Paul's Internet Landfill/ 2022/ Canadian Blood Services is Trans-Hostile

Canadian Blood Services is Trans-Hostile

In my last entry I mentioned that I was still angry at Canadian Blood Services (CBS) because of some new practices I perceived as being hostile to trans people. I am certain that I wrote about that somewhere, but now I can find no evidence that I did. I do have evidence that I researched the issue in preparation of a blog post. This is anxiety-provoking to me. (Re)writing the entry now will not relieve that anxiety, but I might as well document my objections.

Note: Since the MSM ban was lifted, CBS has changed several pages I referred to in my original research. Where relevant I have linked to the version of these pages. Although they have softened their tone on some things (for example bottom surgery) I maintain my criticisms. I'm sorry, but I am not willing to give this organization a free pass given its horrendous past behaviour.

Here is the executive summary: recently (I believe late last year?) Canadian Blood Services changed its screening procedures again. After I fill out my questionnaire I see a nurse to have my hemoglobin levels and temperature checked. As part of this nurse screening I am asked to state my name and date of birth. The change was that in addition to my name and date of birth I am now required to state my sex. The justifications for this change are flimsy, and I believe the intention is to create a more hostile environment for trans and nonbinary people attempting to donate blood. It may not be intentionally hostile, but it is effectively hostile.

This makes me very angry. As I documented extensively in my Does Canadian Blood Services Have an Image Problem?, CBS has a long history of justifying hurtful and discriminatory screening practices on weak public health grounds:

Canadian Blood Services had the gall to claim that these deferrals were based on geography, not race. As of this January they continued to claim that "donor screening deferrals are based on risk factors. It has nothing to do with race or ethnicity." (See the "Geographic Deferrals" section.) Based on how quickly they narrowed the ineligibility window for European donors, I do not believe them.

We all thought that CBS had turned a new leaf. In 2015 they changed the questionnaire significantly. Since then it seems that the Latin American and African screening questions are gone. They even offered a half-apology buried in their site with respect to their racism:

We acknowledge that our donor health questions currently and in the past have disproportionately impacted racialized Canadians due to our geography-based policies. As the patterns of disease and our testing platforms evolve, we commit to reviewing and updating our safety procedures.

This is not an actual apology. It is a "I'm sorry you were offended" apology, especially in light of the assertion that the deferrals "have nothing to do with race or ethnicity" above. However, this half-apology goes further than they were willing to go before. So it sounded as if CBS was serious about treating minority donors with dignity. Then comes this sex identification nonsense.

Look. I am perceived as a cisgendered male and I identify as a cisgendered male, but I do not particularly feel comfortable proclaiming that out loud. There is some chance that CBS is trying to make trans and nonbinary donors feel more comfortable by verbally declaring their sex to a nurse when donating blood, but I doubt this. For one thing, CBS is a strongly binary organization: their information system has two checkboxes for sex: "Male" and "Female". If you identify as nonbinary you had better pick a side. Furthermore, CBS classifies trans donors as male or female based on whether they have had bottom surgery. Those donors who have had bottom surgery over three months ago may donate as their identified sex, and everybody else identifies as their birth sex. This reinforces the conception that people are not "really trans" unless they have bottom surgery, which I think is deeply harmful. This also makes me even more skeptical that the verbal sex declaration is intended to be friendly to transpeople. If a transwoman says her sex is female, but has not had bottom surgery, then CBS will tell her that for the purposes of blood donation her sex is actually male. How does that foster a welcoming environment? (Update: it looks like this will change when the gay male ban is lifted. At that point trans people will be allowed to identify as their preferred gender, but that gender must still be male or female.)

I have twice asked the nurses why they now require me to state my sex when donating. Each time I was lied to. Each time they told me they needed to confirm my sex so that I "received the correct questionnaire", because the questions CBS asks of male donors differs from those they ask of females. This is nonsense. By the time I see the nurse I have already completed the questionnaire, so if I was given the wrong questionnaire the damage is done. Why are the nurses lying to me?

Furthermore, why do I need to declare my sex out loud? There is lots of information (such as my address) that I am asked to visually confirm when I see the nurse. Why is my sex not one of those fields?

The story gets worse, of course. If you read this archived copy of the trans eligibility page you see the medical justifications they use to care about transness at all.

Donors who transition from male to female often identify as gay men pre-transition, which means maybe they had anal sex, which means they are at higher risk for AIDS. Thus CBS is justified in discriminating against them. I do not love this reasoning but (just as I can agree with the reasoning behind the MSM deferrals) I can believe it.

What about donors who transition from female to male? This is where their justifications fall apart. Just as they needed to justify discrimination against Latin American donors via maternal transmission, CBS discriminates against transmen on the basis of something called TRALI: Transfusion-related acute lung injury. From the trans eligibility page:

Transfusion-related acute lung injury (TRALI) is a rare but potentially fatal complication that can occur in recipients after transfusion. Donors who have had a past pregnancy, including miscarriages and abortions, are more likely to have antibodies present in the liquid portion of their blood (plasma) that may cause TRALI in a recipient. To reduce this risk, plasma from donors at risk for TRALI is used to produce plasma protein products, such as immune globulin (Ig), instead of being transfused directly to patients.

I have no doubt that TRALI exists, and that it can be serious. I completely disbelieve that it is something CBS cared about before the issue of transmen donors came up. How long are these antibodies supposed to last? There is one question in the screening questionnaire having to do with pregnancy; it asks whether donors have been pregnant in the last six months. In the big list of deferral criteria, it is stated that there is a six month deferral after pregnancy, and a six-week deferral after a miscarriage or termination of pregnancy. Nowhere do they ask "have you ever been pregnant"? Nowhere do they tell cisgendered women that their blood will not be used for whole-blood donation. So why do they emphasize this for transmen? Why is this used as a justification? If the deferral period is six months after a pregnancy, why is this not stated on the trans eligibility page? If the risk of TRALI is longer than six months, why does that not apply to cisgendered women donors? Here's my guess: Canadian Blood Services does not know how to deal with trans and nonbinary people, and they would prefer these people not be donors.

Just think of the nonsense justification from the nurses: "We want to make sure you get the right questionnaire". If you have a particular set of dangly bits you get a particular questionnaire. Why? They could ask the pregnancy question for all people, and then cisgendered men could snigger at the question, mark "No, of course not!" and then get on with their lives. Instead we have two questionnaires to sex-segregate the questions.

This ridiculousness extends beyond trans people. Canadian Blood Services made another recent change that discriminated against ciswomen. They used to be eligible for donation every 56 days, or eight weeks. This was increased to 84 days, or twelve weeks. This was awful for CBS on a number of fronts: first, it meant they were cutting the number of units of blood they could harvest from cis women, and it threw the donation cycles off between men and women, which means straight couples could not schedule their donations on the same day if the male wanted to donate as often as possible. Why this change? I have not researched the answer thoroughly, but my guess is "menstruation". I have a lot of problems with this. Firstly, some people who menstruate continue to maintain their iron levels, and so would be perfectly okay donating every eight weeks. Other women do not menstruate at all -- there is a thing called "menopause" which apparently happens. These women may be old, but they are still eligible to donate. Why should they not be allowed to donate at the same frequency as old men?

Canadian Blood Services claims that it is more sensitive to minority concerns now. It holds consultations with the LGBTQ community. It pays lip service to the fact that their policies might hurt people's feelings: "We recognize that being turned away from a blood donor clinic can leave a donor feeling hurt and rejected. This is especially true of blood donation because it is a purely altruistic gift." But I do not think CBS has changed its culture. There are certain categories of donors the organization cares a lot about, and others they are happy to neglect. When there is a public relations disaster (as with the MSM deferral) then they start to care; otherwise they couldn't care less. If you look through the board minutes at CBS you can see how much of a priority they have made the MSM deferrals over the past few years. I still argue that this is because CBS cares about straight people boycotting them, not because it cares about the gays. Similarly, I do not think that CBS cares much about the trans community yet. Maybe this will shift. More and more kids are identifying as trans and nonbinary, and those kids will revolt against blood donation. If straight people start to care then you can be sure CBS will start to care too. CBS has another public relations disaster looming, and this verbal declaration of one's sex does not help.

I do not know whether asking donors to verbally confirm their sexes is intended to be hostile, just as I do not know that the Africa/Latin American deferrals were intended to be racist. But in my opinion the verbal sex confirmation has the effect of being hostile, and that matters. I am frustrated and angry that CBS is playing these games, and it makes me want to continue donating less and less.

Update (2022-06-10)

I donated blood yesterday and was not asked to declare my sex. I do not know whether this was a one-off or whether CBS has gotten pushback and changed their practices.