Opinion
To meet demand, blood donation should not rely solely on volunteers
When Sarah Vawai’s two-year-old daughter fell critically ill and needed a blood transfusion, the local blood bank at Koidu Government Hospital in Kono, Sierra Leone was empty.
Vawai’s older daughter, Adama, was a university student in the capital city of Freetown and shared her sister’s plight on Facebook. A nurse collaborating with Lifeline Nehemiah Projects happened to read the Facebook post and coordinated a blood donation for Vawai’s two-year-old.
Vawai’s daughter survived because a local donor was given an incentive—food and transportation—to donate blood. Blood donations save lives, but using incentives for them is controversial; even the Vawai family initially disliked the idea.
The World Health Organization advocates for 100 percent voluntary, non-remunerated blood donation—a position that was more defensible in the 1970s, before widespread screening for bloodborne diseases like hepatitis. Today, two-thirds of the world face shortages of blood and blood products, leading to many preventable deaths, especially among women and children. More than 80 percent of the world’s population has access to only 20 percent of the global blood supply. These global inequities in blood and blood product supplies are unacceptable.
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Africa, in particular, faces a disproportionate demand for blood and blood products. The continent relies heavily on family-based donation, which is not sustainable. Policies about blood supply in Africa, meanwhile, are generally based on research generated outside the continent—and in that research field, the idea of addressing blood shortages in Africa by providing adequate incentives and compensation to blood donors is met with skepticism.
We are conducting research with nonprofit organizations such as Lifeline Nehemiah Projects and with government agencies in West Africa, and shortly we will begin field experiments, to study whether non-cash incentives increase blood donation.
While it is admirable for countries to strive for self-sufficiency in blood donations, the idea may not always be feasible, especially in smaller or resource-poor nations. In times of crisis—due to food insecurity, natural disasters, or health emergencies—many countries need external help to sustain their blood supply. The need for help from abroad will only become more urgent as the frequency and severity of such crises continue to rise.
The misalignment between blood supply and demand is especially acute in low-income countries, where the demand for blood is high due to disease burdens, traumatic injuries, and medical conditions that require transfusions. Blood shortages in these regions are also driven by factors such as a higher prevalence of sickle cell anemia and bloodborne pathogens. And yet problems such as poor nutrition limit people’s ability to donate blood voluntarily.
The United States pays donors for plasma—and exports it to countries that do not pay, and have not realized self-sufficiency in plasma supply, such as Australia, the United Kingdom, and the Netherlands. The U.S. generates billions of dollars from these sales—in a market that low-income countries cannot participate in.
This inequity should not continue. Low-income countries should be able to obtain these supplies when needed, at a fraction of current market prices, as with HIV drugs. African countries should also be allowed to share safe blood resources with each other.
Blood donation should not rely solely on charity but also on empowering individuals and communities to meet their own needs. In Sierra Leone, for instance, humanitarian organizations provide food and transportation to blood banks, to encourage blood donations. These incentives have significantly increased donation rates, though blood banks sometimes struggle with supply shortages, such as blood bags and needles.
Local health authorities worry about the sustainability of a safe blood stock, if or when humanitarian organizations stop providing such incentives. But the truth is that when blood supply is low, a shadow economy of paid blood donations emerges outside of hospitals, sometimes facilitated by hospital staff.
More research is needed to identify the most effective incentives for increasing blood donations in Africa and other resource-limited settings. This research should be driven by local communities and health care workers, ensuring that policies are informed by the needs and realities of these regions. It should be led by people within these settings, so that their voices are heard, understood, and respected.
Image: antoniotruzzi / Adobe Stock
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<p>A misalignment between supply and demand especially hurts people in low-income nations.</p>
<p>Written by Jlateh Vincent Jappah and Ruoying (Carol) Tao</p>
<p>This <a rel="canonical" href="https://harvardpublichealth.org/global-health/to-meet-demand-blood-donation-cant-rely-solely-on-volunteers/">article</a> originally appeared in<a href="https://harvardpublichealth.org/">Harvard Public Health magazine</a>. Subscribe to their <a href="https://harvardpublichealth.org/subscribe/">newsletter</a>.</p>
<p class="has-drop-cap">When Sarah Vawai’s two-year-old daughter fell critically ill and needed a blood transfusion, the local blood bank at Koidu Government Hospital in Kono, Sierra Leone was empty.</p>
<p>Vawai’s older daughter, Adama, was a university student in the capital city of Freetown and shared her sister's plight on Facebook. A nurse collaborating with <a href="https://www.lifelinenehemiahprojects.org/" target="_blank" rel="noreferrer noopener">Lifeline Nehemiah Projects</a> happened to read the Facebook post and coordinated a blood donation for Vawai's two-year-old.</p>
<p>Vawai’s daughter survived because a local donor was given an incentive—food and transportation—to donate blood. Blood donations save lives, but using incentives for them is controversial; even the Vawai family initially disliked the idea. </p>
<p>The World Health Organization advocates for 100 percent voluntary, non-remunerated blood donation—a position that was more defensible in the 1970s, before widespread screening for bloodborne diseases like hepatitis. Today, <a href="https://www.nejm.org/doi/full/10.1056/NEJMp2403596?query=TOC" target="_blank" rel="noreferrer noopener">two-thirds</a> of the world face shortages of blood and blood products, leading to many preventable deaths, especially among women and children. More than 80 percent of <a href="https://unctad.org/data-visualization/now-8-billion-and-counting-where-worlds-population-has-grown-most-and-why#:~:text=As%2520the%2520population%2520has%2520grown,should%2520reach%252086%2525%2520by%25202050" target="_blank" rel="noreferrer noopener">the world’s population</a> has access to only 20 percent of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6510980/" target="_blank" rel="noreferrer noopener">global blood supply</a>. These global inequities in blood and blood product supplies are unacceptable.</p>
<p>Africa, in particular, faces a disproportionate demand for blood and blood products. The continent relies heavily on family-based donation, which is not sustainable. Policies about blood supply in Africa, meanwhile, are generally based on research generated outside the continent—and in that research field, the idea of addressing blood shortages in Africa by providing adequate incentives and compensation to blood donors is met with skepticism.</p>
<p>We are conducting research with nonprofit organizations such as Lifeline Nehemiah Projects and with government agencies in West Africa, and shortly we will begin field experiments, to study whether non-cash incentives increase blood donation. </p>
<p>While it is admirable for countries to strive for self-sufficiency in blood donations, the idea may not always be feasible, especially in smaller or resource-poor nations. In times of crisis—due to food insecurity, <a href="https://www.ifrc.org/sites/default/files/2023-01/20230130_2022_WDR_DataAnnex.pdf" target="_blank" rel="noreferrer noopener">natural disasters, or health emergencies</a>—many countries need external help to sustain their blood supply. The need for help from abroad will only become more urgent as the frequency and severity of such crises continue to rise.</p>
<p>The misalignment between blood supply and demand is especially acute in low-income countries, where the demand for blood is high due to disease burdens, traumatic injuries, and medical conditions that require transfusions. Blood shortages in these regions are also driven by factors such as a higher prevalence of sickle cell anemia and bloodborne pathogens. And yet problems such as poor nutrition limit people’s ability to donate blood voluntarily.<s></s></p>
<p>The United States pays donors for plasma—and exports it to countries that do not pay, and have not realized self-sufficiency in plasma supply, such as Australia, the United Kingdom, and the Netherlands. The U.S. generates <a href="https://www.colorado.edu/today/2024/03/06/plasma-donations-financial-lifesaver-and-ethical-dilemma" target="_blank" rel="noreferrer noopener">billions of dollars</a> from these sales—in a market that low-income countries cannot participate in. </p>
<p>This inequity should not continue. Low-income countries should be able to obtain these supplies when needed, at a fraction of current market prices, as with HIV drugs. African countries should also be allowed to share safe blood resources with each other. </p>
<p>Blood donation should not rely solely on charity but also on empowering individuals and communities to meet their own needs. In Sierra Leone, for instance, humanitarian organizations provide food and transportation to blood banks, to encourage blood donations. These incentives have significantly increased donation rates, though blood banks sometimes struggle with supply shortages, such as blood bags and needles.</p>
<p>Local health authorities worry about the sustainability of a safe blood stock, if or when humanitarian organizations stop providing such incentives. But the truth is that when blood supply is low, a shadow economy of paid blood donations emerges outside of hospitals, sometimes facilitated by hospital staff. </p>
<p class=" t-has-endmark t-has-endmark">More research is needed to identify the most effective incentives for increasing blood donations in Africa and other resource-limited settings. This research should be driven by local communities and health care workers, ensuring that policies are informed by the needs and realities of these regions. It should be led by people within these settings, so that their voices are heard, understood, and respected.</p>
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