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FDA Urged To Relax Decades-Old Tissue Donation Restrictions for Gay and Bisexual Men
A portrait of a mother standing outside, holding a picture of her late son.
Sheryl J. Moore has been advocating for the past decade to update the rules about gay men donating tissue since she lost her eldest son, Alexander 鈥淎J鈥 Betts Jr., to suicide in 2013 and his corneas went to waste. (KC McGinnis for 天天看片 Health News)

FDA Urged To Relax Decades-Old Tissue Donation Restrictions for Gay and Bisexual Men

The federal government in 2020 and 2023 changed who it said could safely donate organs and blood, reducing the restrictions on men who have had sex with another man.

But the FDA鈥檚 restrictions on donated tissue, a catchall term encompassing everything from a person鈥檚 eyes to their skin and ligaments, remain in place. Advocates, lawmakers, and groups focused on removing barriers to cornea donations, in particular, said they are frustrated the FDA hasn鈥檛 heeded their calls. They want to align the guidelines for tissue donated by gay and bisexual men with those that apply to the rest of the human body.

Such groups have been asking the FDA for years to reduce the deferral period from five years to 90 days, meaning a man who has had sex with another man would be able to donate tissue as long as such sex didn鈥檛 occur within three months of his death.

One of the loudest voices on lightening the restrictions is Sheryl J. Moore, who has been an advocate since her 16-year-old son鈥檚 death in 2013. Alexander 鈥淎J鈥 Betts Jr.鈥檚 internal organs were successfully donated to seven people, but his eyes were rejected because of a single question asked by the donor network: 鈥淚s AJ gay?鈥

Moore and a Colorado doctor named Michael Puente Jr. started a 鈥淟egalize Gay Eyes鈥 and together got the attention of national eye groups and lawmakers.

A photo of a mom and two sons looking in a folder in a bedroom.
Moore said Betts was enthusiastic about becoming an organ donor when he got his driver鈥檚 license. When he died at age 16, his heart, lungs, and liver were among the organs that helped prolong the lives of seven people, but his corneas went untouched.(KC McGinnis for 天天看片 Health News)
A photo of two young children looking at their late older brother's artwork in his room.
Xander and Jackson Moore look through belongings in a room dedicated to Alexander 鈥淎J鈥 Betts Jr. at home in Des Moines, Iowa.(KC McGinnis for 天天看片 Health News)

Puente, a pediatric ophthalmologist with the University of Colorado School of Medicine and Children鈥檚 Hospital Colorado, said the current patchwork of donor guidelines is nonsensical considering advancements in the ability to test potential donors for HIV.

鈥淎 gay man can donate their entire heart for transplant, but they cannot donate just the heart valve,鈥 said Puente, who is gay. 鈥淚t鈥檚 essentially a categorical ban.鈥

The justification for these policies, as a means of preventing HIV transmission, has been undercut by the knowledge gained through scientific progress. Now, they are unnecessary and discriminatory in that they focus on specific groups of people rather than on specific behaviors known to heighten HIV risk, according to those who advocate for changing them.

Since 2022, the FDA鈥檚 Center for Biologics Evaluation and Research has put changes to the tissue guidance on but has yet to act on them.

鈥淚t is simply unacceptable,鈥 Rep. Joe Neguse (D-Colo.) said in a statement. He was one of dozens of Congress members who that said the current deferral policies perpetuate stigma against gay men and should be based on individualized risk assessments instead.

鈥淔DA policy should be derived from the best available science, not historic bias and prejudice,鈥 the letter read.

The FDA said in a statement to 天天看片 Health News that, 鈥渨hile the absolute risk transmission of HIV due to ophthalmic surgical procedures appears to be remote, there are still relative risks.鈥

The agency routinely reviews donor screening and testing 鈥渢o determine what changes, if any, are appropriate based on technological and evolving scientific knowledge,鈥 the statement said. The FDA provided to Neguse in 2022.

In 2015, the FDA dubbed the 鈥渂lood ban,鈥 which barred gay and bisexual men from donating blood, before in 2023 with a policy that treats all prospective donors the same. Anyone who, in the past three months, has had anal sex and a new sexual partner or more than one sexual partner is not allowed to donate. An FDA study found that, while men who have sex with men make up most of the nation鈥檚 new HIV diagnoses, a questionnaire was enough to low-risk versus high-risk donors.

A photo of a sign outside of the FDA's headquarters.
The FDA’s headquarters in White Oak, Maryland, on July 20, 2020.(Sarah Silbiger/Getty Images)

The U.S. Public Health Service adjusted the guidelines for organ donation . Nothing prevents sexually active gay men from donating their organs, though if they鈥檝e had sex with another man in the past 30 days 鈥 down from 鈥 the patient set to receive the organ can decide whether or not to accept it.

But Puente said gay men like him cannot donate their corneas unless they were celibate for five years prior to their death.

He found that, in one year alone, at least 360 people because they were men who had had sex with another man in the past five years, or in the past year in the case of Canadian donors.

Corneas are the clear domes that protect the eyes from the outside world. They have the look and consistency of a transparent jellyfish, and transplanting one can restore a person鈥檚 sight. They contain no blood, nor any other bodily fluid . Scientists there are no known cases of a patient contracting HIV from a cornea transplant, even when those corneas came from donors of organs that did infect recipients.

Currently, all donors, whether of blood, organs, or tissue, are tested for HIV and two types of hepatitis. Such tests aren鈥檛 perfect: There is still what scientists call a 鈥渨indow period鈥 following infection during which the donor鈥檚 body has not yet produced a detectable amount of virus.

But such windows are now quite narrow. Researchers with the Centers for Disease Control and Prevention , which are commonly used to screen donors, are unlikely to miss someone having HIV unless they acquired it in the two weeks preceding donation. Another study even if someone had sex with an HIV-positive person a couple of weeks to a month before donating, the odds are less than 1 in a million that a nucleic acid test would miss that infection.

鈥淰ery low, but not zero,鈥 said Sridhar Basavaraju, who was one of the researchers on that study and directs the CDC鈥檚 Office of Blood, Organ, and Other Tissue Safety. He said the risk of undetected hepatitis B is slightly higher 鈥渂ut still low.鈥

At least one senior FDA official has indirectly agreed. Peter Marks, who directs the FDA鈥檚 Center for Biologics Evaluation and Research, that said 鈥渢hree months amply covers鈥 the window period in which someone might have the virus but at levels too low for tests to pick up. Scott Haber, director of public health advocacy at the American Academy of Ophthalmology, said his is that the tissue donation guideline 鈥渟hould be at least roughly in alignment鈥 with that for blood donations.

Kevin Corcoran, who leads the Eye Bank Association of America, said the five-year abstinence required of corneal donors who are gay or bisexual isn鈥檛 just 鈥渂adly out of date鈥 but also impractical, requiring grieving relatives to recall five years of their loved one鈥檚 sexual history.

That鈥檚 the situation Moore found herself in on a July day in 2013.

Her son loved anime, show tunes, and drinking pop out of the side of his mouth. He was bad at telling jokes but good at helping people: Betts once replaced his little sister鈥檚 lost birthday money with his own savings, she said, and enthusiastically chose to be an organ donor when he got his driver鈥檚 license. Moore remembered telling her son to ignore the harassment by antigay bigots at school.

鈥淭he kids in show choir had told him he’s going to hell for being gay, and he might as well just kill himself to save himself the time,鈥 she recalled.

That summer, he did. At the hospital, as medical staff searched for signs of brain activity in the boy before he died, Moore found herself answering a list of questions from Iowa Donor Network, including, she recalled: 鈥淚s AJ gay?鈥

A portrait of a mother outside her home.
Moore said her son鈥檚 organs helped save or prolong the lives of seven other people, including a middle-aged woman who received his liver and with whom she sometimes exchanges messages on Facebook. (KC McGinnis for 天天看片 Health News)
A photo of a framed picture of Sheryl Moore's late son.
Betts’ internal organs were transplanted, but his eyes went untouched because of an FDA rule that essentially bans sexually active gay men and boys from donating tissue. (KC McGinnis for 天天看片 Health News)

鈥淚 remember very vividly saying to them, 鈥榃ell, what do you mean by, 鈥淲as he gay?鈥 I mean, he’s never had penetrative sex,鈥欌 she said. 鈥淏ut they said, 鈥榃e just need to know if he was gay.鈥 And I said, 鈥榊es, he identified as gay.鈥欌

The Iowa Donor Network said in a statement that the organization can鈥檛 comment on Moore鈥檚 case, but said, 鈥淲e sincerely hope for a shift in FDA policy to align with the more inclusive approach seen in blood donation guidelines, enabling us to honor the decision of all individuals who want to save lives through organ and tissue donation.鈥

Moore said her son鈥檚 organs helped save or prolong the lives of seven other people, including a boy who received his heart and a middle-aged woman who received his liver. Moore sometimes exchanges messages with her on Facebook.

She found out a year later that her son鈥檚 corneas were rejected as donor tissue because of that conversation with Iowa Donor Network about her son鈥檚 sexuality.

鈥淚 felt like they wasted my son’s body parts,鈥 Moore said. 鈥淚 very much felt like AJ was continuing to be bullied beyond the grave.鈥