September 29, 2014

News | November 18, 2013
Queering bioethics
Institutionalizing homophobia in organ donation

Correction appended November 20, 2013.

In Canada, 4,000 people are waiting for an organ donation, yet only 1,803 organ transplants were performed during the past year. 185 people died while waiting for an organ.

With such a large need for organ donors, Jason Behrmann, a post-doctoral fellow at McGill in the Institute for Gender, Sexuality, and Feminist Studies (IGSF), questions why donor regulations exclude homosexual men. As part of the IGSF’s “Esquisses” series last Tuesday, Behrmann addressed this issue.

“These policies [...] exclude a certain group from contributing to society. Gay, bisexual and MSM people have come to be called freeloaders of society.”

“Sex, gender, and sexual orientation are factors that have a huge influence on health [...] and health policy,” Behrmann told The Daily. “Correspondingly, [sexual orientation] has a dramatic influence on the structuring of your healthcare system and the availability of very [...] scarce resources in health.”

The late 1970s saw thousands of people infected with HIV and hepatitis, often related to blood transfusions. In particular, HIV was prevalent in the gay community at that time. In 1977, men who have sex with men – referred to as MSM by Health Canada – were banned from donating blood or organs.

This meant that if a man had had sex with another man anytime since 1977, they would not be eligible to donate. This regulation also applied to intravenous drug users, sex workers, prisoners, and anyone sexually involved with these groups, as well as people directly exposed to HIV, Hepatitis B (HBV), or Hepatitis C (HCV) infected blood, as published on the website of the Parliament of Canada.

In summer 2013, the government changed these policies to a five-year deferral on MSM. According to Canadian Blood Services, “The change means that any man who has not had sex with another man in the last five years and meets other screening criteria may be eligible to give blood.”

During the “Esquisses,” Behrmann contested this regulation, stating that technology has developed rapidly to control infectious diseases in blood, so that only 1 in 7.8 million transfusions ‘tainted’ with a transmissible disease evade the tests.

However, in the context of the five-year deferral period, Behrmann said that, “These policies [...] exclude a certain group from contributing to society. Gay, bisexual and MSM people have come to be called freeloaders of society.”

“The fact that we have regulations that exclude or try to exclude men who have sex with men – an exclusively male population that’s cut out of the donor pool – inadvertently requires the female population having to make up for that slack. That burden gets placed on the backs of women.”

Behrmann also raised the issue of sperm donation in Canada.

“It seems really strange that someone is banned until the day they die, from being an anonymous sperm donor, just because they happen to be MSM.”

Behrmann claimed that these restrictions are intrusive, with the government overly involved in individual, private reproductive freedoms. He also asserted that the quality of health services received by patients from the Lesbian Gay Bisexual Trans* Queer (LGBTQ) community may be negatively affected, as they would not feel as comfortable consulting medical services.

“It does raise tensions and a negative perception of the gay community toward the medical community. This is rather well-known. These regulations do dissuade people from seeking medical attention,” he said.

Behrmann also looked at the gender discrepancy in the organ donor pool.

“The fact that we have regulations that exclude or try to exclude men who have sex with men – an exclusively male population that’s cut out of the donor pool – inadvertently requires the female population having to make up for that slack. That burden gets placed on the backs of women.”

Behrmann also discussed a loophole provision known as “exceptional circumstances,” which allows for organs from the MSM population to be used in life-or-death situations in which there are no available organs from other eligible populations and the patient has given consent.

This provision does not generally apply to blood or sperm donations and still prevents MSM donors from giving certain organs such as kidneys. While the overall scarcity of available organs results in up to half of donated organs coming from ‘undesirable’ populations, Behrmann emphasized that there are still many problems with this MSM donor criteria, as well as other high-risk populations.

“It reinforces this notion that organs are not equal. It’s not just a human thing, it’s a gay thing. You would have what is deemed ‘high-risk’ organs because they come from a gay donor and you would know it.”

He claimed the current policies enable the discrimination and stigmatization of homosexual men, and deter them from participation in the healthcare system.

“We look [at] how when we structure health interventions for the [MSM] population, we can inadvertently stigmatize people and force this othering and notions of unwantedness of certain population groups.”

Behrmann addressed the ways in which he believed the current donation policies could be improved.

Among others, his proposed changes included reducing the five-year ban on blood donation to 12 months. He also recommended organizing surveys and collecting data that quantify the waste produced by excluding MSM organ donations. Raising awareness of these issues for doctors would also ameliorate the issue, according to Behrmann.

Although implementing such changes would not be easy, Behrmann remains confident in the positive impact they could bring about in the future.

“The question is: now can we change these regulations that exclude broad members of the population, and still keep a very safe and effective system, without increasing the risk of disease. I believe through my proposals that we can achieve those goals.”

The graphic in an earlier version of this article stated that in 1988, a five-year deferral was introduced into the blood screening process. In fact, that year saw an indefinite deferral introduced. The Daily regrets the error.

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