Thursday, 31 December 2009

'Tis the season of giving - Blood!

I feel I need to write a post on the issue of blood donation.

Tim Trent generously gave me a guest post out of an email exchange I had, so I'll summarise a few of the points here.

Health is a policy area which impacts every single one of us, so it is an issue of equality. Simply put, health is a human rights issue.

I understand the National Blood Service estimates it requires 9,000 units of blood to be donated every day to keep up with UK demand (7,000 in England) as stocks must be used within one month of donation.

However, over holiday periods supply typically drops by 10% and becomes stretched as emergency demand increases (largely from rises in road traffic accidents associated with drink-driving). Similarly bad weather can take its' toll as the elasticity of both supply and demand becomes apparent.

It is "an integral and essential part of our health care system," but only 4% of the population are regular donors - primarily because there are restrictions on who may give blood.

Some of these restrictions are natural enough, but others reflect the state of our politics - in particular the blanket ban on all gay men.

This strikes me as particularly ridiculous and self-defeating.

Earlier this year (Summer 2009) there was a review of the public policy by government. It concluded that there should be no change to the policy prohibiting any man who has had any homosexual contact (ie including safe and non-penetrative sex) since 1977 from being automatically excluded as a potential donor.

According to the Terence Higgins Trust the blanket ban is "more workable, more cost-effective and more efficient than opt-out exclusions" [1].

In the FAQs on the THT site they mount a resolute defence of this policy position, arguing that the initial appearance of a discriminatory attitude is safer because government cannot commit to an adequately funded blood screening programme, stating that it is merely 'unfortunate' and 'reasonable' that generalisations must be made in the statistical models which go into policy formation.

In essence the THT supports the status quo (discrimination) on cost grounds.

I wonder would that have reached the same position if there were a Conservative government or no financial crisis? Clearly the THT is playing party politics rather than sticking up for principles.

In mitigation they do also state that new developments in epidemiology and testing technologies may enable authorities to 'maximise guidance', but surely this then demands funding for these areas be instigated to demonstrate commitment to the cause.

They also push for continual review of the evidence, alongside a "need to review and improve the quality of their communication with members of the public".

Of course this is a delicate area relating to highly personal matters, but it is simply not good enough to justify automatic exclusions (and such a lengthy list of them too) by arguing in favour of inspecific reviews as the primary means to placate popular opinion when lives are at stake.

Perhaps more importantly, without an adequate screening programme the service puts itself at risk of disease transmission from people who lie or are simply ignorant of the issues.

This has been highlighted by a recent case of an organ donor passing on a rare amoebic pathogen (Balamuthia mandrillaris) because standard tests were not sufficient to pick up the parasite which attacks the auto-immune system, which has lead to calls for greater restrictions on who qualifies for donation as improvements in surgery allow more donations to be made and infection rates increase.

It is also particularly relevant considering the proposed change from opt-in to opt-out systems of presumed consent for organ donation in the UK and the increasing demand for platelets due to longer life-spans and the increasing incidence of cancer.

As Scott Hensley says, it is a matter of balancing exclusions with better testing facilities.

So if the different parties want to be trusted on where they stand with regard to the NHS they need to be clearer about whether they are prepared to make the required funding commitments.


Update: Nick Clegg deserves top marks on equality

1 comment:

Tim Trent said...

I think the THT attitude stinks. There's no point in being equivocal about it. That's one reason why I've given this substantial publicity over the past two days.

Do not forget Petitioning the idiot Brown at the Number 10 Web site where I was signatory 541. We can do better than that, surely we can.