Black patients in Canada who want to donate blood face barriers including racism, according to a new qualitative study.

“Barriers were predominantly rooted in the restrictive and racist policies adopted by blood donation systems in Canada, in the individual, institutional, and structural experiences of racism in healthcare systems, and in the distrust that historical race relations have established in Canada,” the study authors wrote.

“What surprised us most was the impact [that discrimination] has on people’s health behaviors and how it shapes their relationship with the healthcare system, including blood donation,” lead author Jude Mary Cénat, PhD, professor of psychology and University of Ottawa Research Chair on Black Health, told Medscape News Canada.

“Experiences of racial discrimination in the healthcare system at large lead to a process of self-rejection that is a self-defense mechanism for these Black people,” said Cénat, who is also chair of the university’s Interdisciplinary Centre for Black Health. “More importantly, we discovered the racism embedded in the rules governing blood donation in Canada.”

While the US and other countries have made changes regarding malaria and blood donation, “Canadian institutions have resisted,” he said. “Canadian Blood Services (CBS) and Héma-Québec refer the issue back to Health Canada, while Health Canada does the same in return. This demonstrates that institutional and systemic racism is real [and] that its impact on how people behave and experience the healthcare system is equally real and significant.”

The study was published online on August 24 in CMAJ.

What Patients Are Saying

The researchers conducted a qualitative study with semistructured interviews with 42 English- or French-speaking Black adults living in Canada who were recruited through social media and community organizations. Participants’ mean age was 38.5 years, and 57.1% were women. Most were highly educated, with 37 (88.1%) holding a bachelor’s degree or higher.

Responses yielded 14 key themes that the researchers grouped into five clusters, each of which represented a type of barrier to blood donation for Black patients in Canada. Systemic and policy barriers were the most commonly cited. They included restrictive blood donation policies adopted by CBS and Héma-Québec, institutional racism, and historical anti-Black racism. Knowledge and awareness barriers encompassed lack of information, perceptions that Black donors’ blood wasn’t really used, and exclusionary outreach.

Accessibility and practical barriers included inaccessible donation centers, financial constraints, and challenges in finding veins during venipuncture on Black patients. Social and cultural barriers included stigma, lack of Black representation among staff, and unwelcoming environments. Psychological barriers involved fear of needles and widespread mistrust of the system.

Among the 14 themes, the four most frequently cited by participants were restrictive blood donation policies, institutional and systemic racial discrimination against Black people in healthcare systems, historical anti-Black racism, and lack of confidence in blood donation systems.

The study contained numerous comments from participants, including the following:

• “Black people feel diminished in society and feel that their blood doesn’t count.”
• “You experience so much racism that you’re afraid to give blood. The blood of many Black people has been refused because of racism, and even when it’s the norm, the way it’s said, you feel you’re impure.”
• “If a Black person hasn’t experienced racism here, it means he has never been to the hospital.”
• “I lived in France and gave blood [for] 14 years. I was shocked when they said I cannot give blood in Canada because I got malaria.”

“Our findings highlight ongoing, restrictive policies that challenge blood donation among Black people in Canada and underscore deep mistrust in the healthcare and blood-donation systems owing to historical and current racial discrimination,” the authors concluded.

“This study gives CBS, Héma-Québec, and Health Canada an opportunity to make simple and obvious changes that could have a significant impact,” Cénat added. “They have been discussing the issue of malaria, for example, for years. Simply changing this specific aspect would enable hundreds of thousands of people from Black communities to donate blood. These are changes that could be made before the end of the year. What, specifically, is preventing them from making this change?”

What Organizations Are Doing

CBS and Héma-Québec acknowledged barriers to blood donations by Black patients.

“We have come to better understand barriers to inclusion and how they can shape people’s experiences with and perspectives of blood donation through reflection and examination of some of our donor screening practices, along with research, consultation, and ongoing engagement with impacted communities,” CBS representative told Medscape News Canada.

Héma-Québec “recognizes that being unable to donate blood can be disappointing and frustrating for anyone who wishes to contribute to the health and well-being of their community,” said Marc Germain, MD, PhD, the organization’s vice president of medical affairs and innovation. “Such experiences can be discouraging and may affect trust in the blood donation system.”

A key barrier to blood donation in Canada is a previous malaria infection. “Until recently, there was no test available in Canada sensitive enough to detect low levels of malaria parasites in donated blood,” which has led to the turning away of many people who have had malaria, including those who are no longer infectious, according to CBS.

“In 2025, Health Canada approved the first-ever nucleic acid test (NAT) designed specifically to screen blood donations for malaria,” the CBS representative said. “Unlike antibody testing, the NAT detects the malaria parasite at low levels, so it can identify the small number of people who could transmit malaria, instead of deferring everyone who may have been exposed.”

Since then, CBS has been working to introduce the malaria NAT into the blood screening process. In June 2026, CBS sought approval from Health Canada to do so. “The test will remove certain donation barriers and reduce wait times for many people who have recovered from malaria or lived in malaria-endemic regions and are currently unable to donate due to existing test limitations,” the representative said. CBS anticipates introducing malaria NAT in late 2026 or early 2027, subject to Health Canada approval.

Héma-Québec is following developments related to this advanced molecular testing, but “each blood operator must carefully evaluate the benefits, risks, costs, and logistical implications associated with any new testing strategy,” said Germain. “Decisions regarding donor eligibility always require balancing inclusion and safety.”

Meanwhile, CBS and Héma-Québec have initiated outreach efforts aimed at better understanding Black communities and improving their donation experiences. Germain pointed to Héma-Québec’s blood drives, tailored educational and promotional materials, and partnerships with the Sickle Cell Anemia Association of Quebec, among others.

CBS has established a national African, Caribbean, and Black advisory group made up of community and thought leaders, professionals, and advocates. It is training donor-facing employees and decision-makers in cultural sensitivity and recognizing and addressing unconscious and implicit bias. The organization also is developing an action plan focused on enhancing the availability of appropriately matched blood products to improve the health of patients with sickle cell disease.

What Clinicians Can Do

Outside institutional-level action, “individual clinicians can help raise awareness, educate themselves, and train their colleagues on issues related to racism,” said Cénat. Additional actions, he said, could include the following steps:

• Recognizing and challenging their own biases, including implicit biases that can influence clinical judgment, communication, pain assessment, diagnosis, and treatment.
• Listening to Black patients and taking their experiences seriously, particularly when they report discrimination, mistreatment, or barriers to care.
• Avoiding dismissing or minimizing patients’ concerns and recognizing that mistrust of the healthcare system may be rooted in real experiences of discrimination.
• Creating a clinical environment where patients feel safe, respected, and heard, regardless of their race or background.

“Ultimately, individual clinicians cannot dismantle systemic racism on their own,” Cénat said. “But they have an important role to play in recognizing it, refusing to reproduce it, challenging it when they encounter it, and advocating for changes within the institutions where they work.”

This study was funded by the University of Ottawa under the framework of Cénat’s University of Ottawa Research Chair on Black Health. Cénat and Germain reported no relevant financial relationships.

Marilynn Larkin, MA, is an award-winning medical writer and editor based in New York City whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health.