Stepping Stones or Second Class Donors?: a qualitative analysis of gay, bisexual, and queer men’s perspectives on plasma donation policy in Canada

Canadian provinces and territories are able to decide the terms for compensating plasma donors. In Ontario, for example, Bill 21 - Safeguarding Health Care Integrity Act prohibits any form of compensation for any kind of blood donation [18]. However, in the provinces of Saskatchewan, Manitoba, and New Brunswick private clinics are able to offer compensation for plasma donation [19, 20]. Within Canada, plasma transfusion utilizes either (a) uncompensated donation collected from Canadians or (b) compensated donation from the United States that has been procured by Canadian Blood Services or Héma-Québec. Compensated plasma donation from within Canada is used in manufacturing drugs and other medical/biological therapies.

There are several key differences in plasma collection, testing, and processing that make plasma donation unique. With plasmapheresis, a higher volume of plasma can be collected each time and a person may donate more frequently since some blood components are returned into the donor. A proportion of recovered plasma, and most of plasmapheresis plasma, are sent to fractionation to produce important blood elements such as albumin and immunoglobulins. At present, approximately 90% of plasma collected by Canada’s blood operators is recovered plasma (through whole blood donations) with approximately 10% being plasmapheresis (source) donation. Due to insufficient plasma volume collected in Canada that is needed to produce plasma protein products, these plasma protein products are imported from foreign sources [17]. Canadian Blood Services has articulated its commitment to increasing plasma sufficiency in Canada, noting current shortfalls in the supply (e.g., what is currently collected only meets 13–14% of the need for immune globulin (Ig)—a high-demand plasma protein product [21].

As we have described elsewhere: “we refer to the target population of the current deferral policy as being for men who have sex with men (MSM), but reference the participants we interviewed as [gay, bisexual, queer, and other men who have sex with men] GBM to signify the diverse ways in which they identified themselves. MSM is an epidemiological category with policy relevance, but everyday people are more likely to refer to themselves and communities through common monikers or identities like gay, bisexual, and queer” [5].

This was determined by using the HIV Risk Index for men who have sex with men (HIRI-MSM) scores which measures the likelihood of MSM acquiring HIV based on sexual behaviours, health history, and other socio-demographic information [33]; 39% of participants were at higher risk for HIV (> 10) at the time of their baseline quantitative survey. This risk score is the threshold for recommending pre-exposure prophylaxis (PrEP) for HIV prevention [34].