Week 11 Flashcards
Blood donation in the past
Historically voluntary, local, altruistic
Wars, historical events shift
If blood is sold and commercialized, who is paying for it?
Commodification of the human body
Incentivizes mostly the poor to donate
Reinforces socioeconomic stratification
What are the positives of viewing blood as an economic good?
Value people’s time and discomfort
Augment economy
Redistribute the $ gains to support other needs or welfare
Economic view fails to take into account the social costs or externalities (and what is an externality?)
externality is a factor/outcome in a situation that is not directly affected by the transaction, but indirectly or secondarily affected. Thus, they might be considered outside or external to the transaction itself.
think of downstream effects such as hepatitis and medical malpractice insurance to counter cases or outcomes like this
4 criteria were used to compare commercialized blood donation and the voluntary blood donation systems in the UK and US
economic efficiency
administrative efficiency
cost per unit or price
purity, potency, and safety
According to Titmuss, the US ‘fails’ all of the criteria
The differences in cost per unit in US £10-20/pint vs. UK £2/pint (circa 1970)
the gap lately is not as much, avg. US $200/unit vs. UK $200/pint vs. Canada $250/unit (all USD)
The US system sometimes fell in short supply and was not administratively efficient
The US system engendered defensive professional/medical practices
Why is blood wasted?
Excessive orders for blood
Unnecessary surgeries/procedures
Outdating
Inefficiency (excess in one location/shortage in another)
How do people become ‘blood indigent’, i.e. in blood debt?
In the US, the consumer pays for blood. Who pays in the UK? In Canada?
How does policy (paid or remunerated vs. unpaid or non-remunerated) affect those with certain diseases?
e.g. Can the VNRBD or ‘gift’ system provide enough clotting factor for hemophiliacs?
UK/Canada public health system pays so patient doesn’t pay for blood unlike US
Chain of selling the blood product:
Donors → blood bank → hospital → patients
How does a gift (unpaid donation) vs. product (paid donation) change people’s motivation?
Is a commercial system corrosive to the ‘spirit’ of giving and supporting a community in an anonymous way? Does it erode the sense of responsibility to the community? Does it diminish altruism and keep people from donating?
“There is nothing permanent about the expression of reciprocity” (page 264)
Would altruism be lost if blood was donated for $?
How do these symptoms impact chronically ill patients needing constant blood donations: quality over quantity don’t want to risk patients’ health – infection
e.g. hemopheliacs need blood clotting factors from plasma, does voluntary system meet need?
-Gift creates social bonds + trust, product is transactional
Why would hemophiliacs experience a sense of burden, guilt, and be considered uninsurable? (page 272)
guilt bc relying on donated blood, fear of being uninsurable, marginalization as burden on system when volunteer
Why could the commercial blood system be said to “maximise diswelfares”? (page 265)
max diswelfare = policies that increase suffering
What is the “Paretian myth of consumer sovereignty”?
false belief that consumers always benefit in free market
Is there such a thing as a “biological need to help”?
bio need to help = ties into psychology, public health, anthropology
Why do people give blood?
Intrinsic motivation or internal reward
Extrinsic motivation or external reward
From ‘The Gift Relationship’
Altruism
Duty
Rare – valuable blod type or factor
General appeal (marketing, advocacy)
Sense of worth/belonging
Reciprocity
Other?
blood donation motivators vs deterrents
Motivators
Altruism
Reciprocity
Values, morals, religion
Social norms
Self esteem
Perceived need
Convenience
Marketing
Incentives
Deterrents
Low efficacy
Lack of involvement
Values, morals, religion
Fear
Negative experience
Lack of knowledge
Inconvenience
Lack of marketing
Ineffective incentives
misinformation about blood donation e.g. might not have enough blood and after donate will have health issues like anemia or trauma after blood donation
No single factor enough, complex mix of factors
The WHO has recommended that all countries should strive toward collecting blood from donors as _________ (VNRBD)
voluntary non-remunerated blood donors
WHO recommends that _% or more of a nation’s population donate blood to meet the demand
1%
General trends in blood donation levels by country (n = 144)
Note the trendlines (GNI = gross national income)
General trends in transfusion transmitted infections (n = 45)
Note the trendlines
-TTI: HIV, hepatitis B/C, syphilis
-income level stronger determinant than voluntary for tti safety
-voluntary must be supported by training, and safety measures
Only ___/124 member states of WHO are meeting the recommendation to rely solely on VNRBD by 2020
62
In many countries (even with financial compensation) the donation rate is <1% even with remuneration (Canada donation rate is around __%, though about 50% are eligible!)
2%
About ___% of 7160 donors from eight studies named monetary incentives a reason for their donation
19%
Meta-analysis and comprehensive reviews largely find higher infection rates in donations from remunerated donors
Attracting non-remunerated donors key
convenience
Germany
Study in Germany finds ideal combination of features:
public agency/organization is in control
paid €30 0km travel done in spare time
Germany utilizes both VNRBD and VRBD (up to 25 Euros)
Retrospective survey and analysis of motivation for donating (by mail)
> ½ indicated that helping others was motivation for first time donation in the initial survey (‘I enjoy helping others’)
Although VRBD showed higher return rates in a 2 year period, long term donation was highest among the VNRBD
Australia
Australia currently VNRBD based, about 3% of those eligible donate
telephone survey showed 12% more likely to donate if paid, vs. 10% less likely
$ for travel was most supported
85% thought if donors were paid, there would be more donors, although 76% stated that payment would not affect there decision to donate
While 9% would have concern receiving blood from paid donors, 90% believed that offering money could influence donor’s answers to screening questions
Sub-Saharan Africa
Sub-Saharan Africa blood donation is most commonly done on a family/replacement basis
Review of HIV, HBV, HCV-positive rates led the author to conclude that the WHO recommendation for only VNRBD is impractical and provides no additional safety over the existing practice
First time VNRBD have highest rates, repeat VNRBD have lowest rates of above viruses. Replacement/family donors are in the middle
Family accompaniment at hospitals does not require recruitment drives or special collection services. Saves $. (estimated ½ to 1/3 the cost)
As supplies are often short, family/replacement source is still key to saving lives
reasons for donating in Uganda
Blood donation coordinated by Uganda Blood Transfusion Services (UBTS) and the Uganda Red Cross Society (URCS)
Based on VNRBD
Interviewed donors, non-donors and staff to find reasons for and against donation
Motivators: altruism, duty, testing for disease,
Deterrents: fear of needles, lack of awareness/misconceptions, poor access, fear of disease information
Many also noted ineligibility for why they were not donors
VNRBD not enough, must also educate public, normalize donation in schools and workplaces, consistent access, offer supportive communication on blood donation especially for 1st time
Analysis of knowledge, attitude, practice, and behavior from surveys on subject of blood donation from developing countries (18 surveys from 17 countries)
Wide variety of VNRBD levels (3.8% up to 100%)
Commonalities included misinformation about blood donation (e.g. belief of high rate of infection from donating or loss of strength, infertility), fear of donating (concern about pain, infection), belief that blood is sold, yet willingness to help family and friends
In some countries religion or culture were cited as reasons for not donating
Payment or incentives were never the majority reason for considering to donate
Converting first time donors into repeat donors may require different motivational strategies. How do we create the best donor population?
What do people know, believe, and do and how it influences national donation system especially for those working with VNRBD,
Myths common across countries e.g. health fears like fear from needles, weakness/loss of strength, mistrust in system, believe blood sold for profit or misued by authorities thus should reduce fear through education, respect cultural values, focus on donor experience and retention not just recruitment, create systems that foster trust, transparency, sense of belonging
what’s the situation in Canada?
As with so many policies, regulated on multiple levels, the collection and remuneration policies and practices in Canada are evolving
Blood: no paid donations
Plasma: unpaid donations and paid donations, lately through the partnership of CBS and Grifols
Reduce reliance on foreign suppliers, partnership w Grifols = Spanish pharm company to reduce reliance on foreign and increase domestic collection
Canada commitment to unpaid blood, plasma paid and unpaid = public tension
Future debate over ethics, donor motivation, public trust, supply security
Altruism
Actions to help others (strangers), even at the expense to your own benefit.
Actor must benefit less than the other.
Opposite of selfishness or egoism.
