Defender o Quadrado

Ciclicamente a questão da não elegibilidade das pessoas pertencentes a grupos de risco (conjunto de pessoas estatisticamente associado a determinado risco), neste caso mais exactamente a comportamentos sexuais de risco (entenda-se risco como a possibilidade de contraírem doenças transmissíveis pelo sangue) como dadores de sangue é trazido à discussão, assistindo-se a acusações de descriminação, confundindo-se o que são medidas de segurança para toda a população com posições políticas e/ ou ideológicas sobre determinado tipo de comportamentos e escolhas de vida.

Já aqui me referi a esse problema, em 2009. Vou voltar a ele 6 anos depois, citando outros documentos que estão ao alcance de quem quiser informar-se. Os conhecimentos e as evidências científicas não são estáticas ou seja, o que se considera cientificamente correcto hoje pode evoluir e ser diferente de amanhã. Mas o enviesamento da discussão científica exclusivamente por causas ideológicas é muito perigoso. Todos os cidadãos têm o direito de se apresentar como dadores de sangue, o que não é sinónimo nem equivalente a ter o direito de doar sangue. Os serviços de saúde têm como missão assegurar que os vários componentes do sangue são recolhidos em condições de segurança, reduzindo o risco de infecções ao mínimo que os conhecimentos actuais permitem e que o estado da arte podem garantir. Começo pela OMS, um organismo internacional no âmbito da ONU, cientificamente independente e distanciada das batalhas ideológicas sobre a igualdade de géneros, que já produziu centenas de guidelines sobre múltiplos aspectos da prática médica. Esta é sobre a selecção de dadores de sangue.

Blood Donor Selection - Guidelines on Assessing Donor Suitability for Blood Donation – WHO (2012) -  Pág. 87 e 88:

(…) It is essential that BTS identify and defer from blood donation individuals whose sexual behaviour puts them at high risk of acquiring infectious diseases that can be transmitted through blood.

(…) High-risk sexual behaviours include having multiple sex partners, receiving or paying money or drugs for sex, including sex workers and their clients, men having sex with men (MSM) (250,251) and females having sex with MSM (246,247,252). MSM account for the largest subpopulation of HIV-infected people in most developed countries (253,254,255,256) and many countries therefore permanently defer men who have ever had oral or anal sex with another man (254,257,258). The permanent deferral of MSM has been criticized as being selectively discriminatory and lacking scientific rigour (253,259,260,261) and has undergone review in some countries in the light of increasingly sensitive and reliable technologies for donation screening (249,262). Studies using mathematical modelling to predict the effect of reducing deferral intervals for MSM to one or five years have suggested that the increased risk of an HIV-infected donation entering the blood supply is small, but not zero, with little gain in terms of additional donations (263,264,265,266). These studies rely on some assumptions, are applicable only to the populations studied, and relate to testing methodologies that are not available in some countries and have been superseded in others. However, no comparable evidence is currently available. The permanent deferral of MSM therefore continues to be endorsed as the default position based on the principle of risk reduction to “as low as reasonably achievable” (ALARA).

Pág. 220 – 224: (…) Decision-making process

The Guideline Development Group concluded that permanent deferral of MSM as blood donors should continue to be recommended by WHO as the safest option, based on the principle of risk reduction to “as low as reasonably achievable” (ALARA). This policy should be critically and frequently reviewed by blood transfusion services in the light of changes in disease epidemiology, residual risk of HIV transmission, sensitivity of HIV screening assays and ongoing research. (…)

Blood, tissues and cells from Human Origin - The European Blood Alliance Perspective (2013)

Pág 134:

6.5 Precautionary principle - On several occasions the precautionary principle [25] is applied. In health care and transfusion contexts this principle is applied by letting the safety of the recipient prevail. This becomes tricky when sensitive issues arise, such as the exclusion of men having had sex with other men (MSM) [26]. Clearly, discrimination must be avoided.

6.5.1 Criteria for exclusion - Justified distinctions may still be made for deferring certain groups of prospective donors, when clear health risks for the recipient exist [27]. The primary reason for excluding candidate male donors on the ground of MSM is not that being homosexual made them non-eligible, but that their sexual behaviour carries a greater risk of transmitting HIV-infected blood. The deferral criteria are not a judgement on behaviour or (sexual) preference or (ethnic) descent, but a judgement on the (general, anticipated) risk related to behaviour. Having travelled in the jungle does not make someone a bad person, but does entail that person carrying a greater risk of transmitting malaria.

 

Position Statement on MSM & blood donation - The European Haemophilia Consortium (2015)

By deferring all persons in a risk category, risk is decreased over thousands of transfusions over many years. The deferral of MSM donors has been legally challenged in Canada, Australia and Finland and the legality of the deferral was upheld in each case. Decisions on deferral of donors should be taken nationally, bearing in mind the incidence and prevalence of both sexually transmitted infections as well as transfusion transmitted infections in each country. Donor deferral should not be regarded as primarily an issue of social policy, fairness or equality.

The EHC position is that decisions on donor deferral, including deferral of MSM donors, should always be based on data and scientific evidence and not on considerations of social policy or politics. The safety of recipients of blood transfusion and blood components is always the primary concern. In considering any change to deferral policy, countries should carry out a risk assessment based on the scientific evidence available. They should examine if any change in policy will result in an increased risk to blood recipients and decide on the degree of risk tolerance, bearing in mind that the risk is borne by recipients and not by donors. The level of compliance with any policy should also be examined insofar as this is possible to estimate.

Transfusion of safe blood and blood components is the objective of blood transfusion services and this should always be the driving force in any decision on donor deferral.