Donating blood as a transgender individual

Being transgender is not a reason to prevent you from donating blood. If you are having hormone therapy you will have to wait until you are three months into the therapy before giving blood, plasma or platelets. Beyond that, you are subject to the same deferral periods as every other donor: a deferral of 2 weeks to 4 months for a surgical operation and a deferral of 4 to 12 months following a risk of HIV and other sexually transmitted diseases.

Hormone therapy: three months deferral from start of treatment

We ask transgender individuals who are receiving hormone therapy as part of a medical transition to wait until they are three months into their therapy before donating blood. This is because hormone therapy can affect blood counts such as haemoglobin. After three months we can be sure that these blood counts, particularly the haemoglobin concentrations, have settled at the levels typical for the new gender. Haemoglobin counts are an important means of ensuring that donors are not anaemic. No deferral periods are needed for other transgender individuals (e.g. people who have been on hormone therapy longer or have stopped altogether). 

Surgery or sexual risk behaviour: all equal before the law

The deferral periods are the same for everyone who has an operation: 2 weeks to 4 months, depending on the surgery. Operations undergone as part of a medical gender transition are no exception.

The same holds true for the risk of blood borne sexually transmitted diseases. As is the case with other donors, the deferral period for transgender individuals is a minimum of 4 months following sexual contact with a new partner. In the case of sexual contact with a person who is at higher risk of HIV and other sexually transmitted diseases, such as bisexual individuals and men who have sex with men, the Belgian law prescribes a deferral of 1 year after last contact. Applicable to all donors, this rule covers transgender individuals too.   

Donor and patient safety

Since we updated our blood bank computer system, it has become possible for transgender individuals to give, blood, plasma and platelets in a way which is safe for themselves and the patients destined to receive their blood products. Important aspects for donors include haemoglobin concentrations (to prevent donor anaemia) and the ratio of safe donation volume to total blood volume. The criteria are set by law and differ for men and women. Patients who are destined to receive the blood products run the risk of gender-related transfusion reactions. It is therefore important that we know the donor's (original) sex at birth and any change thereafter. For this reason the medical checklist asks: "Is your current sex the same as your certified sex at birth?" Needless to say, this information is treated in the strictest of confidence (as are the other answers given in the medical checklist and info discussed with the doctor).   

Registered donor? Please note!

When you give blood we register you by means of your eID. When you have had a legal sex change your social security number also changes, and a new donor identity is created when the new eID is captured. It is crucial to the safety of the blood chain that we be able to trace every blood product given by a donor and the corresponding historical lab results.

For this reason, the procedures for matching donor identities and ensuring that they refer to one and the same person must be watertight. Belgian Red Cross: Flanders therefore requests that, when attending to give blood after a legally recognised change of gender, donors produce a certificate from the register of births, marriages and deaths showing the old social security number alongside the new one. The certificate can be written and issued by the registrar for the current district of residence. This helps us guarantee donor traceability as well as the safety of the blood we collect. You will need this certificate only if you have donated your blood, plasma or platelets to Belgian Red Cross: Flanders in the past. 

In June 2019, the media reported deferrals for transgender individuals. Why is it that transgender individuals are now able to give blood?

The blood bank computer system we use is binary in design (M/F). The binary classification is used to find the haemoglobin count (different for men and women) and work out the total blood volume. It also determines which additional tests can be carried out and which end products can be made from the blood donation. For example, plasma from female donors is used for medicines and not transfusions, because it increases the chances of a serious transfusion reaction in the patient. We had to modify these elements without risking errors in the other production processes. The modifications have now been made and the blood bank computer system is ready to welcome transgender individuals as donors.

How was the new policy decided?

The new policy came about thanks to input from çavaria, the transgender info service, and is based on a prospective cohort study (by UZ Ghent, UMC Amsterdam) on the effects of gender affirming hormone therapy on hematocrit levels (haemoglobin concentrations), evidence backing HIV prevalence among transgender individuals, the Belgian law on blood and blood derivatives of human origin and the Transgender Act of 25 June 2017.