- Philippa Howden-Chapman, senior lecturer in public healtha,
- John Carter, senior lecturer in haematologya,
- Nicholas Woods, medical studenta
- Correspondence to: Dr Howden-Chapman.
- Accepted 5 December 1995
Blood is an unusual product in a market economy: donors give it freely to strangers. Titmuss concluded that if this gift was commercialised, donors would feel less inclined to donate blood without payment and would face incentives not to disclose diseases.1 The opposing view is that the most efficient way of rationing a scarce product like blood is to put a price on it and let a market develop in which it can be traded.2
In 1993 a purchaser-provider split was introduced into the New Zealand health service. The Blood Transfusion Service was embedded in the new hospital organisations, crown health enterprises, which were required to be profit driven.3 A National Blood Transfusion Trust was set up to preserve the gift relationship and to ensure that there is no profiteering in blood. Nevertheless, the costs associated with collecting, processing, and distributing blood products can be passed on to providers, who are later reimbursed. This study aimed to examine the motives of New Zealand blood donors and whether the changes in the blood transfusion service might affect their donations.
Method and results
After obtaining ethical committee approval we asked 345 consecutive blood donors attending the Wellington Transfusion Centre (and its mobile units) to fill in a questionnaire: 338 (98%) did so. Most were long term donors (87% had been donating for over a year and almost half for over 10 years). Just over half were men (52%), but Europeans (93%, P<0.0005), professionals and managers (48%, P<0.0005), and the employed (97%) were overrepresented compared with the general population. Most people (89%) gave blood for a “general desire to help people.” Other reasons were to repay a transfusion given to someone they knew (8%) or to themselves (5%), or because of future need or a family tradition.
Donors were asked about actual and hypothetical situations in relation to the reformed transfusion services (table 1). There was opposition to profit being made from blood, with 52% of donors unlikely to continue donating if this occurred, and even cost recovery alone was opposed by 13%. As a result of the introduction of user charges 20% of donors had reconsidered their donations; 71% of donors expressed concern about the quality of blood in a more commercial service.
Opinions of New Zealand donors, who have experienced the privatisation of many public sector agencies and the introduction of user charges for health care, are more pecuniary and divided than those of Titmuss's donors. Increasingly being asked to bear the costs of services, many donors would find it acceptable to be offered payment. While some donors voiced concerns about the introduction of market mechanisms in the blood service, most had long established patterns of donating, which they valued. As suggested by some authors, it may be possible, and desirable, to combine altruistic and pecuniary motives in the donor population.4 5 If even a small number of donors cease donating, however, there are policy implications. Donor numbers have been hard to maintain, and even a 10% reduction would severely compromise the service. We are aware that a higher proportion of donors than usual have resigned since the introduction of the 1993 health reforms. This group is the subject of a separate study.
A recent report from Iowa suggests that blood quality is not compromised when rigorously selected paid donors are used, but most of our donors had serious concerns about quality in a commercially driven blood service. If this concern is shared by the general public commercial changes in blood transfusion services may be met with public opposition. Embedding transactions that rely so heavily on altruism in commercial organisations endangers the nature of the gift. Whether there will be compensating factors such as greater efficiency or the attraction of sufficient new, high quality donors is not clear.
We thank the blood donors and transfusion staff for participating in this study.
Funding Wellington division, New Zealand Cancer Society.
Conflict of interest None.