Motivations to donate blood and plasma: A scoping review of quantitative studies

Abstract

Introduction

Effective recruitment and retention of donors are essential for the supply of blood components and blood‐derived medicines. In many high‐income Western countries, there is an imbalance between demand and production of blood‐derived medicines. Motivational factors behind donations range from altruism and health concerns to incentives or responding to a need from friends or family. Motivations might differ according to beliefs and social norms. The aim of this review was to identify the motivations that influence blood and plasma donation behavior in high‐income Western countries.

Materials and Methods

We conducted a scoping review following the PRISMA‐ScR guidelines. A comprehensive search was performed in MEDLINE, EMBASE and CINAHL for studies published from 2013 onwards that examined motivations for blood or plasma donation in high‐income Western countries. Reported motivations were coded and grouped into predefined categories and subcategories.

Results

Thirty‐eight studies including 147,010 participants met the inclusion criteria. Most studies assessed motivations for blood donation, while few focused on plasma donation. Across studies, prosocial motivations were the most frequently reported drivers of donation. Among blood donors, altruistic reasons such as helping others and social responsibility predominated. Non‐donors more often cited collectivist motives, such as donating when a friend or relative needed blood. For plasma donation, prosocial motivations remained important, although incentives were cited more often than for blood donation.

Discussion

Prosocial motivations, particularly altruism and personal values, are the main drivers of blood and plasma donation in high‐income Western countries. However, motivations vary across donor groups and between blood and plasma donation.

Abbreviations

IQR

interquartile range

MeSH

medical subject headings

PRISMA‐ScR

preferred reporting items for systematic reviews and meta‐analyses extension for scoping reviews

PROSPERO

International Prospective Register of Systematic Reviews

UK

United Kingdom

USA

United States of America

1. INTRODUCTION

Recruitment and retention of donors are essential for the supply of blood components and medications critical for severe and rare diseases. In many high‐income Western countries, there is an imbalance between demand for and production of blood‐derived medicines. Healthcare systems in countries where plasma donation is not remunerated rely on an insufficient number of donations to meet the demand for self‐sufficiency in plasma components. ¹ , ² , ³ , ⁴ , ⁵ , ⁶ , ⁷ Countries purchase blood‐derived medicines from the international market and plasma from countries where people are paid to donate, raising issues regarding safety. ⁸ , ⁹ , ¹⁰ , ¹¹ , ¹² Plasma collected through remunerated apheresis is used to manufacture plasma‐derived medicines. Plasma collected through non‐remunerated apheresis is used for transfusions and to manufacture medicines. Significant challenges are observed in donor availability and blood supply to meet demand for red blood cells (such as blood type O) and platelets. There have also been shortages of plasma‐derived medicines, such as intravenous immunoglobulin. ¹³ , ¹⁴

The World Health Organization encourages self‐sufficiency through voluntary, non‐remunerated donations to prevent blood shortages and meet transfusion needs. The World Health Assembly urged member states to take measures to establish, implement and support coordinated, efficiently managed and sustainable national blood and plasma programs with the aim of achieving self‐sufficiency. ¹⁵ , ¹⁶ Donations from voluntary non‐remunerated donors had a lower incidence of transfusion‐transmissible infection seroreactivity, and the repeat donors are the safest. ¹⁷ , ¹⁸ , ¹⁹

The motivations behind donations can be strongly influenced by individual and contextual factors. A previous systematic review aiming to identify the strongest antecedents of blood donation behavior and intentions ²⁰ showed that the cognitions most strongly associated with blood donation were the intention to donate, the perceived behavioral control, and attitude towards donation. Moderate effects were observed for self‐efficacy and the donor role identity. The effect of subjective norms or social pressure, site experiences, satisfaction, and service quality were small. ²⁰

Multiple studies have been carried out to gain further knowledge on the motivational factors for donation. The motivational factors identified range from altruism and health concerns to incentives or responding to a need from friends or family. ²¹ , ²² A previous scoping review found that the main motivators for blood donation were altruism, donating blood for family, and incentives. ²³ Another recent review identified altruism as the main motivator, belonging to a family with blood donors, or suffering a traumatic event. ²⁴ Although plasma donation shares many of these motivational factors, the level of engagement in plasma donation seems to be lower. ²⁵ A review on the factors of plasma donation identified the amount of time and fear of the apheresis machine as reasons for not donating. ²⁶ The authors suggest that it is important to further explore factors to attract plasma donors, focusing on broader social‐level influences. ²⁶ The motivational factors behind blood and plasma donations might differ substantially according to different beliefs and social norms and vary over time and age. ²³ , ²⁷ , ²⁸ , ²⁹ , ³⁰ , ³¹ Because there are both paid and unpaid plasma donors, their motivations and willingness may differ. ¹³

No up‐to‐date synthesis of evidence exists on the motivations for blood and plasma donations in high‐income Western countries. In European countries, less blood is consumed annually, but fewer donations are obtained. The amount of plasma‐derived medicines obtained from national plasma donations is increasing annually, but also their consumption, resulting in decreasing self‐sufficiency and greater dependence on foreign countries. ³² , ³³ , ³⁴ , ³⁵

Understanding the factors that influence blood and plasma donation behavior is important to develop strategies for donor motivation and retention, enabling the design of better recruitment and loyalty strategies and improving blood supply. The purpose of this literature review on donor motivation for blood and plasma donation is to highlight the available evidence and identify the motivations that influence blood and plasma donation behavior in high‐income Western countries.

2. METHODS

We conducted a scoping review following the PRISMA‐ScR statement (Preferred Reporting Items for Scoping Reviews) ³⁶ , ³⁷ adhering to methodological criteria such as protocol design, search methodology, selection criteria and synthesis of findings. The search protocol was registered in the PROSPERO database under code no CRD42024527645.

2.1. Bibliographic search

A comprehensive bibliographic search was performed in the leading biomedical databases (MEDLINE, EMBASE, and CINAHL) on March 15, 2023. Search strategies were developed using key words and MeSH terms: “motives, motivation, incentive*, recruitment, voluntary, encourage, intention, blood, plasma, donate, donation*, and donor*”, combined using Boolean operators. We selected studies published since 2013 because this year was published a previous review. ²⁰ We also searched Google Scholar and Research Gate, and screened references cited by included studies to avoid missing literature. The search was updated monthly until October 31, 2025. The search designed is presented in Table S1.

2.2. Eligibility criteria

We included quantitative cross‐sectional studies conducted in high income Western countries ³⁸ , ³⁹ that reported on blood or plasma donor motivations, irrespective of the donor status (i.e., first‐time donors, regular donors, non‐donors or lapsing donors) or the way they conveyed their motivations (Table 1).

TABLE 1.

Study eligibility criteria.

Inclusion criteria	Exclusion criteria
Quantitative cross‐sectional studies conducted in high‐income Western countries	Motivational interviews or interventions aimed to encourage blood or plasma donation, opinion articles, letters to the editor, editorials and conference abstracts.
Assessed donor motivations for donating blood or plasma
Across adolescent and adult population
All genders
Published in peer‐review journals
Written in English, Spanish, French, Italian and Portuguese

2.3. Data selection and extraction process

Data selection and extraction were performed by two independent researchers. After removing duplicated studies, titles and abstracts were screened to identify eligible studies. Potentially relevant studies underwent a thorough full‐text review to ensure they met eligibility criteria. Any discrepancies were resolved through consultation with a third researcher.

The researchers extracted the relevant information using a predesigned Excel data‐extraction form. This form was piloted on a selection of studies before being applied to the remaining ones. It included key study details such as author, year of publication, country, study year, setting, sample size, and study design. Additionally, it captured survey administration mode, population characteristics, and outcome measures, specifying how they were assessed.

2.4. Quality assessment

We adapted the Newcastle–Ottawa scale to assess the quality of cross‐sectional studies on motivation to donate. The risk of bias was assessed by two independent investigators using this scale (Table S2) that contains three domains relating to the following criteria: selection, comparability, and outcome. Discrepancies were resolved by consensus and, when they remained, a third researcher was consulted.

2.5. Analysis and synthesis of data

Two researchers independently analyzed the responses regarding reasons for donation. Responses to fixed questions or free‐text responses were coded and classified into predefined categories and subcategories. The categories and subcategories used for coding (Table S3) are obtained by grouping all the motivations identified in a comprehensive review of the literature on the behavior of blood and plasma donors according to their reasons for donating ²⁰ , ⁴⁰ , ⁴¹ , ⁴² , ⁴³ , ⁴⁴ , ⁴⁵ and cross‐validated by the two coders.

In some studies, the questionnaires included only single‐choice responses, while in others, multiple‐choice responses were allowed, meaning the total number of responses could exceed the number of participants. To ensure comparability across studies, we calculated the proportion of responses in each motivational category (or subcategory) by dividing the number of responses assigned to that category by the total number of responses provided.

For studies that used different Likert scales (e.g., 1–5 vs. 0–4), we standardized the results by grouping them into five word‐based categories: “very important,” “important,” “neutral,” “not very relevant” and “irrelevant” (Table S4). We then calculated the number of responses that fell into each of these standardized categories, allowing for meaningful comparisons across studies.

For subgroup analysis, we grouped donors in accordance with the “Donor management in Europe” project definitions ⁴⁶ : first‐time donors, regular donors, and lapsing donors. Donor definitions can be found in Table S5.

3. RESULTS

3.1. Search results

The literature search yielded 2231 results, 86 were selected for full‐text reading and 38 fulfilled the pre‐established criteria and were included. The flow diagram is shown in Figure 1.

FIGURE 1.

Flow chart of included studies.

3.2. Study characteristics

Out of the 38 studies that complied with the eligibility criteria, 33 assessed motivations for blood donation, three for blood and plasma donation, and two for plasma donation. Of these, 32 studies provided separate results on motivations for donating blood, four studies for donating plasma, and two studies for donating blood or plasma (without separate results) (Table S6). Most studies were conducted in European countries (n = 25) and the USA (n = 6).

Table 2 provides the type of population surveyed in each of the studies (blood donors, plasma donors, non‐donors or general population) and the reporting and analysis methodology. The number of participants included in the studies ranged from 50 to 61,123 individuals (IQR: Q1 = 243; Q3 = 2428). Overall, studies included 147,010 participants.

TABLE 2.

Main characteristics of the included studies.

No.	Author, year	Country	Study year	Setting	Sample size	Age (range)	Age (mean)	Women	Ethnicity	Motivation to donate	Type of population	Type of donor	Survey design	Outcome measure
1	Ferguson et al., 2020 40	UK	2013	UK Donor Survey	61,123	17–55+	45+	65%	White 90%	Blood	Blood donor	Regular donors	Self‐administered online	MC
2	Paulson and Travers, 2015 63	USA	2011	Mobile Blood Bank units	39	18–36	NS	NS	NS	Blood	Blood donor	Regular donors	Self‐administered paper and pencil	MC
3	Kalargirou et al., 2014 53	Greece	2009–2010	Big city	800	18–65+	18–30	62%	NS	Blood	General population	General population	Face to face	MC
4	Sheldon et al., 2022 64 , 65	USA	2019	University and community	223	17–68	20	85%	NS	Blood	Blood donor	Regular donors	Self‐administered paper and pencil	LK
5	James et al., 2013 54	USA	2009	Big city	218	<20–60+	40–60	70%	African American and white 50%	Blood	General population	General population	Self‐administered	MC
6	Huis In ‘t Veld et al., 2018 55	European Union	2014	European countries	27,868	15–70	47	52%	NS	Blood	Blood donor, non‐donor	General population	Face to face	MC
7	O'Brien et al., 2012 56	Canada	2010	Blood Services	218	17–50+	17–29	53%	European 80%	Blood	Blood donor	First‐time or regular donors	Telephone	MC
8	Alfieri et al., 2016 66	Italy	2008–2014	Hospital and big city	774	18–60	36	46%	NS	Blood	Blood donor	NS	Self‐administered paper and pencil	LK
9	Rael et al., 2021 67	USA	2015–2019	YouTube videos	136	NS	NS	NS	NS	Blood	General population	General population	Video content	SC
10	Bani et al., 2014 68	Italy	2008–2009	Big city	121	NS	41	38%	NS	Blood	Blood donor	Lapsing donors	Self‐administered	SC
11	Bart et al., 2014 69	Switzerland	2012–2013	Sample of Swiss Population	3091	NS	40	48%	NS	Blood	General population, blood donor, non‐donor	General population	Self‐administered online	MC, LK
12	Charbonneau et al., 2017 57	Canada	2014–2015	Big cities	50	18–56+	18–39	50%	NS	Plasma	Plasma donor	Regular donors	Face to face	MC
13	Sereti et al., 2021 58	Greece	2020	Big city hospital blood center	261	>18	30–50	12%	NS	Blood	Blood donor	NS	Self‐administered paper and pencil	MC, LK
14	Martín‐Santana et al., 2013 70	Spain	NS	Town (Canary Islands)	1015	18–65	18–32	49%	NS	Blood	Blood donor, non‐donor	General population	Face to face	LK
15	Nonnis et al., 2020 71	Italy	2018–2019	Blood agency	1215	NS	48	35%	NS	Blood	Blood donor	NS	Self‐administered	LK
16	Charbonneau et al., 2015 72	Canada	2014	Big cities	1268	15–55	40–56	55%	NS	Blood, Plasma	Blood donor, Plasma donor	Regular blood and plasma donors (37%)	Self‐administered	MC
17	Veldhuizen and van Dongen, 2013 59	Netherlands	2008–2009	Blood agency	2465	NS	35	63%	NS	Blood, Plasma	Blood donor, Plasma donor	First‐time blood donors and plasma donors (9%)	Self‐administered paper and pencil	LK
18	Suemnig et al., 2017 60	Germany	NS	Small university town	2443	18–65	25	55%	NS	Blood	Blood donor	Regular donors	Self‐administered	MC
19	Gomes et al., 2019 61	Portugal	2017	University	362	NS	<23	84%	NS	Blood	Non‐donor, blood donor	General population	Self‐administered	MC
20	Vahidnia et al., 2016 62	USA	2010–2013	Blood Agencies	2589	18–55+	43	49%	White 63%, Black 15%, Hispanic 1%	Blood	Blood donor	First‐time and regular donors	Telephone‐administered	MC
21	Fogarty et al., 2023 47	Ireland	2021	community of patients hospital	311	>18	25	67%	African 59%, Caucasian 25%	Blood	Non‐donor	NS	Self‐administered online	MC
22	Padilla‐Garrido et al., 2021 48	Spain	2019–2020	University	120	18–55	23	60%	NS	Blood	Blood donor	NS	Self‐administered paper and pencil	SC
23	Guiddi et al., 2015 73	Italy	2009–2012	Blood Agencies	237	18–73	36	35%	NS	Blood	Blood donor	First‐time and regular donors	Self‐administered	LK
24	Sousos et al., 2018 49	Greece	NS	Hospital	291	20–61+	40–50	80%	NS	Blood	General population	General population	Self‐administered paper and pencil	SC
25	Gilchrist et al., 2019 74	Canada	NS	University	347	18–65	26	76%	NS	Blood	General population	General population	Self‐administered online	LK
26	Guglielmetti Mugion et al., 2021 50	Italy	2018	Blood agencies	260	18–65+	25–34	55%	NS	Blood	Blood donor, non‐donor	General population	Self‐administered online	SC
27	Martín‐Santana et al., 2020 41	Spain	2018	Blood agencies and universities	2383	18–40+	18–25	74%	NS	Blood	Non‐donor	NS	Self‐administered online	MC, LK
28	Alfieri et al., 2017 7	Italy	NS	Schools	285	15–19	17	63%	NS	Blood	Non‐donor	NS	Self‐administered	LK
29	Romero‐Domínguez et al., 2021 75	Spain	2018	Blood agencies	5353	18–55+	36–45	51%	NS	Blood	Blood donor	Regular donors	Self‐administered online	MC, LK
30	France et al., 2022	USA	2021	College sample and volunteer registry	813	>18–70	20 and 51	77%	White 88%, Black 5%, Asian 2%	Blood and Plasma	General population	General population	Self‐administered online	LK
31	Öhrner et al., 2019 51	Sweden	2017	Blood agency of big city	511	18–35	26–30	0%	White 90%, Black 5%, Latino 3%, Asian 2%	Blood	Blood donor	Lapsing donors	Self‐administered online	MC
32	Hyde et al., 2013 77	Australia	NS	University	211	17–57	22	82%	Caucasian 88%	Blood	Blood donor	First‐time donors	Self‐administered online	LK
33	Alfieri et al., 2017 78	Italy	2015	Blood agencies	2674	18–65	40	33%	NS	Blood	Blood donor	NS	Self‐administered	LK
34	Saltzman and Boenigk, 2022 52	Germany	2021–2022	Blood agency	1263	20–73	41–60	52%	NS	Blood	Blood donor	Lapsing donors	Self‐administered online	MC
35	Bagot et al., 2015 79	Australia	2012	Blood agency	693	NS	40	45%	NS	Plasma	Blood donor	First‐time and regular donors	Face to face or telephone	LK
36	Greffin et al., 2021 81	Germany	2020	Sample of German Population	2531	14–93	49	51%	NS	Blood	Blood donor, non‐donor	General population	Face to face	MC
37	Athanasaki et al., 2025 91	Greece	2023	University	320	NS	22	57%	NS	Blood	General population	General population	Self‐administered paper and pencil	SC
38	Schröder et al., 2025 80	Netherlands	2007–2013	Blood agency	22,128	NS	47	53%	NS	Blood and plasma	Blood and plasma donors	Regular donors	Self‐administered	LK

Note: General population includes donors and non‐donors.

Abbreviations: B, blood; LK, Likert; MC, multiple choice; NS, not specified; P, plasma; SC, single choice.

In 18 studies, participants' motivations were reported verbatim, ⁴⁰ , ⁴⁷ , ⁴⁸ , ⁴⁹ , ⁵⁰ , ⁵¹ , ⁵² , ⁵³ , ⁵⁴ , ⁵⁵ , ⁵⁶ , ⁵⁷ , ⁵⁸ , ⁵⁹ , ⁶⁰ , ⁶¹ , ⁶² in 18 other studies they were categorized, ⁷ , ⁶³ , ⁶⁴ , ⁶⁵ , ⁶⁶ , ⁶⁷ , ⁶⁸ , ⁶⁹ , ⁷⁰ , ⁷¹ , ⁷² , ⁷³ , ⁷⁴ , ⁷⁵ , ⁷⁶ , ⁷⁷ , ⁷⁸ , ⁷⁹ , ⁸⁰ and two studies provided the results in both ways. ⁴¹ , ⁸¹

3.3. Study quality

Table S7 shows the risk of bias of the 38 studies assessed by the modified Newcastle‐Ottawa cross‐sectional scale. Most studies had a low or intermediate risk of bias.

3.4. Categorization of motivations

We identified eight main categories and 12 subcategories of motivations for donating (Table 3). Table S3 provides a detailed break‐down of the reasons categorized into each of the predefined motivational categories and subcategories.

TABLE 3.

Self‐reported motives alleged for blood and plasma donation by study participants grouped in categories and subcategories, expressed as percentage of responses (where n is the number of times the reasons pertaining to each motivational category or subcategory were selected) and in Likert scales word‐based category (very important, important, neutral, not very relevant, and irrelevant).

Motivation (subcategory)	Blood donation							Plasma donation			Plasma and blood donation
Type of donors	Blood donors				Non‐donors	General population	Blood donation Overall	Blood donors	Plasma donors	Plasma donation overall	Plasma and blood
Subtype of donors	First	Regular	Lapsing	Blood donors overall
Prosocial (%, n)	—	64% (84,690)	16% (584)	69% (131,411)	58% (31,297)	79% (11,233)	68% (173,941)	—	60% (1138)	60% (1138)	—
Prosocial (Likert)	Important (2/6), neutral (2/6), not very relevant (2/6)	Important (2/3), not very relevant (1/3)	—	Important (13/24), neutral (7/24), not very relevant (4/24)	Important (4/8), neutral (4/8)	Important (2/7), neutral (4/7), not very relevant (1/7)	Important (19/40), neutral (16/40), not very relevant (5/40)	Neutral (2/2)	Very important (1/3), important (1/3), not very relevant (1/3)	Very important (1/5), important (2/5), neutral (1/5), not very relevant (1/5)	Important (3/5), very important (1/5), neutral (1/5)
Altruism (%, n)	—	34% (44,579)	3% (100)	33% (63,467)	6% (3179)	35% (4940)	28% (71,586)	—	29% (552)	29% (552)	—
Values (%, n)	—	30% (39,923)	13% (458)	30% (56,090)	25% (13,512)	36% (5076)	29% (74,678)	—	29% (555)	29% (555)	—
Collectivism (%, n)	—	0% (188)	1% (26)	6% (11,854)	27% (14,606)	9% (1217)	11% (27,677)	—	2% (31)	2% (31)	—
Intrinsic (%, n)	—	12% (15,434)	12% (452)	9% (16,981)	10% (5461)	0%	9% (22,442)	—	2% (38)	2% (38)	—
Intrinsic (Likert)	Important (2/5), neutral (1/5), not very relevant (2/5)	Not very relevant (1/1)	—	Very important (1/15), important (5/15), neutral (4/15), not very relevant (5/15)	Neutral (2/4), not very relevant (2/4)	Neutral (5/5)	Very important (1/24), important (5/24), neutral (11/24), not very relevant (7/24)	Important (3/4), neutral (1/4)	Not very relevant (1/1)	Important (3/5), neutral (1/5), not very relevant (1/5)	Important (5/7), very important (2/7)
Warm glow (%, n)	—	12% (15,434)	4% (144)	8% (15,975)	7% (3974)	—	8% (19,949)	—	2% (30)	2% (30)	—
Self‐efficacy (%, n)	—	0% (0)	8% (308)	1% (1006)	3% (1487)	—	1% (2493)	—	0% (8)	0% (8)	—
Incentives (%, n)	—	10% (13,008)	8% (286)	9% (16,621)	16% (8387)	6% (851)	10% (25,499)	—	24% (465)	24% (465)	—
Incentives (Likert)	Important (1/2), neutral (1/2)	Important (1/3), neutral (1/3), not very relevant (1/3)	—	Very important (1/14), important (3/14), neutral (6/14), not very relevant (4/14)	Neutral (6/7), not very relevant (1/7)	Neutral (1/2), not very relevant (1/2)	Very important (1/23), important (3/23), neutral (13/23), not very relevant (6/23)	—	Important (1/2), not very relevant (1/2)	Important (1/2), not very relevant (1/2)	—
Health benefits (%, n)	—	8% (10,452)	0% (0)	6% (11,337)	10% (5148)	2% (240)	6% (16,725)	—	0% (7)	0% (7)	—
Material incentives (%, n)	—	1% (1183)	4% (155)	1% (2154)	3% (1401)	4% (594)	2% (4149)	—	7%(137)	7% (137)	—
Recognition (%, n)	—	1% (1373)	4% (131)	1% (1507)	1% (379)	0%17	1% (1903)	—	0% (0)	0% (0)	—
Indirect reciprocity (%, n)	—	0% (0)	0% (0)	1% (1623)	3% (1401)	0% (0)	1% (2664)	—	17% (321)	17% (321)	—
Knowledge (%, n)	—	0% (0)	0% (0)	0% (0)	0% (58)	0% (0)	0% (58)	—	0% (0)	0% (0)	—
Ego‐protection (Likert)	—	—	—	Neutral (2/5), not very relevant (3/5)	—	—	Neutral (2/5), not very relevant (3/5)	—	—	—
Social norms (%, n)	—	5% (6189)	10% (349)	4% (8183)	4% (1899)	2% (308)	4% (10,390)	—	4% (77)	4% (77)	—
Social norms (Likert)	Neutral (1/1)	Not very relevant (1/1)	—	Neutral (5/7), not very relevant (2/7)	Neutral (3/5), not very relevant (1/5), irrelevant (1/5)	Neutral (3/3)	Neutral (9/15), not very relevant (5/15), irrelevant (1/15)	Neutral (1/1)	—	Neutral (1/1)	Neutral (1/2), not very relevant (1/2)
Marketing (%, n)	—	6% (7333)	13% (466)	5% (9514)	9% (4965)	5% (707)	6% (15,186)	—	8% (150)	8% (150)	—
Marketing (Likert)	—	Important (1/1)	—	Important (3/7), neutral (4/7)	Important (2/5), neutral (1/5), not very relevant (2/5)	Neutral (1/1)	Important (5/13), neutral (6/13), not very relevant (2/13)	—	—	—	—
Convenience (%, n)	—	1% (889)	28% (1028)	1% (2187)	4% (1893)	4% (613)	2% (4694)	—	2% (40)	2% (40)	—
Convenience (Likert)	—	—	—	Important (1/4), neutral (2/4), not very relevant (1/4)	Neutral (2/3), not very relevant (1/3)	Important (1/1)	Important (2/8), neutral (4/8), not very relevant (2/8)	—	—	—	—
Facilitating factors (%, n)	—	0% (0)	19% (680)	1% (950)	4% (1893)	4% (605)	1% (3449)	—	2% (40)	2% (40)	—
Positive experiences (%, n)	—	1% (889)	9% (348)	1% (1237)	0% (0)	0% (8)	0% (1245)	—	0% (0)	0% (0)	—
Other (%, n)	—	3% (4441)	13% (459)	3% (4941)	0% (7)	3% (496)	2% (5444)	—	0% (0)	0% (0)	—
Other (Likert)	—	—	—	Neutral (1/1)	Important (1/1)	Important (1/1)	Important (2/3), neutral (1/3)	—	—	—	—
Overall (percentage results)	—	131,984	3624	189,838	53,909	14,208	257,596	—	1908	1908	—

A total of 350 reasons to donate were identified. The prosocial motivation category accounted for the highest number of reasons cited across studies (n = 100 reasons). Within this category, 49 reasons were related to values, 31 to altruism, and 20 to collectivism. The second most common category was incentives, with 71 different reasons reported. Within this category, the most frequently cited reasons referred to health benefits ³⁴ and material incentives. ¹⁸ Other frequently cited categories included: intrinsic motivation, ⁵⁷ social norms, ⁵¹ marketing communication, ³⁰ convenience ²³ and ego‐protection. ⁷

3.5. Motivations for blood donation

Overall, the reasons given for donating blood fell most commonly in the prosocial motivation category (68%). This percentage was obtained by dividing the number of times prosocial reasons were chosen (173,941) by the total number of reasons given for blood donation (257,596).

3.5.1. Blood donors

In the 16 studies that examined blood donors' motivations for donation, ⁴⁰ , ⁴⁸ , ⁵⁰ , ⁵¹ , ⁵² , ⁵⁵ , ⁵⁶ , ⁵⁸ , ⁶⁰ , ⁶¹ , ⁶² , ⁶³ , ⁶⁸ , ⁶⁹ , ⁷² , ⁷⁵ most of the participants cited prosocial reasons. Among them, approximately half referred to altruistic motives such as “to help someone in need”, and almost half mentioned values such as “feeling of personal responsibility of giving blood”, while a few cited collectivism, for example, a “friend or relative needs blood” (Table 3). Additionally, a few blood donors reported intrinsic reasons, “warm glow” being the most frequently quoted subcategory. A few other donors cited incentives, mainly related to health benefits, such as undergoing a health check. Less common motivations included marketing communications, social norms, and convenience. Table 3 shows the motivational reasons reported.

In the 11 studies that used Likert scales to assess the importance of motivational reasons, ⁵⁸ , ⁵⁹ , ⁶⁴ , ⁶⁵ , ⁶⁶ , ⁶⁹ , ⁷⁰ , ⁷¹ , ⁷³ , ⁷⁵ , ⁷⁷ , ⁷⁸ prosocial motivation ranked the highest (Table 3).

3.5.2. Blood donor's subgroup analysis

First time blood donors

The only two studies examining first‐time blood donors assessed the importance of motivational reasons using Likert scale scores. ⁵⁹ , ⁷⁷ Participants identified prosocial, intrinsic, and incentive‐based motivations as the most important (Table 3).

Regular blood donors

In the four studies examining regular blood donors' motivations, ⁴⁰ , ⁶⁰ , ⁶³ , ⁷⁵ most of the participants identified prosocial factors as their main reason for donating. Among these, a little over half mentioned altruism and almost half emphasized personal values (Table 3).

In the two studies evaluating the importance of motivational reasons using Likert scales, ⁶⁴ , ⁶⁵ , ⁷⁵ participants rated two out of the three prosocial reasons enquired about in the surveys as important. The sole reason assessed within the marketing category was also classified as important. Reasons related to social norms and intrinsic motivation were considered not very relevant (Table 3).

Lapsing blood donors

In the three studies that evaluated lapsing blood donors' motivations, ⁵¹ , ⁵² , ⁶⁸ almost a third of respondents cited convenience reasons. Within this category, two thirds alleged facilitating factors and one third positive past experiences. Results for other motivational categories are shown in Table 3.

3.5.3. Non donors

Among non‐donors surveyed in four studies, ⁴⁷ , ⁵⁰ , ⁵⁵ , ⁶¹ the most frequently reported motivations for blood donation fell into the prosocial category. Unlike blood donors, non‐blood donors primarily cited collectivism (just under half), with reasons such as “friend or relative needs blood”. The second most frequently cited reasons refer to values (nearly half) such as “personal responsibility to donate”, “social obligation”, or “moral duty”. Intrinsic motivations were mentioned by only a few of the included non‐blood participants, with almost three quarters of these linked to the warm glow effect and a little over a quarter to self‐efficacy. Additionally, some cited incentives, predominantly health benefits, and a few mentioned marketing influences such as an “urgent call of blood donation”. Other motivations like social norms and convenience accounted for the smallest share of the motives.

In the four Likert scale studies assessing non‐donors, ⁷ , ⁴¹ , ⁶⁹ , ⁷⁰ the prosocial category had the highest proportion of reasons rated as important. Within this category, altruism and collectivism were the most highly scored motivations (Table 3).

3.5.4. General population

Prosocial motivation was the most frequently cited reason for blood donation among the general population, ⁴⁹ , ⁵³ , ⁵⁴ , ⁶⁷ , ⁶⁹ , ⁸¹ accounting for the vast majority of the responses. Within this category, altruism and values were the dominant subcategories with almost half of the choices each. Incentives, marketing, and convenience were each mentioned by only a few of the respondents. Among those citing incentives, the most common reasons were material rewards, a little over half, and health benefits, a little less than half.

In the two studies using Likert scales, ⁶⁹ , ⁷⁴ only two of the seven prosocial motivations enquired about were rated as important. Within this category, altruism received mixed ratings (important and neutral). All reasons related to social norms and marketing were considered neutral. Incentive‐based reasons were either rated as neutral or not very relevant in the only study assessing these motivations (Table 3).

3.6. Motivations for plasma donation

The most frequent reasons given for donating in the only two studies analyzing plasma donation motivations ⁵⁷ , ⁷² fell under the prosocial motivation category (a little more than half of responses). Among the participants included in these studies, almost half referred to values such as the “feeling of personal responsibility to donate”, almost half to altruistic reasons such as “helping someone in need”, while only just a few cited collectivism reasons such as “family member or friend who needed a transfusion”. The second most common motivation was incentives (almost one quarter). Within this category, indirect reciprocity (a little over two thirds), which includes aspects such as “confidence that others will donate if I ever need it”, and material incentives (almost one third) (e.g., “receiving remuneration”), were the most prevalent reasons. Additionally, only a few of participants pointed to marketing, such as “receiving a call or message from a blood donation center”. Less frequent motivations include social norms, convenience and intrinsic factors (Table 3).

In the two studies that evaluated the importance of plasma donation motivations, ⁵⁹ , ⁷⁹ three out of five reasons within the prosocial category were rated as important or very important. Within this category, two out of three reasons under the values category were deemed important while the sole altruism‐related reason was rated as very important. Additionally, three out of the five reasons under the intrinsic motivational category were considered important, while only one incentive reason was rated as important.

3.7. Motivations for plasma and blood donors

The findings from the two studies evaluating simultaneously motivations for both blood and plasma donation were reported using Likert scale scores. ⁷⁶ , ⁸⁰ Intrinsic motivations and prosocial motivations were rated as important or very important, and social norms category was rated as neutral or not very relevant.

4. DISCUSSION

4.1. Purpose

The aim of the current literature review was to identify the motivations that influence blood and plasma donation in high‐income Western countries. Understanding the factors could be important for developing effective strategies to address blood donor motivation and retention, leading to better recruitment and retention strategies, improving donor management and increasing the supply of blood and blood‐derived medicines. Recruiting new donors is essential to increase the donor pool and replace lapsed donors. ⁴¹

4.2. Prosocial motivations

In alignment with other reviews, ²⁰ , ²³ , ⁸² the results included in the current review consistently show that donors in high‐income Western countries are mainly motivated to donate by prosocial reasons. ⁵⁷ , ⁵⁹ , ⁶⁷ , ⁶⁹ , ⁷² Prosocial motivations for donation, especially altruism, are well documented in the literature. ⁸³ , ⁸⁴ , ⁸⁵ A previous systematic review in sub‐Saharan Africa also identified prosocial motivations as the main reasons for donation. ²³ The authors of this review suggested that altruism could be a common motivator, regardless of donation status and donor type. ²³ Our review partly supports this finding, showing that altruism and values were the most cited reasons for blood and plasma donors.

4.3. Blood donation behavior

A broad range of social theories have been applied to understanding blood donation behavior and altruism. ⁵⁶ Altruism is often defined in blood donation publications as the desire to have a positive impact on other people or social collectives through blood donation. ⁷³ Pure altruism refers to an individual's genuine desire to help others due to personal concerns for their welfare, even at a personal cost, without expecting any reward. While impure altruism can be motivated by personal norms and traditional values, it is differentiated from these donation motivations given that it is specifically associated with the intention to alleviate harm and suffering in donors. ⁸⁶

4.4. Donors

Donors commonly express true altruistic sentiments, such as “my blood can save lives”, when answering open‐ended questions or interview surveys. ⁷² However, existing literature shows that these helping behaviors, though often altruistic, may not be truly altruistic as they are not always undertaken without a prior interest in obtaining internal or external rewards, like recognition or appreciation. Altruistic behavior is commonly shaped by intrinsic factors such as the satisfaction and fulfillment derived from helping others, which is termed “warm glow”, or by many societal attitudes and collective tendencies (collectivism). ⁸⁷

4.5. Non‐blood donors

Non‐blood donors pointed to collectivist reasons, personal values, incentives like health benefits, intrinsic motivations, and marketing as the main factors that would prompt donation. Only a few non‐donors cited altruism as a reason for donating. One of the included studies reported that the “urgent call for blood” (marketing communications) was the main motivator among non‐donors. ⁷⁰ Other research suggests that administering a blood donation survey could also create a sense of obligation in non‐donors by reminding them of their lack of participation. ²⁰

4.6. First‐time donors

Two included studies about motivations in first‐time donors using Likert scale scores ⁵⁹ , ⁷⁷ showed that marketing, intrinsic, and prosocial reasons are important for them. The results align with a previous review of first‐time donors, which found that they mainly gave collectivistic and benevolent reasons for starting to donate. ⁸⁸ It suggests that organizations could design marketing strategies to emphasize the societal responsibility of blood donation to attract new donors. Several studies have highlighted the importance of emphasizing the need for blood and providing supportive factors to enhance donors' self‐efficacy and appeal to their personal motivations. ⁵⁰ , ⁷⁴ , ⁷⁷

4.7. Lapsing donors

Convenience motivation is mainly mentioned in studies with lapsing donors, which may imply that taking care of favorable circumstances for donation such as positive experiences or a suitable and accessible place to donate may be an important component in favoring donor retention. ²⁰ , ⁴⁰ , ⁵¹ , ⁵² Convenience was identified as the main factor influencing donation decisions in lapsing donors. Convenience was often linked to donation drop‐out, suggesting that fostering positive donation experiences, such as providing a suitable and accessible place to donate, could play a key role in donor retention. ²⁰ , ⁴⁰ , ⁵¹ , ⁵² The social norms and convenience categories were the least valued by blood or plasma donors and non‐donors.

4.8. Plasma and blood

Our findings suggest that drivers for donation could differ depending on whether the product is blood or plasma. Although altruism and personal values were still the most common reasons given for plasma donation, only a few participants alleged collectivism reasons. Material incentives and indirect reciprocity were most frequently cited as reasons to donate plasma rather than to donate blood. For blood donors, and especially for regular blood donors, the most highly rated incentives subcategory was health benefits. The relevance of incentives in plasma donation has also been highlighted in other previous studies. ⁸⁹ , ⁹⁰ A possible explanation for the stronger incentive motivations for plasma donation could be the use of cell separators and the longer duration of plasmapheresis. The fact that plasma donation requires more effort from the donor may also explain why self‐efficacy and indirect reciprocity motives are more commonly reported among plasma donors than blood donors. ⁵⁷ , ⁷² , ⁷⁹

We found a lack of studies exploring the motivations of non‐donors to donate plasma. Most of the available research focuses on the motivators for conversion of blood donors to plasma donors. ²⁶ This may be because often new plasma donors are recruited from the pool of established blood donors. ²⁶ , ⁵⁷ , ⁷⁹ These studies suggest that plasma donors can be successfully recruited from highly motivated and informed blood donors by appealing to their cognitive attitudes ⁵⁹ towards donation. Other studies also suggest that recruitment efforts may be effective among younger individuals who are influenced by family. ⁵⁷

4.9. Limitations

The current study has several limitations. First, great heterogeneity was found in the content of the questionnaires or surveys used across the different studies. Some studies only asked a few closed‐ended questions focused on predefined motivations, ⁵³ , ⁵⁴ , ⁵⁵ , ⁶¹ , ⁶³ , ⁶⁴ , ⁶⁸ while others included open‐ended questions or covered a broad array of motivational factors. ⁴⁰ , ⁴¹ , ⁴⁷ , ⁴⁸ , ⁵⁷ , ⁵⁸ , ⁶⁰ , ⁷⁰ , ⁷² The data analysis to define the motivational categories is limited by the information extracted from the original articles due to the adequacy of the primary interpretation to the theoretical basis and the reliability of the identification and coding of the motivational categories. It is possible that similar coding appeared in different subcategories, due to the different classifications and descriptions of each subcategory in the primary papers. The number of questions included in the questionnaires varied from 2 ⁶³ to 28 questions. ⁴¹ As a result, not all studies were appropriate to identify the full range of motivations that donors may have. Studies that used the Likert scale were also constrained by the considerable variation in the scale intervals across the studies. These ranged from 0 to 3, 0 to 4, 0 to 5, 0 to 6, 0 to 7, 1 to 5 and 1 to 7 points. This inconsistency limited the comparability of findings across studies and may affect the interpretation of the results. To eliminate this variety, we have reclassified the different Likert scale ranges into five levels. Second, as motivations were self‐reported, results could be biased in favor of socially desirable reasons. ⁴¹ , ⁵⁵ , ⁵⁷ , ⁶⁹ Recall bias could also have occurred given that some studies asked donors to retrospectively reflect on their initial motivations after they had donated. Third, results could have been biased by self‐selection, as participation in several of the studies was based on volunteers who might be particularly interested in the survey topic and consequently have a more positive attitude towards blood donation. In the case of online surveys, internet access is commonly associated with certain socio‐economic and socio‐demographic characteristics, being generally more popular among younger individuals and those with secondary or tertiary education. Additionally, in some countries men tend to participate more in online surveys than women. ⁵¹ , ⁶⁹ To minimize this bias, it might be advisable to replicate these studies using sampling systems that allow for obtaining a sampling distribution identical to the study population. ⁴¹ Some of the studies identified were conducted in countries where remuneration or financial compensation for plasma donation is allowed ⁵² , ⁶⁰ , ⁶⁴ , ⁶⁷ , ⁷⁶ , ⁸¹ or where some donors may have received a compensation for their donations. ⁵² , ⁶⁰ This should be taken into consideration when interpreting the data from these studies to identify motivations to donate like incentives in plasma donation. For example, students probably appreciate a small financial bonus, which is considered a small economic compensation. ⁶⁰ , ⁹¹ Thus, the main motivation for students to donate plasma could be their own economic interest. ⁶⁷

5. CONCLUSION

This study provides a comprehensive analysis of the factors that drive donation, exploring the differences across subgroups. Our findings show that prosocial motivations, particularly altruism and personal values, are the primary motivators for donation. However, our results also suggest that collectivism and marketing can play a significant role, especially in encouraging non‐donors to participate. In addition, our review is particularly valuable for understanding the distinct differences between drivers for blood and plasma donation. Policymakers could draw on our study to develop targeted donation strategies aimed at both recruiting new donors and retaining existing ones. As there is growing interest in achieving greater self‐sufficiency in plasma‐derived medicines, it is crucial to better understand the motivations of plasmapheresis donors, particularly in the context of unpaid volunteerism. Future studies should use standardized, user‐friendly questionnaires that assess a broad spectrum of motivational factors for both blood and plasma donation. Furthermore, including open‐ended questions would help capture additional motivators that may not be covered by predefined options.

CONFLICT OF INTEREST STATEMENT

The authors have disclosed no conflicts of interest.

Supporting information

APPENDIX S1. Supporting information.

DATA AVAILABILITY STATEMENT

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.