Blood donors' helping behavior is driven by warm glow: more evidence for the blood donor benevolence hypothesis

BACKGROUND: The benevolence hypothesis (both donor and recipient gain) suggests that blood donors, compared to non–blood donors have a general altruistic motivational preference based on warm glow (i.e., “I donate because it makes me feel good”). With objective behavioral economics tests of altruism and warm‐glow giving, this paper offers the first direct experimental test of this hypothesis. The prediction that blood donors will be motivated in general by warm glow was compared to predictions from other theoretical models: strong reciprocity and empathy. STUDY DESIGN AND METHODS: Four experiments and one prospective study examined blood donors' and nondonors' motivations for general charitable giving and blood donation. Variants of the dictator game (DG; a charity DG [CDG] and a warm‐glow version of a CDG) were used to provide objective measures of altruism. RESULTS: Blood donors gave less than nondonors on the CDG, but gave more on the warm‐glow version. Blood donors' actual donations (in the CDGs and blood donation) were associated with feelings of warm glow. There was no evidence that blood donors were motivated by strong reciprocity or empathic concerns. CONCLUSIONS: This paper offers objective behavioral evidence that blood donors' charitable giving and blood donation, compared to non–blood donors, is more strongly motivated by warm glow. This provides additional support for the benevolence hypothesis of blood donation.     

Titmuss and the gift relationship: altruism revisited

RATIONALE: This paper revisits Richard Titmuss' 1970s blood donation model in the light of its 1997 reprint in order to consider whether we are justified in continuing to accept that the main reason for blood donation (and other donation types) is an altruistic desire to help others. AIM: This paper explores how others have examined the notion of altruism, before concentrating on two major elements of Titmuss' work: blood donors' motives to donate and the social implications of gift-giving in relation to the uniqueness of blood donation. DESIGN: Donor motivation is discussed in detail with particular reference to questions 4 and 5 of Titmuss' blood donor survey and through a critical appraisal approach to his work. FINDINGS: Methodological inconsistencies are revealed in the design and implementation of the survey, as well as in Titmuss' list of blood donation's unique attributes, bringing into question the rigour of his findings. It may be that blood donors are altruistically motivated, but such conclusions cannot be drawn from this work. It is also unclear if 'altruism' can be shown in the example of blood donation or other donation types. RECOMMENDATIONS: We should reconsider the motivation behind gifting in health care in the light of these findings and ensure that evidence-based practice is consistent with methodological rigour. Nurses and other health professionals need to have a clearer understanding of concepts such as altruism in order to appreciate why people seek to donate.     

Perceptions and motivations of Canadian autologous blood donors

Preoperative autologous blood donation in Canada has increased in the last decade due to concerns about allogeneic blood safety. As economic policies necessitate the validation of autologous blood donation, it is important to assess potential changes. This study examines the motivations and perceptions of patients participating in a Canadian autologous blood donation programme. The study was conducted at the Ottawa Hospital, Civic Campus. Questionnaires were developed and then administered to 100 consecutive adult autologous blood donors. The questionnaires assessed patient demographics, motivation for participation and perceptions about blood safety. Autologous donation was presented to 82% of patients as an option by their physicians. However, 59% of all patients felt that they were motivated to donate by their own fears. Patients (87%) also felt that directed blood donation should be offered due to their perception that directed donation is safer. Three-quarters of patients would be willing to pay for autologous donation. Patients are concerned about the safety of allogeneic blood and they are motivated to seek other alternatives despite the fact that allogeneic blood is very safe. These perceptions and motivations must be taken into account as health care policy changes are considered.     

Blood Donation and Monetary Incentives: A Meta-Analysis of Cost-Effectiveness

The effectiveness of monetary incentives to increase altruistic behavior is in dispute. Paying blood donors might be ineffective, as it could decrease altruistic motivations of voluntary donors (motivational crowding-out) or decrease blood quality (increase transmittable infectious disease risks). In a meta-analysis, including observational studies, natural experiments and field experiments, the cost-effectiveness of monetary incentives (cash payments and quasi-cash material rewards) for blood donation is estimated. The search strategy identified 17 studies as eligible. After screening for relevance and quality, 8 studies were retained and GRADE-rated for quality of evidence, offering 12 estimates of the marginal donation rate. The combined, random-effects estimate of the marginal donation rate of monetary incentives is 0,4 extra blood units collected per 1000 inhabitants per year per dollar incentive, but with large variation due to large heterogeneity of the studies (explained by different contexts and differences in perceived costs for donors). A higher estimate of 1,0 extra blood units per 1000 inhabitants per year per dollar incentive, is obtained with a restricted meta-analysis that only includes the most reliable and more homogeneous studies. With donor payments, it costs an additional $22 to $121 to increase the blood supply with one unit of whole blood, but this strongly varies with context and local conditions. The positive marginal donation rate of donor payments is inconsistent with a crowding-out effect (a reduction in total blood supply caused by a decrease in altruistic motivations when donors are paid), at least in the short-run. The available studies are not suitable to estimate possible long-term crowding-out effects, negative spillover effects (eg, a decrease in other prosocial behavior or altruistic norms) or transmittable infectious disease risks. Whether monetary incentives are the most cost-effective and ethical strategy to increase blood and plasma supply, remains an open question.     

Sociodemographic and attitudinal factors to blood donation in the urban population of Dakar,Senegal

BACKGROUND: The objectives of this analysis were 1) to compare the sociodemographic characteristics of donors and nondonors, 2) to describe the channels through which Dakar's population is made aware of blood donation, and 3) to analyze the motivations and barriers to blood donation expressed by donors and nondonors. STUDY DESIGN AND METHOD: A survey of 600 individuals age 20 and older representative of Dakar's population was conducted in 2009 to analyze awareness of blood donation, donor characteristics, and barriers and motivations to blood donation. RESULTS: A total of 94.7% of the respondents had already heard of giving blood and 25.8% had already donated. Men and individuals age 40 and over are overrepresented among donors (chi‐square [1 ddl] = 19.54, p < 0.001; chi‐square [3 ddl] = 14.24, p < 0.01). Those with higher education were also more likely to be donors (chi‐square [4 ddl] = 38.91, p < 0.001). Main motivations to blood donation are altruism (43%) and awareness of a blood shortage (20.33%). Never having been contacted to give blood is the number one obstacle to blood donation (37.31%). CONCLUSIONS: In Dakar, the vast majority of people are familiar with the practice of giving blood. The sociodemographic characteristics of blood donors, and the main motivations and barriers to blood donation are the same in Dakar as in other countries, but this study also demonstrates the importance to inform Dakarites that blood donation does not amount to a blood test, that donating is not harmful for one's health, and that the blood donated is quickly regenerated.     

Blood donor satisfaction and intention of future donation

BACKGROUND: New regulatory requirements for donor eligibility challenge blood centers to recruit and retain enough donors. This study evaluated correlations between overall satisfaction with the donation process and donor demographics and the effect of both on a donor's intent to return. STUDY DESIGN AND METHODS: An anonymous, self-administered questionnaire was given to donors at multiple sites of one blood center over a 3-week period. First-time and repeat donors were asked questions on demographic characteristics, satisfaction with the current donation process, motivation for current and future donations, and intent to return. RESULTS: More than 75 percent of donors rated the overall donation process at 9 or 10 on a scale of 10 (mean, 9.19; standard deviation, 1.09), with female, high school-educated, and first-time donors giving higher satisfaction ratings than male, college-educated, and repeat donors, respectively (all p < 0.001). Donor satisfaction was correlated with intent to return for another donation (p = 0.002). For the current donation, donors rated altruistic motivations most highly. Medical testing was the most highly rated incentive for future donations, followed by frequent donor programs and convenient donation times and locations; preferences varied by demographic subgroup. CONCLUSIONS: Blood donor satisfaction varies among demographic and donation history subgroups and is positively correlated with the intent to return for future donation. Although the primary motivation among all donors was altruism, incentives to future donation may need to be tailored according to demographic subgroups.     

The application of multiparameter reference intervals for pre-donation capillary blood counts: the experience of a single institution

Objectives: To evaluate a set of reference counts applied to multiparameter pre‐counts in blood donors. Aim: Analyse the impact of pre‐donation counts and specific reference intervals on donors' management. Background: Multiparameter blood counts allow an improved enrolment process of blood donors due to a prompt identification of abnormalities involving haemoglobin (Hb), white blood cells (WBC) and platelets (PLT). Methods/Materials: Multiple pre‐donation capillary counts were applied in the enrolment process of 13 347 consecutive donors. The rate of specific alterations of permanent exclusion and donor readmittance to donations for temporary exclusion had been evaluated, applying a set of multiparameter reference intervals. Results: Alterations involved Hb in 72·55% of cases, mean corpuscular volume (MCV) in 20·99%, total WBC in 9·39%, lymphocytes in 7·55% and PLT in 6·07%. Among donors with initial alterations (543; 4·06%), 12·70% were readmitted to donations within 15 days, 14·36% had permanent exclusion, 36·83% underwent prompt supplementation treatment and 36·09% were lost at follow‐up or refused treatments. Discussion: The systematic use of blood count reference intervals and pre‐donation multiparameter blood counts allowed prompt identification of WBC, PLT and MCV alterations, readmittance within 15 days of 12·70% of initially excluded donors and contributed to prompt management of supplement deficiency.     

Blood donation and donor recruitment in Iran from 1998 through 2007: ten years' experience

BACKGROUND: Recruiting and retaining blood donors is of utmost importance, especially since there is no alternative for human blood. This article describes different aspects of blood donation to evaluate recruitment activities.
STUDY DESIGN AND METHODS: Data were obtained from annual reports made by the Statistical Committee of the Iranian Blood Transfusion Organization and the national database.
RESULTS: The trend in yearly blood donations has significantly increased from 1,183,630 blood units in 1998 to 1,735,008 by the end of 2007. During this period the overall growth rate was 59.8% (p < 0.005). Yearly blood donation in the northwest region of the country was 13 per 1000 in contrast to 39 per 1000 in the central region. There was a significant decrease in the number of donations during the months of April, September, and January whereas in May, August, and the religious month of Muharram a significant increase was noted. Voluntary donations increased from 77% in 1998 to 100% by the end of 2007.
CONCLUSION: Continuous donor recruitment efforts in Iran have resulted in a significant increase in blood donation rates during the past decade as well as achieving 100% voluntary, nonremunerated blood donors. Nevertheless some provinces will have to put more effort into donor recruitment and retention so as to ensure self sufficiency in their blood supply. Educating blood donors and the public about the continuous need for a sufficient blood supply in every community is equally important and times where supply exceeds demand should be avoided at the most.     

Knowledge, attitude and practice towards blood donation in Iranian population

Background: The increase in demand for blood products because of new surgical and medical procedures seeks more research to find new ways to recruit people to donate blood. Objective/Aim: To determine the level of people's knowledge about donating blood considering its relation with infectious and chronic diseases, drug abuse, unsafe sexual intercourse, menstruation and anaemia. In addition, their attitude towards blood donation regarding their previous behaviour and factors such as altruism, religion, family, fears and availability of blood donation centres has been evaluated. Methods: This study was conducted in Tehran, Iran in 2009 on 1000 respondents. Data were collected through questionnaires that comprised 37 questions considering demographic and background characteristics, level of knowledge and positive and negative attitudes towards blood donation. Finally, data were analysed using SPSS software. Results: Of 1000 in this study, 26% were donors, of whom 55% had donated blood more than once. The mean knowledge score of the participants was 8·6, which was associated with the subjects' gender and level of education (P = 0·031 and P < 0·001, respectively). Age, gender and level of education were significantly associated with one's attitude towards blood donation (P = 0·021, P < 0·001 and P = 0·003,respectively). Ninety‐five percent of people have stated that their main motivation to donate blood was altruism. Conclusion: Altruism and being encouraged by others had the leading roles in peoples' positive attitude towards blood donation; whereas hard access to blood donation centres seemed to be the main inhibitory factor.     

影响公民自愿无偿献血的因素调查分析

目的了解影响公民无偿献血的各种因素以及公民决定献血的重点因素,以制定有针对性的招募策略。方法依照知、信、行(KAP)理论设计调查表,对成都市2385名献血与未献血的公民做现场问卷调查,通过对其无偿献血的知识、态度、行为的研究来做相关分析。结果①对无偿献血的认知:成都地区公民对我国实行无偿献血制度的知晓率较高(87.5%),但对无偿献血常识和危险行为方式总的知晓率较低(分别为29.4%、32.5%),其中献血者(1349名)对无偿献血常识和危险行为方式总的知晓率(分别为33.4%、38.1%)均高于未献血者(1036名)(分别为24.2%、25.1%)(P<0.05);文化程度越低,对献血常识和危险行为的知晓率越低,职业分布以医生的知晓率最高,农民的最低。②了解渠道:献血者通过人际传播的渠道了解的比例高于未献血者(P<0.05)。③献血动机:未献血者、初次献血者和重复献血者愿意献血的主要原因是“献爱心”,但献血动机比较多样,街头献血的行为受各种环境因素的影响;“人道主义”、“同伴招募”和“健康检查”是促使公民初次献血的因素,而影响初次献血的重点因素是“便利和勇气”;再次献血的公民主要是“献爱心、没什么特别原因和享受用血优惠”。④关注信息:未献血者如果打算献血,最希望了解的依次为“献血后是否影响身体”、“是否会感染疾病”、“血液相关知识”、“相关疾病知识”、“献血后优惠”、“献血时间地点”和“其他“。⑤对待献血的态度和行为:认为献血不影响身体的公民占73.5%,献血者(76.3%)的比例高于未献血者(70%)(P<0.05);献血者愿意继续献血的占93.3%,重复献血者(97.1%)高于初次献血者(91.1%)(P<0.05);77.3%的献血者表示“如有危险行为时选择放弃献血”。结论动机、认知、态度、个性及职业与文化程度等自身因素,献血法律法规、献血宣传方式、献血服务过程等环境因素亦都会影响公民献血。献血者招募的策略,首先应研究不同人群对献血不同的需求,采取针对性的措施,促使公民献血;其次,应为献血者提供安全、舒适和方便的服务。     

How Can We Improve Retention of the First-Time Donor? A Systematic Review of the Current Evidence

Blood products are critical to health systems and donations by voluntary nonremunerated donors are recommended. Worldwide, however, only around 5% of those eligible to donate do so and around half of those never return to donate again. This review focuses on what deters first-time donors, what predicts their retention, and what interventions may promote retention of this group. A comprehensive search of relevant databases identified 9 studies investigating motives and deterrents of first-time donors, 14 studies investigating predictors for first-time donors (13 whole blood [WB] and 2 plasmapheresis), and 15 studies (in 14 published articles) detailing interventions conducted on first-time donors. Drawing on an established blood donation taxonomy, studies were classified by 2 independent raters. Interventions were also classified into traditional, behavioral, or social science interventions. With only 2 eligible studies among first-time plasmapheresis donors, analyses focused on WB donors. First-time WB donors reported benevolent and collectivistic motivations, as well as personal benefits to commence WB donation. Self-reported deterrents have typically not been examined. Intention predicted first-time donor retention with intention determined by attitudes and a sense of (perceived behavioral) control. However, anxiety, adverse events, and deferrals all deterred retention. Traditional interventions, such as reminders and incentives, are widespread yet had only a small effect on return of first-time donors. Although behavioral science interventions such as fluid loading are effective, the strongest effect for the return of first-time donors was found when individual psychological support was provided. The purpose of this analysis was to identify the factors associated with the commencement and continuation of first WB donations. The current review revealed that self-reported motivators are typically not effective, and most successful predictive factors identified have not been translated into interventions. Future work would do well to identify, manage, and meet donors' expectations along with developing more individualized donation experiences. Blood donor research should delineate donor career stages; addressing first-time donor retention will support stable panels for blood collection agencies.     

Knowledge,attitude, and practice towards blood donation among health care providers in hospitals at Bahir Dar City,Ethiopia

Like other sub-Saharan Africa, in Ethiopia there is a shortage of adequate and safe blood supplies. Health care providers are potential resource and promoter of voluntary blood donation. This study was conducted to determine the knowledge, attitude and practice towards blood donation among health care providers in Bahir Dar City, Ethiopia. Paper based questionnaire was distributed to 276 health care providers from May 01 to June 30, 2016. Overall, 42.8% had donated blood at least once. Of these, males accounted for 60%. The median age of blood donors was 26 years. Voluntary-unpaid donation was 21.2%. Overall, 75.5% health care providers were knowledgeable. The levels of knowledge were significantly different among different disciplines (One-way ANOVA; F = 69.7; P = 0.004). Males were more knowledgeable than females (P < 0.05). The overall favorable attitude was 78.6%. Previous practice of blood donation determined the odds of favorable attitude to be a future regular voluntary-unpaid blood donor (OR: 5.7, 95% CI: 3.2–10.4). Majority of health care providers had adequate knowledge and favorable attitude. However, voluntary-unpaid donation practice (21.1%) was lower compared to 100% target of voluntary-unpaid donation. There should be motivation packages to enhance voluntary-unpaid blood donation among health care professionals.     

How barriers to blood donation differ between lapsed donors and non‐donors in France

Blood donors are underrepresented in the general population. Thus, comparing barriers to blood donation between non‐donors and lapsed donors is crucial to improving their participation in blood donation and to targeting theses groups in recruitment programmes. The aims of this study were to identify barriers to blood donation and to compare their occurrence between lapsed and non‐donors in France. Data from a 2008 survey of 1400 individuals were used to evaluate differences in barriers between two subpopulations: 619 non‐donors and 567 lapsed donors. Individuals answered questions concerning sociodemographic variables and donation‐related variables. Results show that, in decreasing order, individuals cited medical reasons (32%), lack of time (15·12%), fear (12·20%), negligence (10·03%), lack of information (7·69%), no particular reason (7·18%), lack of solicitation (6·18%), lack of opportunity (5·18%) and prior deferral (4·43%) as barriers to blood donation. After adjusted analysis, non‐donors mentioned fear, lack of information and no particular reason more often than lapsed donors, who cited lack of time more often than non‐donors. This study has pinpointed nine main barriers to blood donation among the French population, the most significant being medical reasons (for both lapsed and non‐donors), lack of time, cited more frequently by lapsed donors, and fear of donating blood, most often cited by non‐donors. Future studies are needed to gain greater insight into what these barriers represent for individuals to improve awareness and for recruitment of French blood donors.     

Asymptomatic carriage of malaria parasites in blood donors in Yaoundé

Background: Malaria can be transmitted through blood transfusion, but there is paucity of data concerning transfusion‐transmitted malaria in Cameroun. Objective: To determine prevalence of malaria infection and association with epidemiological and clinical data obtained from donors' responses. Methods: Microscopic examination of stained thick and thin blood smears for the detection, quantification and specification of Plasmodium sp was performed on 493 blood donors in two main hospitals in Yaoundé during October and November 2007. Results: Overall 6·5% of blood donors were detected positive for Plasmodium sp infection: 90·6% was Plasmodium falciparum and 9·4% was Plasmodium malariae. Parasite counts ranged from 80 to 800 µL^?1 with a median of 320 µL^?1. Asexual and sexual forms were found in 75·9 and 24·1% of cases, respectively. Age, sex, type of blood donor (voluntary non‐remunerated vs familial/replacement) and fate of blood donation (selected vs discarded) did not affect the prevalence of malaria carriage. The lack of malaria prophylaxis as well as the manifestation of malaria symptoms within 2 weeks and 1 month preceding blood donation were significantly associated with high frequency of parasites carriage. Conclusion: Malaria parasites carriage is frequent among blood donors in Yaoundé. These data seem to describe high‐risk donor profile and may help improving blood safety related to transfusion‐transmitted malaria in Cameroon.     

A Dutch blood bank and its donors

Through the aid of a questionnaire, a group of prospective donors, donors and ex-donors was studied. The most important incentive to become a donor was the direct approach by another donor. The most important motives were altruistic in nature and the medical check-up which is a part of donation. The complaints and objections of donors related to the medical check-up, the distance traveled to the site of the medical examination and blood collection and the rather impersonal way donors were treated. The most important reasons why ex-donors had stopped giving blood referred to medical complaints, practical inconveniences, physical reactions to the giving of blood, the impersonal approach and the fear of detrimental side-effects of the giving of blood. The Dutch system, whereby no financial remuneration is offered for the donation of blood, appears to function satisfactorily. The survey justifies future research aimed to a greater degree on the connection between the motives of the donor and the way the blood bank functions.     

Availability of blood components and plasma derived medicines in Iran.

Iran is a country with advanced health care system. In 1974 government of Iran established a centralized transfusion system. Since then donations of blood may not be remunerated and therapy with blood and its components is free of charge for all Iranian patients in need of the treatment. Most of donors in Iran are educated middle age men. In 2005 Iranian donated more than 1.6 millions units of blood. Although Iran population has doubled in past three decades blood donation has increased several folds. Donations are meticulously screened through interviewing of donors and lab testing of the donations using serological methods. In contrary to blood and blood components, Iran is heavily depends on importation of plasma derived medicines. Irrational use of blood components and low surveillance on use of plasma derived medicines, which are highly subsidized by the government, is a major challenge in transfusion medicines in Iran.     

Genetic research in the blood bank: acceptability to Northern California donors

BACKGROUND: Blood banks have large altruistic donor populations and existing infrastructure that make them attractive sites for genetic epidemiologic research, but donors' willingness to participate and the impact on blood donation are unknown. STUDY DESIGN AND METHODS: A total of 2162 blood donors in Northern California responded to a cross‐sectional questionnaire in August and September 2007. Participants were asked their likelihood of participation and future blood donation under three different scenarios: identity‐linked genetic research, identity‐unlinked genetic research, and genetic testing as a service. RESULTS: The majority of blood donors indicated that they would be likely or very likely to participate in identity‐linked genetic research (67%) and in identity‐unlinked genetic research (54%). While older donors and more frequent donors were more likely to participate in identity‐linked research, younger, Caucasian, more educated, and more frequent donors were more likely to participate in identity‐unlinked research. Less than 10% of donors indicated they would be less likely to donate blood in the future if genetic research was conducted at blood banks. More than 75% of donors would be interested in genetic testing as an optional service at the blood bank, but more than 20% of donors would be less likely to donate if such a service was offered. CONCLUSION: Overall, we found that the majority of blood donors would be likely to participate in genetic research and that less than 10% would be less inclined to donate if such research was conducted by blood banks.     

The role of altruistic behavior, empathetic concern, and social responsibility motivation in blood donation behavior

BACKGROUND: Blood donation can be described as a prosocial behavior, and donors often cite prosocial reasons such as altruism, empathy, or social responsibility for their willingness to donate. Previous studies have not quantitatively evaluated these characteristics in donors or examined how they relate to donation frequency.
STUDY DESIGN AND METHODS: As part of a donor motivation study, 12,064 current and lapsed donors answered questions used to create an altruistic behavior, empathetic concern, and social responsibility motivation score for each donor. Analysis of variance was used to compare mean scores by demographics and donor status and to determine the influence of each variable on the mean number of donations in the past 5 years.
RESULTS: The mean score for each prosocial characteristic appeared high, with lower scores in male and younger donors. Higher altruistic behavior and social responsibility motivation scores were associated with increased past donation frequency, but the effects were minor. Empathetic concern was not associated with prior donation. The largest differences in prior donations were by age and donor status, with older and current donors having given more frequently.
CONCLUSION: Most blood donors appear to have high levels of the primary prosocial characteristics (altruism, empathy, and social responsibility) commonly thought to be the main motivators for donation, but these factors do not appear to be the ones most strongly related to donation frequency. Traditional donor appeals based on these characteristics may need to be supplemented by approaches that address practical concerns like convenience, community safety, or personal benefit.