Increasing Blood and Plasma Donations: Behavioral Ethical Scalability

Blood banks around the world often struggle to collect sufficient quantities of blood, plasma and other blood components to meet the needs of the large and growing number of patients who rely on transfusions and blood-derived therapies for their survival. Several blood collection organizations have explored the use of both behavioral nudges and economic incentives, with varying degrees of success. Economic incentives are often perceived as being in conflict with the core mission of blood banks, with donors’ altruistic motivation, and more generally, with moral values. Research, however, shows that properly designed economic incentives do boost donations. In some countries, moreover, paying donors is legal. In the United States, for example, plasma donors receive financial compensation, and the plasma industry is a thriving business that results in 70% of the world supply of plasma-derived therapies. In fact, millions of patients in countries that do not allow payment to plasma donors rely on imports of life-saving, plasma-derived medicinal products from the US. In this chapter, we begin by describing the unique features of the “market” for blood and blood components, emphasizing the mix of moral and material motivations that typically characterizes donors, and the mission-driven nature of blood-collecting organizations. Next, we report findings from empirical research that studied the impact of behavioral nudges and economic incentives provided to blood and plasma donors, with focus on the effects of these interventions on the quantity and quality of collections as well as on donor motivation. By comparing and contrasting donations of whole blood for transfusion (a largely altruistic system chronically affected by shortages) with donations of plasma for the production of medical therapies (a large-scale business that reliably supplies millions of patients around the world), we discuss the tradeoffs that societies face when deciding how to organize the procurement of blood and plasma. Similar to chapter 13 on healthy eating nudges, we also discuss the importance of assessing the public’s opinion as an input into the legislative and regulatory deliberations, particularly concerning the role of and limits to market-based incentives and mechanisms.