Conventional thinking on compensating blood donors comes down to this: Giving should be its own reward. Sure, offer donors a sticker, a lollipop, or some marketing swag for their trouble. But the desire to help your fellow man, not money, should be the motivation for overcoming inconvenience or squeamishness about needles. For four decades, the World Health Organization and blood banks around the world have frowned upon offering economic incentives for blood donation, out of ethical concerns and the belief that it's detrimental not just to the quantity but the quality of the blood supply. Evidence from various surveys and research studies has suggested that substantial perks can actually drive away the altruistic and attract unsafe donors such as drug addicts and those who engage in unsafe sexual practices. Blood banks also worry that if they offer compensation once, people will hold off donating again until there is a new offer.
A recent study published in Science, however, argues that something more than a pat on the back, such as a gift card, can indeed motivate donors in certain instances and locations. Mario Macis, an assistant professor at the Carey Business School, says his team of researchers examined existing studies and conducted their own field research in Europe, Argentina, and the United States (the latter in partnership with the American Red Cross) on the impact of a range of rewards, from T-shirts to one day of paid leave from work. They found that out of 19 incentives tested in the field, 18 increased donations. T-shirts and supermarket coupons led to 16 percent more donations at American Red Cross drives, and a one-day paid leave was associated with 40 percent more annual donations in Italy. In Switzerland, the offer of a $5 lottery ticket increased donations by 5 percent, and a $10 gift card in the United States increased donations by 50 percent. Only one reward, a free cholesterol test, had no appreciable impact. Where data were available, no negative effect on blood safety was detected.
Macis says that while his study does not indicate whether or not offering incentives all the time would have the desired long-term effect, results do suggest that incentives would be a good thing for attracting donations during a crisis, such as the aftermath of a natural disaster. Economic incentives could have a greater impact in developing countries, Macis says, which currently face serious blood shortages. "People are dying due to lack of blood supplies. There simply is not enough blood for surgeries, transfusions, and for cancer patients or those with blood diseases."
The problem is getting worse, he says. The current system of blood collection in many poorer countries relies on family or friends responding to an individual emergency and donating whatever the patient requires. "This sort of system can work in close-knit communities," Macis says. But as developing countries grow and average incomes increase, citizens gain access to better health care, such as elective surgery that requires blood. Collecting blood from friends or relatives in advance of a procedure is inefficient and sometimes ineffective. It's better to have a supply of blood on hand to ensure there will be enough of all blood types to meet demand.
Currently, WHO is pushing developing countries to switch from emergency-based systems to banking undirected donations. To make this possible, Macis says standard guidelines against economic rewards for blood donors should be reconsidered. "We are asking people to do something outside the norm, to donate blood anonymously in an unrestricted way," he says. "The switch is not going to happen overnight but has to start somewhere.