Canada and other countries should reassess guidelines that prohibit offering economic incentives such as gift cards to potential blood donors, says a study from the University of Toronto Mississauga (UTM).
“Blood donation guidelines recommended by the World Health Organization (WHO) and many blood collection agencies are largely based on research that assessed only what study participants said they would do – not their observed behaviour when donating blood,” says Nicola Lacetera, assistant professor in UTM’s Department of Management. “These are two very different things.”
Using recent field-based studies with larger, more representative samples of the behaviour of blood donors in the United States, Argentina, Switzerland and Italy, Lacetera and his co-authors, Mario Macis (Johns Hopkins University) and Robert Slonim (University of Sydney) found evidence that is in striking contrast to the earlier findings upon which the guidelines are based.
The team examined studies that used a variety of incentive items from T-shirts to coupons. For example, a paid vacation day from work for blood donors in Italy led to a 40 per cent rise in annual blood donations. Only one incentive – a free cholesterol test – had no positive effect on donation rates.
There are two primary reasons why organizations such as the WHO recommend using unpaid volunteers to donate blood, Lacetera says. First, donating blood is viewed as an altruistic act, and rewards are believed to reduce donors’ motivation. Rewards could also attract less-than-ideal donors and thus impact the safety of the blood supply.
“But this new evidence – based on actual behaviour – clearly shows that economic rewards work to increase blood donations, in some cases quite substantially, without negative consequences on the safety of the blood or the type of donors attracted,” says Lacetera.
The team was also able to refute another concern, that people would respond to short-term incentives but be less motivated to donate when incentives were removed. None of the studies examined by the researchers showed negative long-term effects on donation rates after the incentive period was over.
Lacetera says that short-term incentives may help to smooth over changes in blood supply levels in periods when blood donations are historically low. One of the reviewed studies showed that some people who were planning to donate may give a bit earlier because of an incentive offer.
“To the extent that one-time incentives are able to modify people’s donation schedules, it can have some practical applications in terms of timing,” he says.
The researchers warn that the evidence should not be interpreted as promoting a straight cash-for-blood policy. The studies they analyzed offered unconditional incentives, where the potential donor received a non-cash reward for arriving at the blood donation centre or drive. Since the reward was not dependant on donating blood, the risk of misrepresentation of health or other information by an ineligible donor who wishes to receive the reward was reduced.
“Since blood is typically in short supply, the basic issue is what can be done to improve donation rates while guaranteeing safety?” says Lacetera. “Current guidelines that prohibit any form of reward will benefit from considering the more recent evidence and possibly reassessing their approach.”
The research is published in the May 24 issue of Science.
Department of Management
University of Toronto Mississauga
U of T Mississauga Communications