Two-Spirit, lesbian, gay, bisexual, trans, and queer and other sexual and gender minority people (2S/LGBTQIA+) have long experienced discrimination in blood, organ, and tissue donation in Canada. Many of these policies initially came into effect during the early years of the HIV pandemic to reduce the likelihood of passing HIV to blood, organ, and tissue recipients. However, policies have been slow to evolve with our growing understanding of HIV transmission, treatment, and prevention and incorporate evidence-based behavioural risk factors for HIV.
Specifically, under previous organ and tissue donation policies, men who had sex with men in the past 12 months had their organs designated as “increased infectious risk” and their tissues outright rejected. These policies are stigmatizing and harmful to 2S/LGBTQIA+ people, and have also resulted in a smaller donor pool with fewer available organs and tissues for all people in Canada who need them.
Thanks in part to strong community advocacy efforts, blood donation policies have gradually evolved and become more inclusive in recent years. CBRC, alongside other researchers and community advocates, led calls for a gender-neutral behaviour-based approach for screening blood donations. After three decades of excluding donors who identified as gay, bisexual, and queer men from donating blood, Canadian Blood Services (CBS) changed its policy in 2022. CBS also acknowledged the harm caused by the previous policy in a public apology, developed in partnership with their 2S/LGBTQIA+ Advisory Committee, which CBRC is a member of.
Now, newly proposed guidelines are promising to bring organ and tissue donation and transplantation policies into alignment with revised blood donation policies, potentially bringing an end to deferral policies that target 2S/LGBTQIA+ people.
Under the new guidelines proposed by the Canadian Standards Association in March 2025, policies for “men who have sex with men” would be replaced with two gender-neutral questions that would be asked of all potential organ and tissue donors:
- “Have you had any new sexual partners or more than one sexual partner in the last three months?”
- If yes, “Have you had anal sex in the past 3 months?”
If yes to both questions, the donor would be considered “increased risk” in organ donation and could not donate tissues.
If adopted, these new guidelines could make organ and tissue donation more inclusive of many 2S/LGBTQIA+ people; newly proposed guidelines, however, still include some stigmatizing criteria that impact our communities. For example, donors who have recently used HIV PrEP and/or have had any sexual contact with a person living with HIV in the past 3 months—even if they are undetectable and cannot pass HIV through sex—will continue to have their organs treated as “increased risk” and their tissues rejected. Additionally, given the broad nature of the gender-neutral screening questions, many potential 2S/LGBTQIA+ donors who would be suitable and safe donors will continue to have their organs treated differently and their tissues denied.
Beyond the policy itself, other challenges remain. As more 2S/LGBTQIA+ donors engage with these systems, ensuring that donation staff are able to provide competent, safe, and affirming care is essential, including through dedicated training efforts. Furthermore, the willingness of many 2S/LGBTQIA+ people to donate will be impacted by the legacy of past discriminatory policies, which have harmed our communities’ trust in organ and tissue operators. Rebuilding this trust will require relationship building with 2S/LGBTQIA+ community leaders and organizations. A formal apology from Health Canada and organ and tissue donation operators for these past harms would be a good first step, as Canadian Blood Services has done.
Ultimately, these proposed changes are a major step towards more equitable organ and tissue donation policies for 2S/LGBTQIA+ people, but work remains to ensure that these policies are rooted in science, not stigma, and that 2S/LGBTQIA+ donors are able to engage with these systems in safe and affirming ways.
CBRC recently collected information from 2S/LGBTQIA+ community members across Canada about their perspectives on organ and tissue donation policies through our Sex Now 2025 survey from April through early June. Data from the survey is crucial in supporting advocacy for more equitable donation policies, and thank you if you participated in the survey!
Written by Dr. Murdoch Leeies
Dr. Murdoch Leeies is a physician and Director of Diversity, Equity and Inclusion for the Transplant Manitoba Gift of Life Program and Director of Equity, Diversity, Decolonization and Inclusion for the Canadian Critical Care Society.
