Hands are being held with drops of blood, representing donation and giving life to other human beings with it.
In March 2021, Thangjam Santa Khurai — a transgender rights activist from Manipur — walked into India's Supreme Court and filed a writ petition challenging the guidelines that ban her from donating blood.
She could not donate. Not because she was unhealthy. Not because she had tested positive for any infection. But because India's National Blood Transfusion Council's 2017 Guidelines for Blood Donor Selection permanently defer transgender persons from blood donation as a category — regardless of individual health status, risk behaviour, or test results.
Four years later, as of 2026, three consolidated petitions are being heard by the Supreme Court on this question. The government has defended the ban. A fresh expert committee has been constituted. And the constitutional and public health questions raised by the case remain some of the most complex in Indian blood banking policy.
This blog presents the facts of this ongoing legal and policy debate as accurately and evenhandedly as possible.
The Guidelines for Blood Donor Selection and Blood Donor Referral, 2017, issued jointly by the National Blood Transfusion Council (NBTC) and National AIDS Control Organisation (NACO), contain two relevant clauses:
Clause 12: Identifies donors "at risk" for blood-borne infections including HIV, Hepatitis B, and Hepatitis C. Among the groups listed as at-risk: transgender persons, men who have sex with men (MSM), and female sex workers.
Clause 51: Mandates "permanent deferral" of transgender persons, MSM, and female sex workers from donating blood or plasma. This is a blanket, permanent deferral — there is no waiting period, no individual risk assessment, no pathway to eligibility regardless of health status or testing results.
These guidelines formalised what had been an informal policy linked to the HIV/AIDS epidemic. The explicit permanent deferral is categorical — based on identity and category membership, not individual clinical assessment.
The three consolidated petitions before the Supreme Court — filed by Santa Khurai (2021), Harish Iyer (prominent LGBTQ+ activist), and Sharif D. Rangnekar (gay author, 2024) — make the following core arguments:
Constitutional challenge: The permanent deferral based on gender identity and sexual orientation violates:
Transgender Persons (Protection of Rights) Act, 2019: This Act explicitly prohibits discrimination against transgender persons in healthcare settings. The petitioners argue that the NBTC guidelines violate this law.
Scientific evolution: Testing technology has improved since the guidelines were written. HIV NAT testing reduces the window period to 7–9 days. All donated blood is screened for HIV regardless of donor category. The risk, petitioners argue, can be managed through individual testing rather than categorical exclusion.
Practical harm: During COVID-19's second wave, Santa Khurai described two transgender friends who went to a private hospital in Manipur to donate blood and were refused. In 2013, a transgender person wanted to donate blood for a sick family member — a government hospital refused. The petitioners argue this ban compounds a blood shortage by excluding willing donors.
International comparison: Brazil's Supreme Court struck down a 12-month deferral for gay men, finding it discriminatory. Multiple Western countries have moved from permanent or lengthy deferrals to individual risk-based assessments.
The Union Ministry of Health and Family Welfare has defended the guidelines in court, making three main arguments:
Epidemiological data: The government's Annual Report 2020–21 states that HIV prevalence among transgender persons, MSM, and female sex workers is 6 to 13 times higher than adult HIV prevalence in the general population. The government argues this population-level risk data justifies categorical deferral.
Expert committee endorsement: The government formed an expert committee following a Supreme Court direction in May 2025 to reconsider the policy. The government's position, as of March 2026, is that experts have "reconsidered, and there is a reconsidered opinion that if this ban is diluted, it will be injurious to the recipients."
Recipient's right to safe blood: The government argues that the primary obligation of the blood banking system is to the recipient — particularly "poor people who depend on government blood facilities" — and that any policy change that increases risk to recipients prioritises donor rights over recipient safety.
The petitioners and supporting advocacy groups raise several responses to the government's defence:
Behaviour-based vs identity-based assessment: HIV risk is associated with specific sexual behaviours (unprotected sex with multiple partners), not with identity categories (being transgender or gay). Two people of the same gender identity or sexual orientation may have completely different risk profiles. The guidelines conflate identity with risk behaviour in a way that science does not support.
Testing as the safeguard: If NAT testing can detect HIV within 7–9 days of infection, the argument goes, individual testing is the appropriate safety mechanism — not categorical exclusion. A transgender person who tests negative at the time of donation presents no different transmission risk than any other donor who tests negative.
The shortage context: India's blood system is short by approximately one million units annually. Excluding entire communities of willing donors — including those who may be in low-risk situations — compounds a shortage that has real consequences for patients. As the Local Samosa analysis noted: "The exclusion of willing donors on the basis of identity is not merely a constitutional question, it is a compounding of one crisis by another."
The public health equity question: The Supreme Court described the petition as a "luxury petition" — a characterisation the petitioners disputed strongly. Sharif D. Rangnekar responded: "I find this extremely biased. I can't believe that it is coming from a Chief Justice." The framing raises questions about whose rights are centred in a public health policy debate.
As of March 2026, the three consolidated petitions are being heard by a Supreme Court bench. A fresh expert committee was constituted following a May 2025 court direction. The government has reiterated its position that the ban should remain.
The case has not yet been decided. The expert committee's reconsidered opinion has been presented to the court, supporting retention of the ban in some form. The petitioners continue to argue for individual risk-based assessment as an alternative to categorical permanent deferral.
This remains one of the most significant pending questions in Indian blood donation policy — at the intersection of constitutional rights, public health science, and the ethics of exclusion.
The global trend in blood donor policy has moved — unevenly and not universally — toward individual risk-based assessment:
India's guidelines, at permanent categorical deferral, represent one of the strictest approaches internationally. The ongoing Supreme Court case will determine whether Indian law — including the Transgender Persons Act — requires a different approach.
This blog does not advocate for a specific legal outcome. The case involves genuine tensions:
These tensions are genuinely difficult. The courts, health authorities, and advocacy communities are working through them in real time.
What is clear is that the question of who can donate blood — and on what basis eligibility is determined — is among the most consequential policy questions in Indian blood banking. Its resolution will shape both the legal treatment of marginalised communities in healthcare and the practical supply of voluntary blood donors for years to come.
Register on TheBloodApp if you are eligible under current NBTC guidelines. Donate regularly. And follow the ongoing Supreme Court proceedings if you are interested in how India resolves one of blood banking's most complex policy questions. To find donation camps and blood banks near you, call the number listed in the app.
Sources: Local Samosa — Supreme Court Blood Donation Queer Community 2026 | IndiasSpend — Trans Persons Blood Donation India | The Body — Transgender Blood Donation Ban India | Prime Legal — SC Blood Donation Ban LGBTQ 2026 | QNews — India Rejects Call End Gay Blood Donation Ban | Wikipedia — Blood Donation India | NBTC Guidelines 2017 | Transgender Persons Protection of Rights Act 2019
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