News release

From: BMJ Group

Non-monetary “honour-based” incentives linked to increased blood donations 

Findings from China show promise and could be applied in other countries to tackle blood shortages, suggest researchers 

Offering non-monetary incentives such as free access to outpatient consultations to frequent blood donors is linked to an increase in donations without compromising blood safety, finds a study from China published by The BMJ today.

The researchers say their findings could encourage policymakers in other countries to design their own incentive models to address blood shortages.

Many countries, particularly developing ones, struggle to sustain an adequate blood supply due to challenges of retaining blood donors under the “gift model” - a system based on voluntary, non-paid donations driven by altruism and social duty.

Several countries around the world have explored granting incentives to blood donors to stimulate donations, including lottery tickets, paid leave, and cash. But research on their effectiveness is conflicting and has raised concerns that such incentives may undermine altruistic motivation.

To address this, researchers in China set out to evaluate the impact of an honour-based incentive model on the quantity and quality of blood donations.

This model grants frequent blood donors privileges such as free access to public bus services and outpatient consultations in hospitals.

The results are based on blood donation data from the National Reports on Blood Safety and Annual Reports on Development of China’s Blood Collection and Supply Industry in 30 provinces between 2012 and 2018 and socioeconomic indicators from the China City Statistical Yearbooks and Provincial Statistical Yearbooks.

During the study period, three intervention provinces introduced the honour model (Zhejiang in 2014, Jiangsu in 2017, and Hebei in 2018), leaving 27 control provinces not exposed to the model.

The researchers found that the honour model increased blood donation counts by 3.5% by the end of the second year of implementation. By the end of the fifth year, this effect had doubled to 7.7%.

Most of these increases were driven by absolute increases in whole blood donation (containing red cells, platelets, and plasma) of 3.3% and 7.2% by the end of the second and fifth years, respectively.

What’s more, the honour model did not significantly affect the donor eligibility rate (the proportion of donors who passed the necessary health screenings and were deemed eligible to donate blood), indicating maintained safety.

This is an observational study so no firm conclusions can be drawn about cause and effect. However, additional city-level analyses and robustness checks confirmed the stability of results, suggesting that they are reliable.

“Our findings show that the honour model can drive sustained improvements in blood donation counts without compromising blood safety,” write the authors.

“Policy makers in other countries should consider the feasibility and desirability of using the honour model and designing their own incentives to address potential blood shortage concerns,” they add.

Caution is still warranted when interpreting these findings, say researchers from France in a linked editorial.

However, the decision to reward altruistic activities, through non-financial or indirect incentives, means that this strategy is likely to be sustainable, as the cost to the healthcare system should remain moderate, they note.

Subsequent economic evaluations could be necessary, they say. Nevertheless, they conclude that these findings “may herald a new honour paradigm for blood donation, or alternatively, a new non-cash model for rewarding it. Only time will tell."