Voluntary non-remunerated blood donation and reasons for donating: is there room for philosophy?

Dear Sir,

Giving life -or rather giving birth- is natural. By contrast, sharing life by donating an organ or blood is not “natural”, nor is receiving a foreign organ or someone else’s blood, even though issues related to biological incompatibility have been largely overcome. Transfusion programmes are now routine in health care. However, there are still concerns regarding myths commonly associated with blood. These myths have been more frequently discussed from the recipients’ point of view rather than from that of donors¹.

Sharing life by donating blood is thought to be motivated by altruism². However, giving blood is not ingrained in human nature. There are historical examples of the exchange of minute amounts of blood between two individuals in the context of shared brotherhood and spiritual matters, possibly evoking a “spiritual life”, but in no way a “biological life”. Blood donation aimed at saving an anonymous recipient requires a “will” that drives the donor to this act of generosity and to donate without any apparent compensation, referred to hereafter as “voluntary, non-remunerated blood donation” (VNRBD). Issues related to family donation and compensated donors will not be considered here. Those types of donation generate different levels of indebtedness that were well presented by Tissot and Lion³ in a recent issue of this journal. It should be noted, however, that in many cultures, there is no donation without compensation with the gift considered a hidden reward, as theorised by the anthropologist Marcel Mauss (1872–1950) who published the essay “Essai sur le don. Forme et raison de l'échange dans les societies archaïques” (“l'Année Sociologique”, Paris, 1923–1924).

Blood donation is very special in this regard. Since the earliest steps towards ethical guidance set up by the International Society of Blood Transfusion in the 1960s, no other sustainable motivation -based on psychological grounds- has been firmly established for the large majority of blood donors, apart from solid ethical principles (the sociological basis of VNRBD, i.e. dignity, non-maleficence, autonomy, justice)⁴. Small token gifts and travel reimbursement are sometimes given. However, there is no strict policy, and the typical compensation is a light meal that gives the blood collection establishment an opportunity to watch the donor in an attempt to prevent fainting episodes.

It is interesting to note that in the earlier years of medically-directed transfusions, i.e. from the late 19^th century, the exchange of blood involved husbands donating to wives who were giving birth. During the First World War, transfusions were for brothers in arms, as if to compensate for the “butchery” of that bloody conflict. One may thus question how altruism (leading to donating blood for transfusions) could develop in the 20^th and 21^st centuries, which have emphasised individualism and egoism. With the exception of anecdotal practices, such as compulsively donating blood to transmit religious ideas as has been reported to occur in places in northern India, or compensating for the absence of periods after menopause (and to clarify blood from rich and fatty food intake) as found, for example, in the Bahia region of Brazil, or relieving plethoric persons by bloodletting, as used to be the case for centuries, the gesture of giving blood is motivated by true altruism with no apparent intent to share more than iron, haemoglobin and oxygen; this may be pondered by unconscious will to fit social norms and model attitudes². Blood donation is not a completely trivial act since, on the one hand, there are risks (which are indeed explained to candidate donors, even though they are very rare), and on the other hand, there is frequently self-satisfaction, a feeling close to self-reward, as indicated by interviews with donors. Two main forms of self-reward can be considered: one is devoid of pride (with no external signs, e.g. medals or framed certificates on walls and no special allusion to the donation in everyday life), while the other is more visible. Being recognised as an active blood donor serves the objective of promotion very well and also identifies the donor as a person of value (a valuable, non-controversial individual within society). Visible blood donors often refer to blood donation as a “civic duty”. However, giving blood seems to be neither a duty nor a right (as opposed, for example, to the right-based duty of voting in elections and referendums in democratic countries). Giving blood cannot be a right because it is denied to a large number of individuals with medical contraindications - and any of them may suffer from that, in addition to their causal disease or disability. Furthermore, some societies value a sense of civism, especially in the context of a community. This may mean that certain donors, instead of feeling rewarded for having given blood, feel relieved of an eventual negative community judgment. In addition, medical criteria for donating blood suggest that the donor is a healthy person. This may be valuable in close communities by indicating, for example, the absence of erratic sexual behaviour without an explicit statement. Considered together with the issue that blood is charged with spiritual values¹, the foregoing shows that the will to give blood may be more complex than simple altruism, though altruism remains the essential core.

Thus, VNRBD is generous, altruistic, and civic behaviour, but it should also be considered as entering the “Theory of Planned Behaviour”⁵, which focuses on social considerations such as self-identity, social norms, and model attitudes. It is necessary because there is still no suitable alternative to replace homologous transfusion. Blood donation is not inlaid in human behaviour but may be self-rewarding. If there is no motive to donate other than accomplishing one’s duty to others, thus, there must be a choice (to donate). Is there room for empowerment? If one goes shopping, goods are needed, although some of these goods, such as clothes, are self-gratifying and provide indications of the personality of the buyer). Are there in-depth motives that are ingrained in the subconscious or the religious/ spiritual essence of the human being besides the psychosocial influence (i.e. to fit a model as stated by the theory of planned behaviour)? Important issues related to donating blood are: (i) the possibility of giving, that is, the logistics of the process, and (ii) communication (e.g. on blood compatibility, needs, and updates on the actual inventory). A better understanding of the motives for donation would help communication and promotion as well as organisation of the donation process by acting on empowerment -the current worldwide trend - and also possibly on the “philosophy” of sharing life by blood donation. Since this latter is private, it cannot be affirmed in order to maintain social/political correctness; however, it may lead to a path for promoting VNRBD worldwide, especially when inventory does not meet demand⁴.