prizes, payments, and donating blood

This old post, on the moral status of donating blood, still attracts a trickle of Google searches to this blog. I wonder who the searchers are – perhaps people trying to get motivated to donate, people trying to rationalize not donating, or biomedical ethics paper writers?

Anyway, I hadn’t donated blood in over six months so I finally went. And there’s something that really bothers me about the United Blood Services center that I visit: they really overemphasize all of these stupid rewards programs for frequent donors. It’s tacky as hell, and somehow a little insulting. No, I don’t want to fill out a slip that will enter me in a sweepstakes to win a car. No, I don’t want to log in online and trade my points for prizes. Just to top off the juvenile atmosphere, they have a popcorn machine in the center, and so the whole place smells like a carnival. (I used to give blood at a Red Cross center, and don’t remember it being like this, but I see that even they have introduced an elaborate racing-themed incentive system).

Obviously, the point of these programs is to offers donors some material benefits (or the chance of winning them), above and beyond any intrinsic satisfaction a person might receive from giving blood. I’d be surprised if the programs worked very well, but who knows? People are funny. Just as I was contemptuously eyeing the popcorn machine, a middle aged lady ran in and excitedly started scooping some out for a pre-donation snack.

And donors have to settle for the stupid incentives or nothing, because most blood donations in the U.S. cannot be compensated in cash, by law (I think only some plasma donations are paid). But actually, I’d rather receive nothing but a post-donation snack rather than be subjected to the incentives. They just make me feel like I’m back in elementary school, being baited with junky plastic toys to sell more overpriced wallpaper to my neighbors in some dumb fundraiser.

So, my blood donation preference ordering:

  1. Paid donation: This is number 1 not so much because I want or need the money, but because there is a strong moral case to be made in favor of paid blood donation. Unlike most organ donations, blood donations do not cost the donor much in terms of time, sacrifice and health/safety. As such, it is not possible for donors to be badly exploited. And there is good reason to think that blood would be available in greater supply if donors were paid, even minimally. This is of moral significance, because blood saves lives. And a payment, even a small one, signals respect for donors.
  2. Totally uncompensated donation: Hey, at least you get to feel purely altruistic. Sometimes you get a “I gave blood” sticker, so that other people will see how virtuous you are.
  3. Incentive systems: Arguably and at least in my opinion, these do not show respect for donors. They probably don’t encourage anyone new to donate, and they are somewhat insulting to those who would have given to begin with. Give us something actually of value to everyone ($, however little) or just don’t even go there.


  • Very thoughtful post. I agree with you that cash is the best way to go. Even though giving blood is trivially easy, I’ve never thought to do it myself. I see no harm in paying people to bring supply up to the necessary demand.

    One caveat: Some truly desperate people may donate blood at various places using different names, to the point of risking illness, just because they’re so hard up for cash. But there’s addictive behavior in all realms of life, and we can’t expect to prevent all of it.

    Also, I think I can one-up you in terms of weird searches that people do to get to your blog. Sadly, a lot of people end up here. I meant it as a thought experiment, but it seems that many are contemplating suicide.

  • Hi Greg, thanks for commenting.

    This is definitely correct: “One caveat: Some truly desperate people may donate blood at various places using different names, to the point of risking illness, just because they’re so hard up for cash.”

    However, this would probably not become a widespread problem as long as blood donation centers still checked vital signs before allowing you to donate. Presumably, if you are actually giving enough blood to harm yourself, you’ll go anemic or something.

    Actually, the blood donation centers could have *more* of an incentive to make sure you were healthy, because if they pay you for your blood but then experience difficulties in collecting it or can’t use it because it’s not of sufficient quality, then they lose money. But I suppose this depends substantially on the medical facts surrounding blood donation, which I don’t know particularly well.

  • The main problem with paid donation is that blood from paid donors has been found to be much more likely to contain transmissible diseases, maybe because if they’re just doing it for the money people might donate even when they know their blood is unsafe and should not be transfused into another person. Checking the vital signs of the donors is not enough to catch everyone who has a transmissible disease. The blood itself is tested with high-sensitivity tests but false negatives do occasionally happen and it’s not tested for every disease that could possibly be transmitted since that would be too expensive. Not allowing paid donation makes it less likely that diseased blood will be transfused into someone and possibly kill them, and reduces the amount of blood that has to be thrown out when diseases are detected in it.

    I agree that incentive systems are the worst, though. If anyone actually donates because of them I don’t see why they’d be any better than offering a small payment.

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