Blood donor safety and selection criteria for individuals self-identifying as trans or non-binary

Social movements in favour of greater diversity, equity and inclusion have led societies to re-examine the concepts of sex assigned at birth and gender identity. These have also impacted healthcare systems and blood operators. Gender identities extending beyond the concept of cisgender binary individuals might have an impact on the safety of blood components for recipients, and on the safety of the donation process itself. Furthermore, the procedures put in place by blood operators to welcome donors from sexual and gender diversity might have a major impact on donors' psychological well-being and retention. This review provides an overview of the processes used by blood operators to mitigate potential health risks for both donors and recipients associated with trans and non-binary donors. It also examines how blood operators address sexual and gender diversity in the donor registration process. Regarding the theoretical risks of human immunodeficiency virus (HIV) transmission and of transfusion-related acute lung injury arising from trans donors, the available evidence suggests that the hypothetical increases would be negligible. Recent studies show that adapting the donor history questionnaire for sexual and gender diversity is still an ongoing process. Improvements are needed, especially in communication with stakeholders, staff training and reducing health risks for donors. The broadening of sexual and gender identities provides an opportunity for blood operators to act as agents of positive social change towards greater safety, diversity, equity and inclusion in our societies.