This article discusses issues associated with the lifetime deferral from donating blood of men having sex with men (MSM), in the context of well-established risk management principles, including ethical considerations associated with the risk-based approach to social policy matters. Specifically, it deals with the questions about the rationale for the existing policy in Canada of lifetime deferral for MSM, a rationale applied in practice by blood collection agencies and supported by the regulatory authority of Health Canada. We identify several alternative time frames for MSM deferral: sexual abstinence over either a 10-, 5-, or 1-year period or no deferral. Two options are selected for more complete discussion, namely, abstinence for a period of either 1 or 5 years before donation. The available evidence about estimated residual risk (RR)-that is, the risk remaining after various safeguards for blood are applied-strongly suggests that choosing a 1-year deferral period for MSM would almost certainly give rise to an incremental risk of transfusion-transmitted infection (TTI), over existing levels of risk, for blood recipients. The report argues that, under these circumstances, such a policy change would represent an unethical type of risk transfer, from one social group to another, and therefore would be unacceptable. The evidence is less clear when it comes to a change to either a 10- or 5-year deferral period. This is the case in part because the current level of RR is so low that there are, inevitably, substantial ranges of uncertainties associated with the risk estimation. There is no firm evidence that such a change in the deferral period for MSM would result in an incremental level of risk, although the possibility of a very small increase in risk cannot be entirely ruled out. Under these circumstances, other social policy issues, relevant to the idea of changing the deferral period for MSM, become worthy of additional consideration.

中文翻译：

---

与男性供者递延风险评估有关的男性：使用风险管理原则的分析。

本文讨论了在公认的风险管理原则（包括与基于风险的社会政策问题方法相关的伦理考虑）的背景下与一生中与男性发生性关系的男子无偿献血有关的问题。具体来说，它涉及有关加拿大现有MSM终身延期政策的理由的问题，这是血液收集机构在实践中应用并得到加拿大卫生部监管机构支持的理由。我们确定了MSM延期的几种替代时间范围：10年，5年或1年期的性禁欲或无延期。选择了两个选项进行更全面的讨论，即在捐赠前禁欲1年或5年。有关估计的剩余风险（RR）的可用证据，即 采取各种血液保障措施后仍然存在的风险强烈表明，对于MSM，选择1年延期的MSM几乎肯定会导致输血传播感染（TTI）的风险超过现有风险水平。报告认为，在这种情况下，这样的政策变更将代表一种不道德的风险转移方式，即从一个社会群体转移到另一个社会群体，因此是不可接受的。当更改为10年或5年的延期时，证据尚不清楚。之所以如此，部分是因为目前的RR水平太低，以致不可避免地存在与风险估计相关的大量不确定性。没有确凿的证据表明，尽管不能完全排除风险极小增加的可能性，但MSM延期的这种变化会导致风险水平的提高。在这种情况下，与更改MSM延期期限的想法相关的其他社会政策问题值得进一步考虑。