Blood donation underpins many medical treatments, including transfusions for trauma, cancer, and sickle cell disease. In Canada, blood collection is managed by Héma-Québec (Quebec) and Canadian Blood Services (other provinces and territories). Under-representation of Black donors limits access to antigen-matched blood for patients who are at higher risk of alloimmunization, notably people living with sickle cell disease, and creates clinical challenges for safe transfusion practice.
Historical events and institutional policies have contributed to persistent mistrust in affected communities. Past restrictive deferral policies applied in the context of the HIV/AIDS crisis have been cited as drivers of medical mistrust among Black people in Canada and elsewhere. The present study was undertaken to document Black adults’ lived experiences and identify barriers to donating blood in order to inform strategies that enhance donor diversity and equitable access to transfusion services.
This qualitative study followed Standards for Reporting Qualitative Research. Researchers conducted in-depth, semi-structured interviews with self-identified Black adults (≥18 years) living in Canada between March and June 2023. Recruitment used social media (LinkedIn, Facebook, X, Instagram), dissemination through Black-led and community-serving organizations across provinces, and snowball sampling. Participants represented seven provinces (Alberta, British Columbia, Manitoba, New Brunswick, Nova Scotia, Ontario, Quebec). Recruitment continued until thematic saturation.
Interviews were conducted virtually via Zoom by bilingual Black research assistants trained in antiracist and antioppressive approaches to foster trust and cultural safety. Participants chose English or French, provided informed online and verbal consent, and completed a brief sociodemographic questionnaire. Interviews lasted 24–38 minutes; participants received a modest electronic gift card and a post-interview debrief form to mitigate potential distress.
Audio recordings were transcribed using a secure automated service, then corrected and reviewed by research assistants while listening to recordings to ensure transcription accuracy. Interviewers kept logbooks documenting atmosphere and participant comprehension. Data storage used secure physical and multi-code digital protection strategies.
The research team used a general inductive approach and applied Braun and Clarke’s six-step thematic analysis using NVivo software. Coding was reflexive and iterative: transcripts were familiarized with, coded, and reviewed to allow themes to emerge from participants’ narratives. The analytic process was informed by the culturally sensitive research practices emphasized during data collection.
Forty-two participants were interviewed; 57.1% identified as women. Participants lived across seven Canadian provinces and were recruited through a combination of social media outreach and community organization networks. Interviews elicited personal experiences and perceptions about barriers to blood donation affecting Black communities.
Participants most frequently cited systemic and policy barriers. These included restrictive eligibility and deferral policies historically and currently adopted by blood organizations, which participants perceived as exclusionary toward Black people. Institutional racism and historical anti-Black discrimination were described as contributing to enduring reluctance to engage with blood services. These systemic factors were linked directly to mistrust and the sense that policies continue to disadvantage Black potential donors.
Participants reported a lack of accessible, relevant information about blood donation tailored to Black communities. There was a perception that Black donors’ blood is underutilized and that outreach efforts are exclusionary or not culturally adapted. Limited awareness of the need for antigen-matched donors for conditions such as sickle cell disease was also described as a barrier to community mobilization.
Practical impediments included inaccessible donation centre locations and financial constraints that make attending donation appointments difficult for some individuals. Participants pointed to logistics—travel, time off work, and family obligations—as deterrents, and noted that insufficiently distributed donation sites reduce opportunities for participation.
Social and cultural barriers included stigma surrounding donation, a lack of representation among blood donation staff, and environments perceived as unwelcoming. Participants reported that limited visible representation and culturally insensitive interactions discouraged engagement and reinforced feelings of exclusion.
Psychological barriers comprised common fears such as fear of needles, but importantly also widespread mistrust of health care and blood donation systems. This mistrust was framed by participants in relation to historical discrimination and prior policies during the HIV/AIDS era, which many described as having long-lasting effects on confidence in blood services.
The study highlights a constellation of barriers—policy-level, informational, practical, social, and psychological—that impede Black participation in blood donation in Canada. Systemic and policy issues were most prominent and are directly tied to mistrust that stems from historical and ongoing racism. Clinically, the shortage of Black donors perpetuates supply challenges for antigen-matched blood necessary to reduce alloimmunization in transfusion-dependent patients, including those with sickle cell disease.
Authors call for policy reform at organizational levels, improved and culturally tailored communication, and collaborative partnerships between blood collection organizations and Black communities to rebuild trust. Interventions should address restrictive policies, ensure inclusive outreach, expand convenient access to donation sites, and increase representation within blood services. The study suggests that such multifaceted efforts are necessary to improve donor diversity and equitable access to life-saving transfusions for Black patients. Specific implementation timelines and operational details for reforms were not reported in the source.