Blood Donation Barriers: Santa Khurai’s Long SC Fight for Trans Rights

Blood donation remains a deeply contested issue for transgender individuals in India, where discriminatory policies perpetuate exclusion and stigma. The Guidelines for Blood Donor Selection & Blood Donor Referral, 2017, issued by the National Blood Transfusion Council (NBTC) and the National AIDS Control Organisation (NACO), permanently bar transgender people, along with men who have sex with men and female sex workers, from donating blood, citing them as "at risk" for HIV and other infections. This blanket ban, rooted in outdated assumptions rather than individual risk assessment, dehumanises entire communities, denying them the fundamental right to contribute to life-saving efforts. 

Santa Khurai, a transgender activist and Nupi Maanbi (transgender woman) from Manipur, decided to challenge this injustice. Through her 2021 Public Interest Litigation (PIL) in the Supreme Court, Khurai is fighting to dismantle these discriminatory guidelines, advocating for equality and dignity for transgender persons in India’s healthcare system.

Confronting Transgender Discrimination in Blood Donation

Her resolve to challenge India’s discriminatory blood donation guidelines was sparked by the lived experiences of her community. In her words, “Initially, I wasn’t aware of the existence of these guidelines. But after listening to numerous community experiences, I realised how unjust they were. Through my work with trans communities, it became clear that the guideline is rooted in deep-seated prejudice—especially against trans women, who are often hyper-visible and marginalised. These biases are reflected in laws, policies, societal attitudes, and even within families. The ban on blood donation is just one glaring example of this discrimination. I felt it was essential to challenge this unfair guideline, not just for the trans community but for all people pushed to the margins—sex workers, for instance, who also face targeted exclusion.” 

Khurai speaks about a distressing incident in 2013 at Jawaharlal Nehru Institute of Medical Sciences (JNIMS), a prominent medical college and hospital in Imphal, Manipur. Three transgender women approached Khurai with a harrowing account. They had gone to JNIMS’s blood bank to donate blood, one of them for her own aunt, a patient in need. “They had gone to donate blood but they were publicly humiliated by the staff at the blood bank.”

Nearly a decade later, in 2021, a similar incident unfolded at Shija Hospitals and Research Institute, a private healthcare facility in Langol, Imphal West. Two transgender women were denied the opportunity to donate blood, facing rejection rooted in the same discriminatory 2017 NBTC/NACO guidelines. Khurai shared the gravity of this moment: “This incident was particularly poignant because Dr. Beoncy Laishram, a trailblazing transgender doctor and Resident Medical Officer at Shija Hospitals, intervened to support them. As Manipur’s first and only transgender doctor, a post-operative trans woman who underwent sex reassignment surgery in Puducherry, Dr. Laishram is a symbol of hope for Nupi Maanbi. Yet, her efforts to advocate for the blood donation rights for these women were met with disdain”. 

The 2021 incident at Shija Hospitals took a particularly insulting turn when blood bank officials mocked Dr. Laishram’s credentials, questioning if she was merely an Ayurvedic doctor, despite her role as a qualified Resident Medical Officer. Khurai recalled this indignity: “This was so humiliating. The doctor told me exactly what she went through and later shared a copy of the 2017 guidelines, which was my first direct encounter with the policy.” 

The discrimination embedded in India’s blood donation policies disproportionately targets transgender women due to their hyper-visibility and societal marginalisation. Khurai highlighted this stark disparity: “I then spoke to several gay men and trans men who told me they had donated blood multiple times without facing any hostility. That contrast made it clear that the discrimination was specifically targeted at trans women, who face higher visibility and marginalisation.” 

The 2017 guidelines blatantly violate Articles 14, 15, and 21 of the Indian Constitution. Article 14 guarantees equality before the law, Article 15 prohibits discrimination based on sex—interpreted to include gender identity in landmark rulings like NALSA v. Union of India (2014)—and Article 21 ensures the right to life and personal liberty, encompassing dignity. Santa Khurai argues that the 2017 guidelines undermine these constitutional protections by singling out transgender women, among others, without scientific justification, thus perpetuating stigma. “It discriminates against individuals based on gender identity and sexual orientation—specifically targeting trans women—and therefore contradicts the constitutional promise of equality and dignity,” she stated. 

The discriminatory impact of the 2017 guidelines is particularly severe for transgender women, who face heightened scrutiny due to their visibility, unlike trans men or closeted gay men who may evade such barriers. This stigma is deeply ingrained in public consciousness.” This targeted stigmatisation, coupled with the guidelines’ restrictions, denies trans women the basic act of altruism—saving lives—while cisgender and heterosexual individuals face no such barriers. The 2014 NALSA judgment, which recognised transgender rights to self-determination under Articles 14, 15, and 21, should have paved the way for inclusive policies. However, Khurai notes, “Despite this judgment, its implementation remains inconsistent across the country. The executive has failed to enforce it effectively.” 

Khurai urges India to emulate inclusive blood donation models like the UK’s, which has eliminated bans on gay, bisexual, and transgender individuals, adopting a gender-neutral, behaviour-based screening process through the FAIR approach, ensuring safety without stigmatising entire communities. “The UK model is something India can replicate. They’ve lifted the ban on certain groups, including gay and transgender individuals, and focused instead on individual scrutiny and screening,” she emphasised. European nations like France and Italy further exemplify this by assessing donors based on individual risk behaviours, not identity, leveraging advanced screening technologies like Nucleic Acid Testing (NAT) to maintain safety. India’s 2017 NBTC/NACO guidelines, however, perpetuate a paradox by recognising transgender individuals as a third gender per the 2014 NALSA judgment while excluding them from blood donation, a policy Khurai likens to being given “rice but no water to cook it.”

The Supreme Court Battle Drags On

The petition filed by Khurai remains pending before the Supreme Court of India. The most recent hearing, held on May 14, 2025, before Justices Surya Kant and N. Kotiswar Singh, marked a significant moment, with the bench questioning the stigmatising nature of the guidelines, asking, “Are we going to brand all of them as HIV-positive?” This remark, as Khurai noted, offered hope, signaling judicial concern about blanket bans based on gender identity. 

However, the process has been slow and arduous. “I filed the petition in 2021, and we got the first reply in 2023. We filed a rejoinder in early 2023, and the first hearing was on October 10, 2023,” Khurai shared, highlighting the delays. 

Despite the exhaustion, she remains optimistic, stating, “I’m still hopeful and keeping my fingers crossed for a positive verdict from the Supreme Court.” For marginalised communities like transgender women, Khurai sees the judiciary as the sole recourse, placing her faith in a favourable ruling to dismantle the unscientific and discriminatory blood donation policy.