Offering rewards boosts blood donations despite ban on payments

Show them the money! Or at least a nice gift certificate.

Kate Shaw Yoshida – May 24, 2013 11:20 am | 86

While it’s illegal to pay someone for a kidney or a lobe of their liver, it’s completely legal to offer blood donors a small reward for giving a pint or two of blood. But for some people, accepting a reward in exchange for a blood donation raises both eyebrows and moral questions. To some, it’s the first small step down a slippery slope that ends in black markets and paid organ trade. There’s also the question of where a donor’s motivation should come from. In theory, it’s akin to paying kids for good grades in school; shouldn’t the motivation come from an intrinsic drive to be a better person, not a reward from an outsider?

And when it comes to blood donations, there’s an additional worry. Critics claim that economic incentives could encourage potential donors to lie about their health history or personal habits, threatening the safety and integrity of the blood supply. Due to this public health concern, the World Health Organization has spent four decades advising against economic incentives for blood donors.

But based on the cumulative findings of several recent studies, Nicola Lacetera, Mario Macis, and Robert Slonim argue that these guidelines are fundamentally flawed. When implemented correctly, these researchers say, economic rewards can benefit the blood supply without threatening its safety.

The FDA prohibits actually paying blood donors, so incentives are referred to as “gifts” or “rewards,” rather than “payments” or “compensation.” To avoid the illegality (and general uneasiness) of trading cash for blood, incentives usually come in the form of gift certificates or small tokens such as CDs or T-shirts. There are some situations in which donors can be paid in cash, but blood from these transactions is kept separate and is limited in its use.

Studies have investigated the effectiveness of various incentives around the world and have found that nearly any incentive is effective in increasing blood donations. In general, rewards with higher monetary values tend to have a larger effect. In Switzerland, a 5 franc (just over $5) lottery ticket increased donations by about 5 percentage points, and a $10 gift card increased donations in the US by 7 percentage points. In Italy, researchers found that offering one day of paid leave from work increased donations by a staggering 40 percent over a year. Only one incentive tested in these studies did not increase donations: a free cholesterol test.

Perhaps most importantly, follow-up testing has shown that not a single one of these offers affected the safety of the blood supply. The authors note that one detail is important here: in each of the studies, the reward was offered for simply showing up to donate, not for actually giving blood. Therefore, there was no reason to lie about one’s drug use, medication, or health history during the screening process in order to walk away with a lottery ticket or gift card.

However, these studies all offered rewards either once or very occasionally, so it’s certainly premature (and very possibly misleading) to claim that economic incentives are a universal solution to blood shortages. As of now, most of the available evidence comes from wealthy nations, and very few studies have investigated the effectiveness of incentives in poorer countries.

Furthermore, some studies have found that blood donors who were surprised with a reward were actually less likely to donate blood in the future compared to those who had not received a reward. It’s possible that these people were offended at the thought of—or at least felt uneasy about—trading their blood for something of value. It’s far too early to know if this effect could be a significant long-term problem when it comes to economic incentives.

What is clear from these studies is that carefully chosen incentives may be able to safely boost blood donations in times of emergency, as well as smooth out occasional fluctuations in a country’s blood supply. Of course, other tried-and-true methods to increase donations, such as appeals to empathy, will continue to be essential, but economic rewards for blood donations may also have a useful place in public policy.

Science, 2013. DOI: 10.1126/science.1232280 (About DOIs).