Tuesday 14 June 2016 is the twelfth World Blood Donor Day, promoted by the World Health Organization with the tagline: Blood connects us all. So this is a good time to think about the history of blood donations and their place in the history of the NHS.
Blood transfusions have a history dating back to the seventeenth century, though it was the conflicts of the early twentieth century that prompted many of the most dramatic advances. In Britain, blood donations have been part of an organised collective system of healthcare since the Second World War. In the first months of the war, the Medical Research Council decided to set up blood depots. This was not new, but proved its usefulness for both air raid casualties and civilian patients during the war. As attention turned to postwar reforms, plans began to fall into place for a National Blood Transfusion Service, managed by the NHS’s Regional Hospital Boards.
Our research at Warwick University is all about the meaning of the NHS and blood donation in particular has often been read as an activity deeply laden with meaning. In 1970 Richard Titmuss published his influential book The Gift Relationship. Surveying blood donation in the UK, USA, South Africa and the Soviet Union, he made the case for voluntary, unpaid blood donation with anonymous recipients as an example of “altruism in modern society”. In particular he drew attention to the NHS:
“What is unique as an instrument of social policy among the countries we have surveyed is the National Health Service and the values that it embodies. Attitudes to, and relationships with, the National Blood Transfusion Service among the general public since 1948 can only be understood within the context of the Health Service. The most unsordid act of British social policy in the twentieth century has allowed and encouraged sentiments of altruism, reciprocity and social duty to express themselves; to be made explicit and identifiable in measurable patterns of behaviour by all social groups and classes. In part, this is attributable to the fact that, structurally and functionally, the Health Service is not socially divisive; its universal and free access basis has contributed much, we believe, to the social liberties of the subject in allowing people the choice to give, or not to give, blood for unseen strangers.”
For me personally, it was a different type of solidarity and community that was fostered from my first time giving blood. After hearing all about blood donation from a local nurse, I was part of a group of maybe a dozen sixth formers from Filton High School who travelled down to Southmead Hospital in Bristol, now old enough to start young. We had varied experiences. There were the girls who were told they didn’t weigh enough to safely give blood. Those, like me, where they had trouble finding a vein. A few who felt a bit light-headed afterwards. But we all went to give blood together, we looked after each other when feeling dizzy or sore or just disappointed at being rejected. Importantly, we all had tea and biscuits (I made sure I got the bourbons) together before leaving – even those who hadn’t been allowed to give blood. A variety of experiences, but all experienced together.
Of course, a community is defined as much by who is excluded as who is included. And I felt a huge sense of injustice when I knew my blood was not wanted because of my sexuality. The question on the form read: Are you a man who has ever had protected or unprotected sex with another man? There was no question of rejecting the blood of straight people for whom a Saturday night meant a club followed by a one-night stand. No question of accepting blood from a long-term monogamous gay couple, or even a straight woman who had ever had protected or unprotected sex with a man who had ever had protected or unprotected sex with another man. I wanted to tell them I’d been tested for everything that might be a concern and which all donated blood would be screened for anyway, but I was on the outside. My blood was not wanted by the NHS.
The lifetime ban was changed to a one-year ban in 2011, delayed until September 2016 in Northern Ireland, and is kept under review by SaBTO (the Advisory Committee on the Safety of Blood, Tissues and Organs). The slow move towards a less exclusionary system is a sign of the shadow cast over blood donation and transfusion by the ethical crises of HIV/AIDS and serum hepatitis. These were not the first fears of infection to provide grounds for the exclusion of whole groups from giving blood. For example, not only those who had overcome tuberculosis or malaria, but those who had lived in the tropics – which in effect meant the exclusion of all ‘coloured’ migrants.
“The central role of blood in transmitting HIV/AIDS”, as medical historian Virginia Berridge has noted, provided “a new twist on the story of the gift relationship.” The risk of contamination entirely separate from any question of personal behaviour – a distinction highlighted with painful satirical honesty in 1990s mock news show Brass Eye as “good AIDS” – served to undermine confidence in the altruistic system of blood donation. Over the 1970s and 1980s, thousands of NHS patients were infected with Hepatitis C or HIV, with many unaware they had been infected until many years later. The only public inquiry held was the Scottish one which reported last year, as victims and families angrily shouted “whitewash”. Prime Minister David Cameron said in the House of Commons that he could hardly imagine the “feeling of unfairness that people must feel at being infected with something like Hepatitis C or HIV as a result of totally unrelated treatment within the NHS… To each and every one of these people I would like to say sorry on behalf of the government for something that should not have happened.”
The insult of rejection hardly compares to the injustice of infection, and the gift relationship must always depend on the gift being a safe one, yet exclusion from donating blood – on the basis of sexual behaviour, drug use, work in the sex industry, getting tattooed or even international travel – does offer a rather different perspective on the boundaries of universality in our universal health service.