Recently, the FDA announced that it would soon lift the long-standing lifetime ban on blood donation by men who have sex with men (MSM). Re-examining blood donation by MSM, it is clear that there are several ethical goods that must be balanced. Through balancing the primary duty to safety with the imperatives to craft a policy that is formally equal, upholds the public's trust, and is non-discriminatory, an ethical blood donation deferral guideline may be advanced, both for MSM and the population at large.