Very Nearly an Armful

by Harry on March 18, 2007

I used to give blood, less often than I probably should have done, but willingly, and without much personal cost. Needles don’t bother me (as long as I am the victim) and whereas I’d feel tired at the end of the day, that was about it. There’s nothing special about my blood, and I’m sure it’s a drop in the ocean, but a recent conversation about why I no longer give blood has prompted me to wonder whether I should start again.

Why don’t I give any longer?

Well, I am, according the American Red Cross, ineligible. The reason is that, having lived in the UK from 1963 till 1985, I fail the following eligibility test:

From January 1, 1980, through December 31, 1996, you spent (visited or lived) a cumulative time of 3 months or more, in the United Kingdom (UK)

Because my up-to-now firm policy toward official queries etc. is one of non-deceit, I have presumed that I should, therefore, not give. I haven’t, since they adopted this standard, walked in to see whether I would be turned down, because I presume I would be.

But said conversation made me wonder whether I should violate my policy of honesty toward officialdom in this case. The case for violation goes as follows.

I find giving blood close-to-costless and there is a need for it, so I have a strong prima facie duty to give. During the long cumulative period I visited or lived in the UK from 1980-1996 I ate meat exactly once, and that was in Cork in the Republic of Ireland (1981…it’s a long story) and it was not beef, but ham. Although I have also, presumably, ingested other meat extracts during that period (through inclusion of animal products in cookies, etc), many if not most people who stayed more than a week but less than 3 months in the UK have had more exposure to mad cows than I have. We know about UK mad cows because the UK eventually adopted an rigorous inspection regime that exposed it, and many actual donors may have been just as much at risk as I, if not more. The policy is designed for official simplicity: if the person who devised the policy had the power to make exceptions and heard (and believed) my story, they’d make an exception in my case.

The above reasoning would smack of self-servingness if I got any benefit from giving blood. But I don’t, not even a glow of satisfaction. Unlike him (part 2, part 3 – fans of the quite remarkable Steve Carrell would do well to watch the whole thing, if you’ve a spare 30 minutes, by the way).

Now, Kieran can probably tell me straightaway whether there’s any need for my blood (B+). And he can presumably tell me what’s at stake – do people die because there isn’t enough blood in the supply? If not, then there’s no issue. And I’m not saying that I’d be able to lie even if you can persuade me that I should. But suppose I knew that someone would die if I refrained from lying. Wouldn’t I then have an obligation to do it?

(Asides: i) I absolutely promise not to raise more ethical issues here for a while; ii) if you don’t recognise the quote in the title, watch the included youtube links).



Tracy W 03.18.07 at 9:36 pm

Why don’t you call the Red Cross and ask?


tom s. 03.18.07 at 9:41 pm

I’m in almost the same circumstances. I live in Canada, but lived – without eating meat – in the UK for 18 months in 1988-89. As a result, Canadian Blood Services won’t take my blood.

I guess this is a reaction to the Aids/Hepatitis scares, but I can’t help thinking that it’s an overreaction.


Yusifu 03.18.07 at 10:39 pm

There’s a strong parallel with the question posed to men asking if they’ve had sex with other men at any time since 1977. I’ve always been offended by the overt homophobia of the premise there (no question that would assess levels of risk within the category of men who have sex with men). Hearing about the mad cow restriction mollifies me a bit.


Aidan Kehoe 03.18.07 at 10:48 pm

Yusifu, this is the best commentary on that particular issue I’ve seen, aimed at someone very offended by the situation, and from an M.D.


Kelly 03.18.07 at 11:21 pm

I’m in similar boat with another restriction on who they’ll take blood from, and have often wondered if I should simply lie, too. I know that what they’re concerned about isn’t an issue, know that I’m fine, and know that my blood is desperately needed (I’m O- – back when I was able to give blood, they’d call me up if I was a day past the time you have to wait between donations).

I have this weird idea, though, that if I’m going to focus on bioethics in my career, it might behoove me to act ethically. Of course, the larger question is what is ethical in this situation – and it might very well be more ethical to lie and give blood/help folks, than follow very outdated and ineffective rules created during periods of fear and misunderstandings of several diseases.


vivian 03.19.07 at 12:19 am

Please keep posting on ethical topics. Surely your comment count shows you have an eager audience.


jim 03.19.07 at 12:19 am

Do the Red Cross rules bind everyone to whom you might donate blood? Or can you go to a local hospital and donate?


rilkefan 03.19.07 at 12:25 am

I’m ruled out for another vCJD reason (went on a date to give blood back in the day and we both got turned down) though I’m pretty sure I’m not a prion risk, so I don’t give blood any more – but I carry an organ donor card.


Matt 03.19.07 at 12:45 am

I was on the rejected list for some time, having got a letter in the mail after the 3rd or 4th time I’d donated saying, effectively, “your blood looks funny to us, so please don’t donate anymore.” A few years later I got another letter that basically said, “We’ve lowered our standards so please consider donating again.”


SG 03.19.07 at 1:49 am

As far as I know (from memory of when the ban was introduced) there is no evidence that the blood of people who have dormant vCJD can actually transmit the disease to anyone else, and this ban is just a precaution until research can clarify the issue. Given this, unless you are really sure that there is no way you could have caught vCJD from anything in england (including lard, meat offcuts in a pasty, etc.) then by lying about your past you could be violating the precautions they are trying to set out. Imagine if you found out a year after your white lie that vCJD could be caught from lard, and then it was revealed that the blood supply was contaminated… could have been you …

I am also affected by this ban and think it is really silly, but I can understand that it is better to be safe than sorry, temporarily reducing the availability of blood so as to avoid a catastrophic later reduction. I would have faith in the Red Cross`s ability to balance risks and consequences, and do what they ask you.


Cryptic Ned 03.19.07 at 2:01 am

The various blood banks plan to reject my blood for the rest of my life because at one time I had jaundice. This was obviously a side effect of mononucleosis, which is an entirely transient condition. I was tested for the various hepatitis viruses a couple of years after this jaundice incident, and I was negative for any history of hepatitis. Should I just say “no jaundice, nope, never in my life” on the form? I presume that I should.


jacob 03.19.07 at 2:28 am

I’m also ineligible to give blood because of CJD–some combination of too much time in the UK and the continent. I tried to bluff my way, but they ask very specific questions about when you were in each country, and you have to be quicker than I am to make it all add up to less that the maximum amount. The problem is, though, that once you try and fail to give blood, you’re put on a list of people never allowed again, so it’s not like I could go to the next blood drive and try to bluff again about how long I’ve spent in Europe. (Also, and this is creepy, they say they will give the list of ineligible donors to the government should it ask.)


jk 03.19.07 at 2:50 am

the ethical question of importance seems to me to be: what is the intent of the elgibility test; can any one person claim to understand the intent well enough to circumvent it; and subsequently, if you grant yourself this priviledge, what are the boundaries as to who gets in and who gets left out of this omniscient club?
i’m inclined to think that you ought not lie, no matter what your intent is, because you can not righfully claim knowledge of the real intent of the rule; nor ought you grant yourself a priviledge (by fiat) that, while not being explicitly self-regarding, seems to be egotistical in some sense.
i do, at times, have trouble finding the moral conundrums in questions of this type though. maybe it is the pragmatist in me (or maybe it is of the ethics vs. morality variety, a distinction of which may or may not exist). but can you lie to give blood, sure, why the bloody not? — they test pretty thoroughly anyway.
i thought the same when i heard you recently discuss the bernard williams example. yes, there is a point (3 people, 20, 1000) where it seems you have to kill the one to save the many. but one can not oblige another to committ murder. here, the example seems to deviate from morality. it becomes an entirely pragmatic matter — minimize deaths. can you kill the one? sure, why the bloody not? the dead will be a martyr and you will be a brave hereo — but there can not be a moral obligation to do so.
although, i think i read the groundwork too early in my studies..


Joshua W. Burton 03.19.07 at 2:53 am

Extended year-old discussion around this topic, here, with back-references (links now broken) to here. Warning: may be contraindicated for some readers vulnerable to stress hypertension.


Chud 03.19.07 at 3:33 am

Personally, I wouldn’t lose any sleep over it. Hand wringing won’t do a thing. If you’re banned by the Red Cross, then you’re banned. Not a lot you can do about it.

As to lying about where you’ve lived, I don’t think that’s very prudent or ethical. There is probably a very good reason why the RC turned you down. This is nothing political, but medical. And for you to just go ahead and arbitrarily lie simply because your conscience goads you into donating blood, quite frankly, you’re putting the donee into a potentially dangerous situation.

Both the RC as well as any potential donees are relying on you in good faith not to lie, and here you are talking about doing so just to silence your conscience. Not very philanthropic if you ask me.


david k. 03.19.07 at 6:14 am

Lie on the form; that’s the option with the best consequences. Then lie to your readers about whether you lied on the form, so as to discourage them from acting in accordance with the rule, “Lie on forms whenever you feel sure the rules are mistaken.” Widespread adoption of that rule could have some pretty bad consequences.


ejh 03.19.07 at 10:45 am

Years and years ago I wanted to give blood but I was told by the Transfusion Service that as I used a Ventolin spray, I couldn’t.

Is this actually right?


Luis Villa 03.19.07 at 12:10 pm

I had planned to give when my ban expires (I slept with an ‘African’, aka my Peace Corps SO), but have decided not to out of solidarity with gay friends who are blatantly and horrifically discriminated against by the Red Cross.


RS 03.19.07 at 12:29 pm

“As far as I know (from memory of when the ban was introduced) there is no evidence that the blood of people who have dormant vCJD can actually transmit the disease to anyone else, and this ban is just a precaution until research can clarify the issue.”

I don’t know what you mean by ‘dormant’, but it looks like blood from someone who later goes on to develop vCJD can transmit vCJD (see e.g. Ironside 2006 Haemophilia 12 (s1), 8–15). There are also some worrying possibilities regarding delayed symptom development because of longer incubation periods in prion protein gene heterozygotes, as in kuru, (all victims have so far been homozygous).


harry b 03.19.07 at 12:56 pm

I notice, though, that British hospitals unaccountably accept blood from people who resided in Britain for more than 3 months between 1980-1996, even if they are not vegetarians. Do we have a sense of how this has compromised their blood supply?

I’m strongly inclined with the people who oppose lying on this, so far (though I like david k’s suggestion). But I shall, as tracy w suggests, call someone (though several experiences suggest that it will not be fruitful).

I’ve never heard the one about ventolin. The eligibility rules say:

Acceptable as long as you are not having difficulty breathing at the time of donation and you otherwise feel well. Medications for asthma do not disqualify you from donating.


paul 03.19.07 at 1:40 pm

I am positive on the “Have you ever been exposed to someone with hepatitis, received an injection of immune globulin blah blah blah” question. (I used to be positive on the “have you ever been rejected” question as well, but they seem to have stopped asking.) I also fall within the class for whom that exposure/injection/whatever is not a bar to giving blood: the whole thing happened 30 years ago, and the exclusion period is 12 months.

So pretty much every time I go to give blood we run through the same rigamarole. Am I wasting my time and that of the technician? Probably. Will I keep doing so? Probably. It’s easier for me to remember, and I don’t have to worry about some database check turning up inconsistent answers (leading to gosh-knows-what). But ultimately it all seems kinda stupid.


aaron_m 03.19.07 at 1:51 pm

What makes you think that the Red Cross is unable to determine for themselves how restrictive they should be in accepting blood donations? Do you have some expertise the Red Cross lacks? I imagine that should the blood shortage be severe enough that it warranted a more sensitive system for weeding out potentially dangerous donors they would implement it. One might argue that the Red Cross will be slow to react because they have liability issues that make them over cautious, ultimately to the detriment of the blood supply. But it is the Red Cross that is liable and if against all odds your blood is tainted they will be accused of failing to ensure the quality of the blood supply. On what grounds are you taking it upon yourself to dictate to the Red Cross what level of risk they should be taking on and to undermine the political society’s decision to place a set of liability constraints on the Red Cross to serve a certain risk aversion end?

On your reasoning you would also have to argue for researches with experimental medicine to give the medicine to someone they know with the relevant disease when they judge that the potential benefits significantly out weigh the risks (maybe the patient is near death). But this means that many many researches on countless occasions will be making individual choices about administering non-certified treatments, and we have general doubts about the accuracy of their risk assessments and their ability to be impartial. Note that bio-medical research groups are often headed by someone who is also a specialist doctor in their research field, thus the opportunity to break a ‘hurtful and unnecessary regulation’ will occur often. But there are various reasons to suspect the quality of individual assessments (i.e. sympathy for patients, wanting to test the research, over optimism on the quality of the treatment, bad understanding of potential unintended effects, pressure to demonstrate results, etc…). It is pretty obvious that to provide the collective good of a tested and safe health care system we need to constrain individuals’ judgements about what is and is not an acceptable levle of risk. If we are constraining society’s top experts on health then way maybe it is OK to constrain philosophers as well.


Matt Kuzma 03.19.07 at 4:29 pm

There must be something about the coarseness of the Red Cross questions that consistently prompts this question, because I’ve contemplated this exact issue with an entirely different question.

One thing I’d like to point out, and maybe it’s been said before, is that you’re presuming to know better than the Red Cross. It’s possible that their questions are exactly what they want them to be. In other words it’s possible that your assumption “The policy is designed for official simplicity: if the person who devised the policy had the power to make exceptions and heard (and believed) my story, they’d make an exception in my case.” is false. Do you have any evidence for that assumption? Also, do you know if answering yes to the question immediately disqualifies your blood? Many of the Red Cross questions have follow-up questions associated with them.

The other similar but distinct issue is that the Red Cross has decided to concern itself with handling blood supply. If it is willing to reject your blood even if you are perfectly healthy, in exchange for greater surety of the safety of the blood supply, then you are working against it by lying, even if you are perfectly healthy.

Finally, I will try to nullify your argument completely by giving you a self-interest in blood donation. The human body produces too many red blood cells, in anticipation of blood loss. Women have a steady method of losing blood that men do not and over time the risk of heart disease in men is higher because of the consistently elevated amount of iron in their blood. Giving blood regularly, therefore, could reduce your risk of heart disease. I cannot cite studies to back up this claim, so the value to you may be very small, once you attenuate it by all the uncertainties, but in any case the resulting benefit will be non-zero. Unless you don’t value reducing the risk of heart disease, I guess.


Katherine 03.19.07 at 5:06 pm

As a resident of the UK, and who was resident and eating meat in the UK for at least of the aforementioned time period, I can tell you that I am not banned from giving blood in the UK. Strangely, we haven’t all fallen down dead.

For the record, I have sort-of-lied on my form for giving blood. Since I have been tested on numerous occasions for the thing they are clearly trying to winkle out in that particular question and found to be negative, I don’t personally have a problem with it.


Aeon J. Skoble 03.19.07 at 5:32 pm

Matt- of course there’s a self-interest in blood donation: free donuts! But seriously, several commenters have been bashing Harry on the grounds that the Red Cross must know what its doing when they refuse to collect his blood. As it happens, I lived in the UK for 6 months during the target dates, so I’m now ineligible also. Why do I agree with Harry that this is silly? Because I was a regular donor for years, after my stay in the UK, but before it occurred to them to ask about that. My blood was fine before they added that question, why would it be worse now? I haven’t been to the UK since 1984, yet they’ve only been refusing my blood for what, 5 or 6 years. I don’t seem to have BSE, and I don’t recall hearing that I killed anyone in the late 80s, so I’m with Harry in finding this question to be a blunt instrument. And I really miss the donuts.


Tom T. 03.19.07 at 5:35 pm

Perhaps the liability fears are greater in the US than in the UK?


just sayin 03.19.07 at 7:59 pm

Different cost/benefit in the US and the UK. Very nearly 100% of potential donors would be disqualified by this policy in the UK, not so much in the US. The small cost in reduced donations to eliminate the relatively small risk is acceptable in the US, but the near-elimination of blood donations in the UK is not.

The HIV screening questions seem to have made a lot more sense in the mid-80’s than in the late 00’s, but perhaps such a blunt approach is still required to maintain confidence among the general public.


Elaine 03.19.07 at 8:01 pm

My blood was fine before they added that question, why would it be worse now?

The point isn’t that they accepted your blood before, but that they are unwilling to accept it now. As the link provided by Aidan (#4) states, many unfortunate victims were given HIV+ and AIDS infected blood through transfusions with blood from Red Cross donations before they even thought to ask questions about it.

Perhaps the Red Cross will change their screening questionaire in the future. Nevertheless, would you want to receive blood products knowing that people were lying on their screening questionaire, not opting out anonymously, and that there is no 100% perfect blood contamination test?


aaron_m 03.19.07 at 8:04 pm

The question is whether or not it is ethically defensible/required to lie, not whether or not the policy is a “blunt instrument.” And motivating that it is OK to lie simply because the policy is not sensitive to relevant individual circumstances has some pretty unappealing consequences in our societies where we need all kinds of regulation and where it is just not workable to regulate based on each individual’s life story.

Isn’t there a better and less ethically dubious way to address perceived inefficiencies at the Red Cross? Think up of a different screening process that gives the Red Cross clear efficiency gains and makes a case to them.


harry b 03.19.07 at 9:19 pm

Actually, the link aidan provides in #4 is very succinct and puts things nicely. Some people here have much more confidence in the design of the tests than I do, but the statement linked to gives a pretty nice defence of using the precautionary principle. Since I predict that many of you are as lazy about cliking as I, here it is:

Every screening test has a sensitivity – an ability to detect the disease when it is truly present – and a specificity – an ability to be confident that a positive result is a detection of true disease. These are ratios, usually expressed as percentages, and they are properties of the test in question.

The ideal test has a 100% sensitivity and a 100% specificity. No ideal tests exist. All tests now in use have sensitivities and specificities below 100%. Think about that for a minute. That means that, given enough units of blood tested, some HIV+ blood and some hepatitis B and C positive blood is going to get through, even if everyone does something right.

How much? Well, that depends on the “Predictive value positive” and “predictive value negative” (PvP and PvN). If the test comes up negative, how likely is it that the blood is truly clean? These numbers have to do with, not only the properties of the test itself, but also the population prevalence of the disease in question. That is, if there are 1/3 infected units in the Red Cross blood supply before the tests are done, the predictive value negative is much lower – worse – than if there are only 1/3000 infected units before the tests are done. Another way, a statistical way, of referring to the population prevalence is the “pre-test probability” that the blood is clean.

To reduce the amount of tainted blood that gets through and condemns some poor unwitting recipient to a slow, horrible death by AIDS, the docs want to reduce the pre-test probability that the blood is tainted.

Population studies show that excluding MSMs reduces the pre-test probability considerably. That’s not homophobia, that’s statistics.

Also, we know that MSMs have a higher rate of Hep C, of Hep B, of HIV+. That’s because of practices they do (penetrative anal sex) that have a high risk of transmitting those diseases.

But in 1983, we didn’t even know that HIV existed. About 50% of America’s hemophiliacs contracted HIV and AIDS from transfusions they’d received before we even knew that HIV existed! So did thousands, maybe tens of thousands of other people.

This is the great catastrophe of which we docs are trying to avoid a repeat performance.


psg (London) 03.19.07 at 10:48 pm

I’m due to make my 4 monthly donation here tomorrow so I have my donation form in front of me.These days the NHS Blood Service are a little like the Readers Digest or the Communist Party–once they have your name they never give up trying so if I miss a date because of a cold or other commitment they’ll send me another form in a fortnight or so.

I’ve donated over 40 times and have never been rejected despite a beef-ridden diet (they don’t ask)

CJD has led to a ban on people who’ve received blood themselves here from donating after a donor who unknowingly had the disease caused recipients to develop it.Apart from that and the tiny number of people who actually have the disease,it’s had no effect on U.K. donations.

2-3 years ago a visit to the U.S. in the preceding 12 months was enough to get you rejected (can’t remember what the concern was but it seemingly passed as although you have to say where you’ve travelled to in the last 12 months the U.S. is off the ‘no’list at the moment afaik.)

I’ve never lied and wouldn’t do so,believing the doctors know better than I what’s an acceptable risk.They accepted my blood on one occasion when I ticked ‘yes’to medicine in the last 7 days and I also recall a young colleague succeeding in pressing them to let her donate even though she had a heart condition.So I would say be honest and keep trying to donate unless or until you’re clearly ruled out.


Michael B Sullivan 03.19.07 at 10:56 pm

Last I checked (which was admittedly a few years ago), there were perfectly viable artificial hemoglobin substitutes that had gone through quite a lot of medical testing and passed with flying colors, but which the FDA was still dragging its feet about approving for general use. If approved, they promised to end both the perpetual blood shortages and the risk of infection from tainted blood.

Anyone heard anything new on this subject?


Mill 03.20.07 at 12:54 am

Dear Crooked Timber,

I am a U.S. president who wants to start a war. The international community is against it, but they are just blindly applying oversimplified rules (like “No wars”). I understand what they want and need better than they do, and I am sure they would agree with me if they knew the facts as well as I do.

It is ethical, in this case, to force the war upon them (lying about the circumstances if necessary) — right?

(Overblown analogy? Yes. Identical logic? Yes.)


harry b 03.20.07 at 2:02 am

mill — same logic. But this premise “I understand what they want and need better than they do, and I am sure they would agree with me if they knew the facts as well as I do” was first of all false, and second of all probably not sincere in that case. The question in my case is whether its false or not. I absolutely promise to follow tracy w’s advice! (to which I have to confess, in an attempt to salvage some sort of a reputation for honesty, my immediate response was “Why didn’t I think of that?” and my second was “I don’t really want to admit that I didn’t think of that”).


Anne 03.20.07 at 7:17 am

I have the lived-in-the-UK-at-the-wrong-time issue too.
Can’t donate to the Red Cross but get this…other blood donation organizations are perfectly happy to take my blood. Now why would that be? Isn’t there a general standard? Seemed odd to me.


Moz 03.20.07 at 10:10 am

I was in the interesting position recently where I made an autologous deposit, and when they asked if I’d donate it to the general pool after they didn’t use it we had a wonderful chat. The doctor came very, very close to saying “just lie”, based entirely on my claimed sexual history (broadly, not having unsafe sex since 1987). But he wasn’t willing to discuss whether my (possible) willingness to lie on the blood form might indicate willingness to lie about the same topic to him… but he did agree that not wanting to lie on the form was a good sign in that respect.

I agree with them in some ways, hence my autologous deposit. I much prefer my own blood back than taking any chances with some random strangers.


Michael Mouse 03.20.07 at 2:50 pm

Also, we know that MSMs have a higher rate of Hep C, of Hep B, of HIV+. That’s because of practices they do (penetrative anal sex) that have a high risk of transmitting those diseases.

Even if you grant all that … if the intent is to exclude people who engage in particular risky practices, why not ask about that instead of a proxy measure? There are many men who have sex with men who never have anal sex.

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