On Oct. 16, Jack Edwards attempted to donate blood at Canadian Blood Services (CBS) for the second time. The first time he donated blood, he received little questioning and was screened as a man. 

On paper with all government entities, Edwards has identified as a man since he started transitioning in 2016.

“(Transitioning) has just been such a gift. Everything fits now. It all fits; I’ve just never looked back,” he said.

But this time was different.

During the interview process, the nurse asked Edwards if he currently took any medication. He said yes—one small aspirin per day. Asked why, he said it’s because he’s trans, and testosterone causes high hemoglobin, which increases the risk of stroke. According to Edwards the nurse stopped, left the room, and then another nurse restarted the interview process.

Edwards said the nurse insisted that he must identify as the gender assigned him at birth, and throughout the 45-minute conversation continuously insisted Edwards was “anatomically female.” The nurse also asked him about his genitalia, insisting that information regarding gender-conforming surgery was necessary to determine the health of his blood. 

He felt like he had been sucker punched. Edwards says information regarding his genitals is completely irrelevant to questions necessary to determining the health of his blood, such as potential pregnancy. When Edwards insisted he would have had to have had sex with a man in order for pregnancy to be possible, the nurse didn’t have an answer. 

Edwards completed the blood donation that day, but when he was leaving the nurse insisted when he returns he “absolutely must” identify himself as female. He told CBS he would never be back.

“I did say to her, ‘This is a really triggering conversation, I’m upset about it, I don’t like this conversation.’ But she just kept on. Honestly, I think she said three or four times: ‘You are anatomically—and she really emphasized anatomically—female.’”

Edwards says being trans is the very essence of who he is. 

“It’s just a really painful process, living in the wrong body. And so I think when someone insists that you call yourself by the opposite gender of what you identify with, what they’re saying is your experience isn’t important and your pain of having lived in the wrong body for so long is irrelevant.” 

‘Ineffective’ and ‘unnecessary’

The Canadian Press first reported on Tuesday morning that Canadian Blood Services is asking Health Canada for permission to change its rules around gay male blood donors, toward screening questions based on behaviour rather than sexual orientation.

Those existing policies have a long history.

When the AIDS epidemic began in 1981, it changed many things, including who was allowed to donate blood. Men who had sex with men, even in monogamous relationships, could no longer donate due to fear of blood tainted with HIV/AIDS or Hepatitis C. Those who wanted to donate were thereafter screened based on their sexuality and gender, rather than their sexual activity. This new set of policies limited mass groups of individuals under suspicion based on identity, and much of these policies still exist in part today.

In 2020, it was reported nationally that the “blood ban,” which Prime Minister Justin Trudeau vowed to dismantle before he was first elected in 2015, had been found by Health Canada to be “ineffective” and “unnecessary.” Today, men who have sex with men must be abstinent for three months before donating, regardless of their sexual practices and health.

This has changed over the years—from a permanent ban for the gay and trans women community, to a five-year ban, to a one-year, and now, finally, a three-month ban. But advocates say even that is unnecessary.

“Now, all blood is tested for a range of diseases including HIV. So now, the rationale is completely fear-based,” said Kole Lawrence, a counselling and support services co-ordinator with Qmunity in Vancouver.

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Issues surrounding the blood donation process for gay and trans women are nothing new. Stories dating back to 2014 document examples of BC donors being turned away. 

In the years that followed, stories surfaced discussing the need for gay men to donate blood, about individuals slamming rules for transgender blood donations, and others alleging CBS’s polices are “anti-trans.” 

When reached for comment about Edwards’ experience, CBS told Capital Daily they could not speak to specific incidents, but a spokesperson said CBS staff “recognize that there are limitations in our current donation criteria for trans donors and we are working to improve this.”

They invited Edwards to reach out about his experience. Eventually, after sending three emails, he received a response, and later told Capital Daily he had a good conversation with one of the organization's higher-ups. They did not, however, explain to Edwards how they would help this particular nurse learn to work more sensitively with transgender people, something Edwards has been asking repeatedly for. 

In a statement, CBS explained that their current binary (male/female) eligibility system does not allow them to assess people in an individualized manner. They admitted this is “still far from ideal” for trans donors and that they are “working on improvements to this.”

The stories have continued. This year, more discussions have taken place about the future of blood donations for queer, gay, and trans people, and how current blood policies have left them feeling discriminated against and stigmatized.

For years, Lawrence has advocated for members of the queer community and has researched extensively how the blood donation questionnaire and blood ban affects LGBTQ+ donors.

“I think that questionnaire should be not at all based on someone’s identity. The fundamental thing that’s worth advocating for at this point is, that questionnaire should be based on determining someone's behaviours and not their identity,” Lawrence said. 

“Whether or not someone is an intravenous drug user, practises risky sex, these types of things—these could be, in theory, relevant questions on a questionnaire like this. But those questions don’t exist.”

Further, he debunked the three-month abstinence period for trans woman and men who have sex with men.

Lawrence explained there are at least 21 countries—including the UK, France, Italy, Spain, and Argentina—that have moved away from an identity-based screening model, and adopted a behaviour-based model instead. Canada and the United States are not on that list.

According to CBS, “Health Canada alone has the authority to approve changes to donor selection criteria that impact human safety or the safety of blood... For Canadian Blood Services to apply to make a change, we must be able to provide evidence that the proposed change will not compromise safety.”

Health Canada told Capital Daily on Tuesday that it is aware of CBS's plan to submit a request to change their process, that it is funding research on the matter, and that it "shares CBS's and HQ [Hema Quebec]'s goal of further reducing and ultimately ending any deferral period provided that submissions received from the blood operators are supported by scientific evidence."

The spokesperson said CBS understands there are some who were assigned female at birth who could never have had a pregnancy, but “the current system does not allow us to screen donors in this individualized way.”

Within the next year, CBS says they hope to, alongside the queer community, figure out how they can screen blood donors in a way that is “respectful and safe.” As a part of this, the spokesperson confirmed they are submitting a request to Health Canada by the end of 2021 which would, if approved, allow them to stop screening in a way that requires them to ask invasive questions about genitalia. They also hope to move towards a system which would allow them to “move beyond binary sex” when screening people. 

“We really don’t want to have to keep asking trans people about their genitals. We know it can cause pain,” they said.

Asked what motivated them to make their submission to Health Canada, CBS told Capital Daily they “seek to be minimally restrictive about who can donate while safeguarding the blood supply for patients in Canada” and that they now have “more evidence than ever before... that indicates this change will not compromise the safety of the blood supply.”

CBS said it has seen no change in HIV risk in two years of monitoring since its last change to eligibility criteria.

Since CBS began managing Canada’s blood system in 1998, the organization added, there has not been a single transfusion-transmitted infection from either hepatitis C or HIV. 

Banned for life

Kori Doty, a trans individual who works as a sex educator in Victoria, is no stranger to challenges that come with being gender-diverse. 

In August 2021 they received a lifetime ban from donating at CBS after asking for clarification on the interview form about sexual exchange, in an attempt to force the system to recognize gender diversity.

They believe the policies set out by CBS are archaic and based on a discriminatory system formulated around fear, rather than science. 

There has always been a culture of donating blood in Doty’s family; both their mother and grandfather were lifetime donors. As a sex educator, Doty is very aware of their own sexual health. 

Doty themself has experienced difficulty giving blood. They arrived at Canadian Blood Services on Aug. 25 and immediately faced an issue. Because they previously donated to CBS prior to when they legally changed their name in 2007, Doty was told they had to sign in as their previous name—a situation trans people call “deadnaming” since it involves using a name that no longer represents them.

“Legally, I’m not. I’m not that person, I haven’t been that person for a long time. But I can’t get to the stage where I could amend that without swearing an oath that I am this person,” Doty said.

When they eventually got past the sign-in process, Doty reached a question in the interview process which asked if they had ever exchanged sex for drugs or money. 

The available answers were “yes,” “no,” and “I’m not sure.” 

To Doty, once again, those were not simple questions with simple answers.

“How are you defining that?” Doty said. “How are you defining ‘drugs,’ how are you defining ‘sex,’ what are the parameters for this exchange? Without having clarification on this, my answer is going to be, ‘I don’t know.”’

That, it turned out, was the wrong answer. Because they nitpicked the question of having made an exchange for sex, Doty was “deferred,” or banned for life, from donating to CBS. 

In a statement to Capital Daily, CBS explained they are required to ask a series of questions to determine donor eligibility, but that, “Staff should be able to respond to donors’ questions during the process, or to refer the donor to someone who can. Staff who screen donors should be able to explain what we mean by ‘sex’ and ‘drugs,’ as those have specific definitions in a donor screening context.”

CBS added, “Work is underway to update an array of questions for clarity,” and said they are “seeking to remove the lifetime deferral for people who have exchanged sex for drugs/money and reduce it to three months.”

Doty has since written about their experience on their blog and have since heard from others who had similar experiences.

“What I have heard is from a lot of other people who would be really happy to give and aren’t allowed for really inane reasons,” Doty said. 

They also demanded an admission of harm from CBS, which they see as “an institution that has been responsible for perpetuating homophobia and outdated ideologies about gender.”

In a statement, CBS could not speak to Doty’s experience, citing privacy considerations.

Going forward, Doty sees a more open world that is more accepting of people in the queer community. With that, as more people feel comfortable coming out, they hope more modern policies will exist to accompany a growing community of queer people.

Lawrence believes that a modernized system based in science and not fear would make a huge difference in an ongoing shortage of blood. For almost four decades, members of the queer community have been unable to donate blood for the most part, he explained, despite them wanting to. 

“There were queer and gender-diverse folks dying in the late 1980s and early 1990s to AIDS, and their queer friends weren’t able to donate blood for them. There’s a lot of that residue that remains,” Lawrence said.

“A lot of queer people want to donate blood. It’s like a fundamental thing at this point that would help a lot of folks feel like they can contribute to the health system again in Canada.” 

Update: This article was updated Tuesday at 5:45 pm after we received a response from Health Canada.