Row over NHS Wales decision to ask blood donors for their ‘assigned sex at birth’

Martin Shipton

NHS Wales has defended its decision to stop asking blood donors their sex and instead ask them what was their “assigned sex at birth”.

Nation.Cymru has learnt that a review of the change, made originally in 2021, was undertaken recently after a blood donor complained that Velindre University NHS Trust – which is responsible for the Welsh Blood Service (WBS) – had allowed gender ideology to dictate the question asked.

We have seen extensive correspondence between the donor, who doesn’t wish to be identified, and the Trust, during which it was confirmed that the safety of transfusions can be compromised if blood from a donor of the wrong birth sex is used.

The correspondence began in October 2022 when the donor, who has given blood on more than 30 occasions, wrote to the director of WBS expressing concern about the change of question, stating: “On Monday October 3 2022 I attended [a specified location in Wales] to donate blood but on this occasion I couldn’t give blood because I refused to answer the question, on the electronic questionnaire, asking for my ‘sex assigned at birth’. The phrase ‘sex assigned at birth’ is a tenet that is used by people who believe in gender identity ideology. They believe that ‘a child is born without a sex’ and that a child can choose whether they are a boy or girl.”

The donor continued: “So what am I asking for? What is my complaint? It’s simple really. You know that sex matters when it comes to blood transfusions. You know that in some cases the wrong sex blood transfusion can have serious consequences. What I want you to do is think about what I’ve said and do what you think is right.”

Pregnancies

The donor received a response from a Velindre Trust official which said: “The question asks donors to ‘confirm your assigned sex at birth’. Donors can then pick ‘male’ or ‘female’ from a list. This information is important for two reasons: to identify biological females so further questions can be asked about past or present pregnancies, and to ensure that plasma rich components are only manufactured from biological males.

“Historically, the WBS has asked all donors to ‘confirm your sex’. This was changed on June 14 2021 to ask all donors to ‘confirm your assigned sex at birth’. This change was made as it was apparent to WBS that a number of donors were answering the question ‘please confirm your sex’ with their gender identity rather than their biological sex.

“Prior to making this change, the diversity and inclusion manager at Velindre NHS University Trust was consulted on the most appropriate and acceptable term to use, and it was suggested that ‘assigned sex at birth’ would be the most appropriate term.”

Review

Following the blood donor’s complaint, a review was held into the issue in August 2023 by WBS. The review states: “The WBS clinical specialist leads contacted counterparts in services in England, Scotland, Northern Ireland and the Republic of Ireland to identify, compare and discuss each organisation’s approach to the management of transgender donors to ensure plasma rich components are only manufactured from donors whose assigned sex at birth is male or from females who have had additional testing for antibodies against human leucocyte and neutrophil antigens (HLA and HNA antibodies) to ensure recipient safety. HLA and HNA antibodies are more than 10 times as common if a person’s assigned sex at birth is female, and these antibodies were the commonest cause of serious morbidity and mortality in recipients of transfusion prior to 2004. Since 2004 several measures have been introduced to reduce the likelihood of recipients being exposed to HLA and HNA antibodies in plasma.

“If individuals declare that they are male when their assigned sex at birth was female, this increases the risk to recipients of being exposed to HLA and HNA antibodies. For this reason, donors are asked their assigned sex at birth.”

The review identified that the “assigned sex at birth” question had been implemented both because of an increased number of enquiries from clinical staff relating to the management of transgender donors, and potential safety issues that resulted from donors providing their gender identity as opposed to biological sex.

The review concluded: “From undertaking this review, the WBS is assured that practices align with national guidance, and that safety requirements and procedures are in place to mitigate any risks posed by donors whose gender identity is not aligned with their biological sex. WBS are assured that the acceptance of transgender donors does not impact upon blood component safety.”

Dissatisfied 

The donor, however, remains dissatisfied, and told Nation.Cymru: “I think the story isn’t really about the WBS but about the NHS obsession with ‘diversity and inclusion’, which costs a fortune, alienates women when they are referred to as chest feeders, cervix havers, menstruators and stops the NHS thinking objectively and rationally. In the case of the WBS, and with the collusion of their diversity and inclusion officer, they were so intent on showing that they were inclusive of trans people that they didn’t ask the simple question: ‘Is it a problem if trans people answer the sex question incorrectly?’ The answer I believe is ‘no’.

“The sex question is asked because women who have gone through full term pregnancies can sometimes produce antibodies that if transfused into an already compromised patient can cause a reaction. It’s called Transfusion Related Acute Lung Injury (TRALI). That’s why the WBS makes blood products from men or women who have been tested for the antibodies.

“If a man who identifies as a woman answers the sex question as female he will then be asked if he’s ever given birth. Off the top of my head I think this might be 100% no, so that person will be cleared for donating. If a woman that identifies as a man answers the sex question as male then they will be treated as male and will not be asked about pregnancy. As a man giving birth is a newsworthy story I googled ‘transman birth Wales’ and there have been two in the last few years in Wales. I wonder if they are blood donors.

“A recent YouGov poll showed that only 7% of the population give blood at any one time, so by changing the sex question the WBS are trying to prevent blood donations from 7% of, at most, a handful of females who have given birth and identify as male. That’s not even one whole person.

“The vast majority of women who identify as men are infertile / sterile from taking testosterone and having surgery removing their ovaries and uterus. Some of the drugs they are taking, such as Finesteride to stop male pattern baldness, will also disqualify them from donating. This is the same for men who identify as women and haven’t had surgery, which is about 95% of them, so they will be taking drugs such as Finesteride to suppress testosterone and will be disqualified from donating. Finesteride in blood products given to pregnant women can cause birth defects.

“So the vast majority of this trans minority community can’t donate because of the drugs they are taking and, of those left, the minority of the minority that are eligible to donate, nearly all of them can’t get pregnant. And when they do get pregnant and have a baby, it’s front page news.”