Advancing inclusivity and equity for trans, nonbinary, Two-Spirit and other gender-diverse donors

¹Canadian Blood Services, ²Carleton University, Ottawa, ³Canadian Blood Services, ⁴Western University, London, ⁵University of Victoria, Victoria, Canada

Background: Trans, nonbinary, Two-Spirit and other gender-diverse donors (henceforth ‘gender-diverse donors’) face unique challenges in blood donation and have increasingly advocated for more inclusive and affirming donation policies and practices. Many blood operators recognise the importance of addressing challenges for gender-diverse donors given their commitment to inclusivity and equity. Moreover, data from several countries suggest that the number of people who are gender diverse is increasing. This has important implications for blood operators as they aim to maintain sufficiency of the blood supply into the future. Expanding gender options for donors in blood systems is one important area for blood operators to consider in their efforts to advance inclusivity.

Aims: To examine (1) the general donor population's and (2) gender-diverse donors’ views on a two-step question for all donors (i.e., asking their gender and sex assigned at birth, SAAB) and expanding gender options for donors.

Methods: We report results from two studies: Study 1- mixed-methods study with the general donor population and Study 2-qualitative study with gender-diverse donors. Participants were recruited from the Canadian Blood Services’ donor database. Study 1 examined understanding and acceptability of a two-step question in current donors through qualitative cognitive interviews (n = 40, Jan–Mar 2021) followed by a quantitative survey. Qualitative results are presented here. Study 2 examined acceptability of a two-step question and views on expanding gender options with gender-diverse donors though semi-structured interviews (n = 85, July–Oct 2022). Thematic analysis was conducted.

Results: Study 1: all participants reported understanding what was being asked with a two-step question. Participants reported that a two-step question is acceptable and comfortable to answer because they view the questions as “not affecting” them, understand why the questions are asked, and recognise changing social norms. Participants recommended examining gender-diverse donors’ views since they are the people to be most affected by the questions.

Study 2: gender-diverse participants had mixed views on whether a two-step question is an improvement on the current single question asking a donor's gender. Most participants who viewed this as an improvement did so because they assumed that it is necessary for the blood operator to know a donor's gender and SAAB. Participants who were not in favour did not assume that it is necessary for the blood operator to know a donor's SAAB and were concerned that a two-step question would “out” gender-diverse donors and compromise their safety. All participants were in favour of expanding gender options beyond the binary to address the erasure of nonbinary donors.

Summary/Conclusions: If a two-step question is implemented, results suggest that donors would understand the questions and find them acceptable. However, gender-diverse donors, the population of donors whose views on this topic should be prioritised, do not necessarily see this as an improvement on the current single question. Results suggest that rather than a two-step question, a better option may be to expand gender options to be more inclusive of gender-diverse donors. When considering expanding gender options, blood operators should collect only necessary information, seek communities’ input and provide clear explanation to donors on how the information will be used.