Our survey received 2,285 responses from adult members of the 2SGBTQI+ communities across Canada. We manually removed 9 repeated response patterns on the basis of their IP addresses, resulting in 2,276 complete responses. The rate of completion through the last question was 68% (1,536/2,276). Participants completed the survey in English (87%; 1,987/2,276), French (12%; 280/2,276), or Spanish (0.4%; 9/2,276). Of the participants, 71% (1,627/2,276) self-identified as gay. Additionally, 11% (240/2,276) self-identified as transgender and 2% (47/2,276) self-identified as intersex. Of the participants, 93% (2,112/2,276) reported having had sex with a man in the past 5 years, and 86% (1,578/2,276) having had sex with a man in the past 12 months. Almost half of participants who were HIV-negative reported currently or previously taking HIV pre-exposure prophylaxis (PrEP; 46%; 738/1604). Of those respondents who were living with HIV (12%; 232/1,994), 98% (222/227) reported currently taking antiretroviral therapy, with 96% (215/224) achieving undetectable viral levels. Of the respondents, 17% (385/2,272) identified as racialized persons (Table).

Furthermore, 95% (1,913/2,010) were familiar with HIV preventative measures such as HIV PrEP, and 89% (1,795/2,010) knew that people living with HIV with undetectable viral levels cannot pass HIV through sexual contact (i.e., “undetectable = untransmittable”).17,18,19,20 Of the respondents, 42% (842/2,012) were familiar with doxycycline PrEP or postexposure prophylaxis (PEP) for sexually transmitted infections such as syphilis and chlamydia.

Health Canada OTDT policies relevant to 2SGBTQI+ populations were presented to participants, who rated their awareness of each. Figure 1 defines 2SGBTQI+-relevant policies and policy gaps. The majority of participants were unaware of existing organ and tissue donation policies before taking this survey, while relatively more participants endorsed awareness of CBS’s donation policies (Fig. 2). Participants endorsed being least aware of HIV PrEP/PEP-related policies in both organ and tissue donation and in blood donation spheres.

Organ and tissue donation and transplantation and blood policies and policy gaps in Canada relevant to sexual- and gender-minoritized communities. The men who have sex with men blood policy and gender-based blood screening policy both contain details about recent changes made to these policies in 2022, with pre-2022 and post-2022 policies presented.

HIV = human immunodeficiency virus; MSM = men who have sex with men; PEP = postexposure prophylaxis; PrEP = pre-exposure prophylaxis; U = U = undetectable equals untransmittable

Awareness of sexual- and gender-minoritized-relevant blood and organ and tissue donation policies among 2024 survey participants

MSM = men who have sex with men; PrEP = pre-exposure prophylaxis; U = U = undetectable equals untransmittable

Most participants perceived Health Canada OTDT policies relevant to 2SGBTQI+ populations to be discriminatory (Fig. 3). Similarly, 59% of participants (920/1,569) perceived CBS’s current donation policies, even after recent policy revisions, to continue to be discriminatory, and 72% (1,118/1,550) agreed that further policy revisions were needed.

Beliefs about current Health Canada organ and tissue donation and transplantation policies

MSM = men who have sex with men; U = U = undetectable equals untransmittable

Regarding the current increased infectious risk donor criterion for MSM when it comes to organ donation (Fig. 1), 44% (693/1,562) indicated that it should be changed to apply only to people whose behaviors increased their likelihood of acquiring or transmitting HIV or viral hepatitis, or that it should be removed entirely (12%, 193/1,562). Of the participants, 46% (714/1,553) indicated that the increased infectious risk donor exclusion for MSM in regard to tissue donation instead should only apply to people whose specific behaviors increased their likelihood of infectious transmission, or that it should be removed entirely (17%, 265/1,553). When it came to the policy that classifies sexual contacts of people living with HIV as increased infectious risk donors, 45% (692/1,552) of participants wanted this criterion updated to reflect the science that sexual transmission of HIV is not possible if the person living with HIV has an undetectable viral level, or they wanted the policy removed entirely (13%; 201/1,552). To address OTDT policy gaps regarding HIV PrEP and PEP, 48% (742/1548) of participants indicated that PrEP use should be considered to decrease a potential donor’s risk of HIV owing to it being highly effective and requiring regular HIV testing for ongoing access to PrEP, or felt that no specific policy on PrEP/PEP was needed (7%; 105/1,548). Of the participants, 44% (677/1,532) indicated that, rather than screening transgender or nonbinary potential donors on the basis of sex assigned at birth, current policies should be updated to allow transgender and nonbinary people to self-identify their gender, while 36% (547/1,532) were uncertain what should be done about this policy (Fig. 4).

2024 survey participant recommendations regarding organ and tissue donation and transplantation policy action

HIV = human immunodeficiency virus; MSM = men who have sex with men; PEP = postexposure prophylaxis; PrEP = pre-exposure prophylaxis; U = U = undetectable equals untransmittable

For blood donation, participants endorsed more precise screening for sexual practices to allow more MSM to donate blood (63%; 984/1,565), allowing PrEP/PEP users to donate whole blood (52%; 811/1,565) and plasma (49%, 769/1,565), the ability to self-identify gender in blood donation systems (35%; 549/1,565), and more clarity around how hormone therapy and/or gender-affirming surgeries impact eligibility to donate blood (25%; 384/1,565) as changes they wanted to see in the policy landscape.

Participants reported a willingness to donate organs (79%; 1,237/1,566) and tissues (72%; 1,123/1,566) after death. Over one third of respondents (35%; 549/1,566) said they would be willing to donate a kidney or part of their liver as living organ donors. In addition, 72% (1,137/1,582) reported they would donate blood if allowed. Over half of participants (55%, 873/1,574) reported having registered their wishes to donate organs and/or tissues online, with their identification, or via a donor registration card. Barriers to donating organs and/or tissues for participants included existing discrimination towards people who identify as Two-Spirit, lesbian, gay, bisexual, transgender, queer, intersex, asexual, and more (2SLGBTQIA+) in the OTDT system (35%; 538/1,524), worry that their donation would be rejected or treated differently because of their sexuality (28%; 433/1,524), insufficient information about what donation entails (25%; 375/1,524), concern about facing discrimination based on sexual diversity in donation and transplantation spaces (24%; 373/1,524), and concern about discrimination based on gender diversity in clinical spaces (15%; 226/1,524). Many (41%; 645/1,524) felt that Canadian blood programs also needed specific 2SLGBTQIA+ outreach efforts to build relationships, and 85% (1,343/1,580) felt Canadian blood programs must do more to repair their relationship with SGM communities.

Endorsed facilitators of respondents’ willingness to donate their own organs or tissues included equitable policy revision that supports the inclusion of people who identify as 2SLGBTQIA+ in the OTDT system (46%; 696/1,503); assurance that one’s body and identity will be treated with respect during the donation process (40%; 595/1,503); specific efforts by Health Canada, CBS, and Héma-Québec to repair their relationship with the 2SLGBTQIA+ community (36%; 546/1,503); a personal connection to a person on the transplant wait list (28%; 414/1,503); the presence of 2SLGBTQIA+-specific supports (25%; 377/1,503); and explicit consideration of transgender and gender-diverse people in health policies (18%; 277/1,503).