India is facing a silent but critical medical crisis — a persistent shortage of blood supply. Despite requiring 14.6 million units annually, the country falls short by nearly a million. This shortage delays treatments, increases preventable deaths, and worsens healthcare inequality.
The issue is exacerbated by the fact that it is not merely driven by a paucity of awareness or inadequate infrastructure; it is compounded by exclusionary policies that prevent those who are willing and healthy from donating blood. Guidelines issued by the National Blood Transfusion Council and the National AIDS Control Organisation categorise transgender persons, men who have sex with men, and female sex workers as “high-risk” populations. The result is a blanket, indefinite ban on their right to donate blood regardless of individual behaviour, testing outcomes, or advances in medical screening.
A public interest litigation case filed by the transgender activist, Santa Khurai, is currently before the Supreme Court. The case challenges the blood donation guidelines as arbitrary and discriminatory for barring certain groups from donating. The State justifies this on the grounds of a higher prevalence of HIV among these populations. However, the petition argues that such a blanket exclusion conflates identity with behaviour. A monogamous gay man or a transgender person who regularly undergoes testing is automatically disqualified while heterosexual individuals engaging in high-risk, unprotected sex remain eligible.
The absence of individualised risk assessment or advanced testing technologies renders the policy scientifically outdated and constitutionally suspect. The petition contends that what is presented as a precautionary measure is, in fact, institutionalised stigma. It is not risk-based but identity-based, resting on presumptions of danger rooted in who someone is rather than what he/she does. This, the petition argues, violates Article 14 of the Constitution by creating arbitrary and unreasonable classifications. The principle of equality requires that any classification must bear a rational nexus to its objective. If the goal is to protect blood supply, then identity-based exclusions, divorced from behavioural or medical evidence, fail that constitutional test.
Further, Clause 12 of the guidelines identifies certain groups as “at risk” purely based on sexual orientation and gender identity. This, the petition asserts, constitutes discrimination under Article 15 of the Constitution, which prohibits discrimination “on grounds of sex”. Following the Supreme Court’s ruling in Navtej Singh Johar, the term, ‘sex’, has been interpreted to include both gender identity and sexual orientation, making such exclusions legally untenable.
But the issue extends beyond functional exclusion. It is deeply symbolic. Denying queer and trans persons the right to donate blood, an act of civic solidarity, implies that their bodies are suspect, their contributions unwelcome. It reinforces the idea that they are not equal members of the moral and civic collective. This, the petition argues, violates the right to dignity under Article 21, reducing their personhood in the eyes of the law and society.
Blood donation is one of the few acts that transcend caste, class, religion, and identity. It is a gesture of shared humanity. Excluding people from this act sends a chilling message: that they are not full humans. The petition urges the court to affirm that constitutional rights cannot be made conditional on majoritarian comfort and that ‘safety’ cannot be used as a cloak for prejudice. In doing so, the case calls upon the judiciary not only to review outdated public health protocols but also to take a principled stand against a deeper culture of exclusion. It asks the court to ensure that scientific reasoning and constitutional morality prevail over inherited biases.
Global practices around blood donation have increasingly moved toward a more science-based approach. Two major models have emerged. First, some countries have adopted a non-discriminatory, gender-neutral system. In June 2025, Australia’s national blood service, Lifeblood, announced reforms to its new 'plasma pathway', removing most deferral periods for plasma donation and allowing gay and bisexual men and transgender women to donate without wait times. At the same time, Lifeblood is transitioning to gender-neutral screening for blood and platelets, which has been approved by the Therapeutic Goods Administration. Under this new system, all donors, regardless of gender or sexuality, will answer the same behaviour-based questions. Meanwhile, Brazil provides a powerful constitutional precedent: in 2020, its Supreme Court struck down the 12-month deferral period for gay and bisexual men as unconstitutional, saying it offended their basic human dignity.
Second, many other countries, such as Belgium and New Zealand, use a short deferral period model. Instead of permanent bans, these systems allow individuals to donate after a brief waiting period, typically a few months, based on the time since their last sexual encounter.
In Belgium, the constitutional court has upheld the deferral period, but made clear that such a policy can only stand in the absence of sufficient scientific progress. Importantly, it mandated a bi-annual review of scientific developments, signalling that the current policy is transitional, not permanent. The reduction in the deferral period is a step forward but Belgium’s legal and policy architecture leaves room, as well as intention, for a permanent removal of identity-based restrictions.
Similarly, New Zealand reduced its deferral period from one year to three months in 2020. However, its national blood service has acknowledged that prior rules, though originally designed to ensure safety, have contributed to the stigma experienced by men who have sex with men. The country is now exploring a transition to a fully individual risk assessment-based model by 2026. India can learn from both models. In modern, rights-based democracies, safeguarding blood supply and ensuring equality are not competing goals but complementary commitments.
Shylock’s anguished cry in The Merchant of Venice, “If you prick us, do we not bleed?”, is a timeless reminder that pain, humanity, and self-worth are not confined to the bodies we deem acceptable. In today’s India, that question surfaces again, quietly yet urgently, in our blood banks and our laws. Denying queer and trans individuals the right to donate blood is more than a policy decision, it is a denial of their citizenship and personhood. It is time this decision pricked our collective conscience. Science and the Constitution tell us that it’s not who you are but what you do that determines risk. And it’s not who you love, but how you live, that defines dignity.
Navami Krishnamurthy and Shivani Mody are Research Fellows at the Vidhi Centre for Legal Policy