Behavior-Based Screening in Organ and Tissue Donor Risk Assessments in Two-Spirit, Gay, Lesbian, Bisexual, Transgender, Queer, Intersex and Other Sexual and Gender Minority (2S/LGBTQI+) People: A Canada-wide Community Survey
Murdoch Leeies, Kimia Rohani, David Collister, Karen Doucette, Emily Christie, Carmen Hrymak, Sonny Dhanani, Warren Fingrut, Tzu-Hao Lee, Ken Sutha, Cameron T. Whitley, Ben Klassen, Nathan LachowskyPurpose
Two-Spirit, Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and other sexually and gender diverse (2S/LGBTQI+) populations experience discriminatory donor risk assessments in the Canadian organ and tissue donation (OTD) system. Based on identity and/or sexual behavior many 2S/LGBTQI+ people are deemed increased infectious risk donors under current regulations. We sought to: 1) understand the predictive ability of newly updated sexual behavior-based screening in both deceased and living donation, 2) describe 2S/LGBTQI+ community perspectives on newly proposed Health Canada donor risk assessment criteria, and 3) identify 2S/LGBTQI+ community priorities in OTD system improvement through a national survey.
Methods
We conducted a cross-sectional, web-based Canada-wide survey of 2S/LGBTQI+ people in Canada (April 16 – June 11, 2025). Participant characteristics were summarized using descriptive statistics. The likelihood of different substitute decision makers to answer sexual behavior-based screening questions was assessed with bivariate analyses, data are presented as counts and row percentages to illustrate the distribution of outcomes within each predictor group. Continuous variables are presented as means with standard deviations (SD) and ranges.
Results
We analyzed responses from 2072 respondents. Participants reported heterogeneity in the likelihood that their medical decisionmakers would accurately answer questions about their sexual behaviors, sexual partners, substance use, and HIV Pre- or Post-Exposure Prophylaxis (PrEP/PEP) use, which particularly depended on who their medical decision maker was (e.g. a partner or friend versus other family). Those at highest risk for HIV were less likely to report that their medical decisionmakers would accurately answer questions about their sexual partners. Approximately 20% of survey participants reported they were uncertain or would not self-report these details if they were directly asked by healthcare providers. More than half of participants felt the newly proposed Health Canada donor risk assessment criteria were discriminatory and required further change.
Conclusions
Sexual behavioral screening for donor risk assessments in 2S/LGBTQI+ people living in Canada is likely to be poorly predictive of the risk of HIV and viral hepatitis transmission through organ and tissue transplantation. Health Canada should support a re-evaluation of the current increased infectious risk donor paradigm guided by evidence and patient/community values/preferences to maximize benefits and minimize harms to patients and to 2S/LGBTQI+ community members.