Health Committee on Dec. 8th, 2016

[Dr. Dana Devine]

No, it was me.

[Rachael Thomas, Conservative, Lethbridge, AB]

That was you?

[Dr. Dana Devine]

Yes, it was, and, yes, you did understand that correctly.

[Rachael Thomas, Conservative, Lethbridge, AB]

Okay. Is that simply because they're basing their blood acceptance on, I guess, self-disclosure, basically, rather than actually testing the blood?

[Dr. Dana Devine]

They just don't ask that question at all if you're a man who's had sex with another man—

[Rachael Thomas, Conservative, Lethbridge, AB]

Okay. They don't ask the question at all?

[Dr. Dana Devine]

That's correct. When they removed the question.... They used to have a permanent deferral, like most other European countries did at the time. They removed it and they saw an increase in the number of donations that were showing up as HIV positive. Either these were men who didn't know that they were HIV positive, or there was some question in Spain at the time that they didn't have a very good system for getting tested, so there were people who were coming to donate blood to get tested.

[Rachael Thomas, Conservative, Lethbridge, AB]

Okay. Do you know what that increase was?

[Dr. Dana Devine]

It was about double.

[Rachael Thomas, Conservative, Lethbridge, AB]

It was double. Thank you.

This question is for CBS. From your perspective, how would patient advocacy groups respond to us totally doing away with the deferral process, let's say?

[Dr. Graham Sher]

I'll perhaps begin. I made that comment a few minutes ago.

I think it's a very important question. Certainly when Canadian Blood Services began its work in 1998, we initially made extensive outreach to the patient communities, because they were really the ones who bore the brunt of the consequences of the so-called tainted blood era in Canada. I think we have understood for many years that with every decision we make with respect to blood safety, the ultimate bearers of risk are those who receive blood. Donors are not obligated to be donors, but recipients are involuntary in their receipt of blood. If you have a car accident or cancer, and your physician prescribes blood, you don't really have a whole lot of choice, typically, in getting it. We have always recognized that every decision we make has to bear in mind the recipient as the ultimate bearer of that risk.

That said, with respect to the MSM policy, we have worked enormously hard with patient advocacy and patient stakeholder groups, as we have with stakeholders on the other side, the LGBT community. For many years the patient groups said, “We're not interested in a change to the policy. It suits us just fine. We don't care that it's broad and discriminatory.” But we were able to bring them along and have them recognize that there's a balance here. There a fairness issue. You can still protect safety at the same time.

That is why we landed on a five-year policy as step one. It is why, with greater trust and confidence, we moved to the one-year period. As Dr. Devine said, the patient groups will be front and centre in helping understand and inform the research agenda. It's essential that we keep onside that community along with the individuals who feel discriminated and left out. We really have to work with stakeholders on all sides of the equation here, but the patients are the ones who bear the risk.

[Rachael Thomas, Conservative, Lethbridge, AB]

Thank you.

[The Chair, Liberal, Bill Casey]

Your time is up.

Mr. Oliver.

[John Oliver, Liberal, Oakville, ON]

Thank you very much, Mr. Chair.

Thank you very much for your testimony today.

Of the blood that's donated, what percentage is used in human transfusion and roughly what percentage goes into research and other purposes?

[Dr. Dana Devine]

It depends on which blood component we've made out of that. If we look at the red blood cells that we use for transfusion, the vast majority of this blood is transfused. A small proportion of it actually outdates, because you can only keep it for 42 days. It may not get used, particularly in some of our smaller hospitals who keep it because they might need it. The discard rates are in low single digits for donated blood.

Research blood is actually donated specifically for research.

[John Oliver, Liberal, Oakville, ON]

So it's recognized by the donor at the time that it's going to research.

[Dr. Dana Devine]

Absolutely. The donors provide informed consent.

[John Oliver, Liberal, Oakville, ON]

Okay.

In a previous life, I worked in a hospital that served a large population of people from the Jehovah's Witness faith group. We had a physician who was part of that faith group and worked through some quite robust strategies in ER and OR to manage the population without having to use blood transfusions. It was all done through the medical advisory committee reviews and whatnot. This was back just when the crisis hit. When we were doing all the look-backs, the patient notifications, and the work on transparency at that time, no one from the Jehovah's Witness group, that I can remember, was involved. That's going back 15 or 20 years.

Do we do enough to push for the non-use of blood products? I was looking at the research last night. There are volume replacement strategies. There are high inspired oxygen concentrators. There are patient blood management programs, both interoperative and post-operative. There are cell salvage strategies that could be employed, and autologous donations. Could we not be doing a lot more to reduce the risk of blood transfusion by doing a better job of using alternatives to blood transfusion?

[Dr. Dana Devine]

The simple answer is, yes, we can always do more. There has been a huge amount of work done in this area. I think society owes the Jehovah's Witnesses a debt, because they have driven surgeons to develop procedures that use less blood. They have changed the mindset around blood transfusion.

Essentially two decades later, most developed countries in the world have seen a dramatic decrease in the amount of blood that's transfused annually. It really is the culmination of better surgical techniques, some better drugs, and the thinking about who gets a transfusion—namely, that it is a medical procedure, and you only need to do it if it's absolutely necessary. I think the mindset about blood transfusion has shifted quite a bit in the way that physicians use blood products. We're probably one of the only businesses I can think of that's actively trying to not sell our products.

[John Oliver, Liberal, Oakville, ON]

I noticed in your document that you're looking for 100,000 new whole blood donors in the next three years. Again, with trying to move away from the reliance on transfusion, what's driving that demand? Is it an aging population or...?

[Dr. Dana Devine]

Part of it is just that there's a large number of people every year who essentially stop donating, for one reason or another. Either they've stopped being a donor and turned into a patient, or they've moved to somewhere where we don't have clinics. We lose a lot of donors every year just for life circumstances, or because they didn't have a very positive experience donating and they don't want to come back. There's a whole lot of different reasons why people stop.

We are always recruiting new donors, all the time. We have brought in a couple of changes in the blood system. Recently, the most notable one is to actually change the amount of time between donations for women donors, because we want to make sure that we're not causing a loss of too much iron for women.

[John Oliver, Liberal, Oakville, ON]

It's more about donor replacement than—

[Dr. Dana Devine]

It is about donor replacement.

[John Oliver, Liberal, Oakville, ON]

—it is about increasing medical usage.

[Dr. Dana Devine]

That's right.