Blood, safety, and arbitrary guidelines.

Today, I tried to give blood. It’s a thing that I- like many people- had always thought that I should do. Recently, I had to get tested for haemochromatosis. I made my mind up that since if I had it I’d have to get blood taken regularly, if I tested negative I’d get my bum down to the blood transfusion clinic, stat, and just bloody well donate.

Turns out that, after feeding myself a rather impressively large lunch and downing almost three pints of water* before my appointment, I’m ineligible to donate. I’ve lived in a malaria zone, you see. While being in a malaria zone for less than six months only means a 12-month ban on donation, doing so for more than that time leads to a lifetime ban. This was a bit disappointing, but hey. But then I got thinking. And what I am thinking about is this, as well as another factor which renders people ineligible to donate, and how this impacts on safety.

The reason, as far as I can tell, why I cannot donate is because malaria can, very rarely, have an incredibly long incubation time. Given that it’s a bloodborne disease, it’s good to be careful.

This is not a thing I have a problem with. Taking care to make sure that people don’t get malaria is a Good Thing! Malaria is a godawful illness, I know several people who’ve died of it. I am very, very much in favour of making sure that the blood that people donate is safe. However, I’m not sure that this ban does that.

Here’s the thing. If there is a chance that everyone who goes to or lives in a malarial zone could, entirely asymptomatically, be carrying around malaria in their systems, then why do we allow people who have been in malarial zones to donate at all? Why is this tied to time spent in a malarial zone and not, say, whether or not the person in question was rigorously taking antimalarials? Anecdata time: I know of people who’ve come down with malaria within a week of landing in a malarial zone. In my (anecdotal!) experience, people tend to get bitten more when they first arrive, and within very short order get very, very sick of mosquito bites and start getting sensible about not getting bitten. Wearing shorts at sunset and not tucking in your mosquito nets properly gets very old, very fast, when the alternative is those whiny feckers making you itch. While I’m happy to see any stats people could provide on this one, I find it hard to accept that there is a vastly increased risk of exposure to malaria when you’ve been in a malaria zone more than a very short time indeed. And yet we allow people who went to a malaria zone for 5 1/2 months and spent their entire time lounging about in shorts at sunset next to stagnant water forgetting to take their antimalarials to donate after a year! But those who were there for a few weeks longer, who took their antimalarials, wore their long sleeves at sunset, stayed away from stagnant water, used their mosquito repellant and tucked in their mosquito nets at bedtime? Lifetime ban.

And yes, there’s a huge parallel here. I’ve advocated for years against the gay blood ban, where any man who’s had sexual contact with another man, ever, even protected, is banned forever from donating blood. Whereas as a cis woman, I could cheerfully have unprotected sex with as many men as I pleased, wait a year, and donate.

My question is this: How do these rules protect people? If I am a significant malaria risk despite having gone 15 years since leaving a malarial zone and never having had malaria, how is a person who was in the same place as me for five months, a year ago, not a risk? If John sleeps with Bob on Tuesday, and me on Wednesday, then how is it safe to allow me to give blood after a year, when Bob is barred for life? These things simply don’t make sense.

*I had hoped that one of those would be exiting through my arm. No such luck.

Blood, safety, and arbitrary guidelines.