Recent relaxation of deferral policies for MSM blood donors: a systematic review

Abstract

Background: Blood safety is important to blood transfusion. As men who have sex with men (MSM) are considered to have a higher risk of sexually transmitted infections (STIs) compared to the general population, blood donations from MSM may lead to a higher risk of transfusion-transmitted infections (TTIs). For this reason, many countries have established lifelong deferral policies for MSM blood donors since 1980s. Research have been conducted to evaluate the risks and benefits of relaxing MSM deferral policies from lifelong to a finite period, and countries such as the United Kingdom have implemented such relaxation in recent years. Nevertheless, there remains a lack of risk-benefit analyses on this topic in many countries, especially the developing ones. This review can help such countries to reconsider their MSM deferral policies.

Objective: The objectives of this review are (i) to review the current deferral policies of blood donation from MSM implemented in major countries and (ii) to review the major determining factors in the risk-benefit analyses of these countries.

Method: PubMed, Google Scholar, and China Journal Net were used for literature search. Only literatures with abstract and/or available full text in English or Chinese were included. The PICOS approach was used for study selection, and 37 articles were finally selected. Surveys, cohort studies, cross-sectional studies reviews, and national reports were included in this systematic review.

Result: Countries with permanent/indefinite MSM deferral policy include the United States, Canada, France, Mexico, Germany, Norway, Sweden and China (including Hong Kong). Countries with a finite deferral period include New Zealand (5 years), the United Kingdom (12 months), Australia (12 months), Brazil (12 months), Argentina (12 months), Japan (6 months) and South Africa (6 months). Countries without specific deferral criteria for MSM include Spain, Italy, Poland and Russia. The recent relaxation of deferral policies was based on scientific evidence provided by risk-benefit analyses that evaluated the residual risk of TTIs associated with alternative deferral policies. Major determining factors of risk-benefit analyses include the following: 1. epidemiological characteristics that determine the proportion of MSM among HIV-infected patients; 2. screening technologies that have shortened the window period and improved the early detection of STIs; and 3. non-compliance after relaxation, which determines the increasing risk of TTIs.

Conclusion: Majority of countries that have recently relaxed their deferral policies for MSM blood donor reduced the deferral period to 12 or 6 months. Most of the risk-benefit analyses found that relaxation of deferral policies for MSM blood donors would lead to a relatively small increase in the risk of TTIs. Policies aimed at lowering the non-compliance may be an effective way to reduce the residual risk of TTIs from MSM blood donors who are within the window period.