumulation of research, the engagement of high-interest stakeholder groups, and shifts in the perceived costs and benefits of maintaining the status quo vs. changing the MSM blood donation policy. Examining the costs and benefits of a policy change for blood recipients and the MSM community suggests that what is needed for the policy to change in the future is more research into alternative screening criteria which can maintain the safety and adequacy of the blood supply.
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