Toward a More Stable Blood Supply: Charitable Incentives, Donation Rates, and the Experience of September 11

Abstract

Although excess blood collection has characterized U.S. national disasters, most dramatically in the case of September 11, periodic shortages of blood have recurred for decades. In response, I propose a new model of medical philanthropy, one that specifically uses charitable contributions to health care as blood donation incentives. I explain how the surge in blood donations following 9/11 was both transient and disaster-specific, failing to foster a greater continuing commitment to donate blood. This underscores the importance of considering blood donation incentives. I defend charitable incentives as an alternative to financial incentives, which I contend would further extend neoliberal market values into health care. I explain my model's potential appeal to private foundations or public–private partnerships as a means for expanding both the pool of blood donors and the prosocial benefit of each act of blood donation. Finally I link my analysis to the empirical literature on blood donation incentives.

Keywords:

• cultural studies
• health economics
• health policy
• public health
• social science research

Acknowledgments

The author thanks Professor Stuart J. Youngner for his insightful comments, humor, and engaging conversation.

Notes

1. Given the 42-day shelf life of liquid red blood cells, total product wastage eventually equaled more than 300,000 units (Hess 2005, 80).

2. Although subsequent scholars (e.g., Bayer 1999) have questioned the reliability of the data upon which Titmuss based his estimate, there is little doubt that commercial whole-blood collections were a salient feature of the U.S. blood system before the early 1970s.

The AIDS crisis would of course call these assumptions into question. But one should keep in mind the stringency of current blood safety guidelines in the United States, as well as the sheer number of transfusions–44,000 per day (American Association of Blood Banks 2012).

During future national disasters, we may be able to reduce the blood wastage characterizing 9/11 by improving distribution efficiency and following the recommendations of the American Association of Blood Banks’ Interorganizational Task Force on Domestic Disasters and Acts of Terrorism (Hess 2005, 80).

One could distinguish among three sources of motivation in a blood system that promotes prosocial behavior. Compared with an incentive-free system, a system with charitable incentives could intensify all three sources of motivation. First, given the widely acknowledged public benefit of blood donation, the act of donation might improve donors’ self-esteem, reinforcing donors’ image of themselves as socially useful and socially conscious. Second, donors might donate because of the satisfaction they take in knowing they are improving others’ health and quality of life. Perhaps this best exemplifies “intrinsic prosocial motivation.” Third, donors could be influenced by image motivation—the desire to impress others by showing dedication to the needs of society. In the context of blood donation, image motivation might be most relevant in public settings such as blood drives. While gains to reputation (or even self-esteem) might seem self-interested, the key point is that charitable incentives facilitate donors’ involvement in an incentive system that directs all its resources toward the health of the community.

In Sanner's (1994) survey of 1950 Swedish individuals, respondents were approximately 25% less likely to favorably consider donating a next of kin's organs as opposed to their own.

Some patients have antibodies to common blood antigens, so they require transfusions of blood lacking these antigens. Such rare blood types may occur with a frequency of 1 in 1000 or even 1 in 10,000. Patients with these blood types can now rely on donations tracked by the American Rare Donor program, a joint collaboration of the American Red Cross and the American Association of Blood Banks (Flickinger et al. 2004).