Chief Science Correspondent
Alexander “AJ” Betts (pictured above) died with one wish: that his organs be used to save the lives of others.
The 16-year-old Iowa teen took his own life in July 2013. Betts had been bullied by his peers after coming out as gay 18 months prior to his death, his family said. Betts had registered as an organ donor six months prior to his death.
Moore recently received a letter from the Iowa Donor Network detailing what became of each of her son's organs. Betts' heart, lungs and kidneys had all found recipients, according to the Des Moines Register. However, Moore learned that her son's eyes were rejected. The reason? Moore could not confirm with absolute certainty whether or not her son had had sex with another man.
"I was floored," Moore said. "It didn't make any sense to me at all...It's completely discriminatory. I never planned on becoming a gay rights activist, but I guess I am now."
Betts' organs had been handled by the Health Resources Services Administration. However, because eyes are considered a tissue rather than an organ, the decision to reject the donation was made by the U.S. Food and Drug Administration, which maintains its own policies on donor eligibility.
A man who has had sex with another man is banned from donating most tissues for five years after his last encounter. However, these men are currently banned from donating blood, which is also a tissue, for life.
Most other developed countries do not impose a lifetime ban on donations; the United Kingdom holds a one-year waiting policy and Canada holds a five-year policy, according to HealthDay.
Moore called the practice "archaic," saying it is "just silly that people wouldn't get the life-saving assistance they need because of regulations that are 30 years old." Many have pointed to the FDA's policy as discriminatory.
I believe the FDA's policy was not intended to be homophobic. It was put into place with one goal in mind: safety. And there are certainly reasons to still consider gay men as a high-risk group, even 30 years later. Young gay and bisexual men (13-24) accounted for 72 percent of new human immunodeficiency virus infections for their age group in 2010, according to the Centers for Disease Control and Prevention. This was a 22 percent increase from 2008. Even with improved education and protection, something is going wrong.
For this reason, I believe the FDA is more than justified in its monitoring of this demographic. On a small scale, the practice may not seem just; certainly not every sexually active gay man has a sexually transmitted disease, and not every straight man holds a clean bill of health. However, it is important to remember that the FDA made this policy on a larger scale; all gay men do not carry STDs, but out of the thousands (or millions) of gay men who might wish to donate, there is a statistically higher chance that some of these men are infected. And until we better address this health crisis, these odds will remain as they are.
That being said, I also believe the FDA's policy is too extreme. We have much better technology than we did in 1986. All blood donations are tested for a variety of infections before transfusion. That's just common sense; distributing tissue samples to humans solely based on a questionnaire would be extremely dangerous.
One of these screenings is for the presence of HIV. The FDA maintains that while this test is "highly accurate," but might not catch early cases of infection.
"The "window period" exists very early after infection, where even current HIV testing methods cannot detect all infections," the FDA stated. "During this time, a person is infected with HIV, but may not have enough virus or have developed sufficient antibodies to be detected by available tests. For this reason, a person could test negative, even when they are actually HIV positive and infectious."
This makes complete sense. However, researchers at the University of California, San Diego advertise tests that can detect the presence of HIV only one week of exposure. I was not able to determine what HIV tests are standard for blood transfusions. If these tests do not keep up with comparable detections (i.e. much longer than one week), then perhaps it is time they are updated.
With the technology to detect the presence of HIV in blood after only a week, a lifetime ban seems excessive. While regulation is certainly still wise, a more lenient waiting period, perhaps somewhere from one to five years, should be sufficient time to detect the virus.
However, although I feel deep sympathy for Moore and her family, I believe the decision was necessary in this case. The issue is the uncertainty surrounding the donation. Betts may have not ever even come close to having a sexual encounter with another man. But unfortunately, there is just no way to ever know the truth for certain. His mother could not assert that her son had not had sex - recently or otherwise.
(I do not know what the testing policy is for eye tissue, but I would imagine the protocol is similar to that of blood.)
When in doubt, it is always safer to turn someone away than to risk harming a patient. And sometimes that doubt results in extremely difficult decisions. The FDA has to reject donors based on a variety of factors. I have been rejected from donating blood, twice, because my iron levels fell barely below the minimum. Depending on the state, some people are blocked from donating for a year after receiving a tattoo.
These regulations were made with the patients' best interest in mind. Until we can find a better way to prevent HIV contractions with gay men, I believe the FDA is justified in labeling this demographic as "high-risk," even if some of their policies are in desperate need of an update. Ultimately, it is important to remember this isn't about the donors - it's about the safety of the recipients.