Blood donation in the EU : exploring behavioural insights for innovative interventions : a literature review and an overview of the blood donation landscape in the EU.
Date: 2024-06-13
Institutions: Joint Research Centre
Subjects: EU Member State, blood transfusion, health control, innovation, public health, quality standard, report, safety standard

ISSN 1831-9424

BLOOD DONATION IN THE EU: 
EXPLORING BEHAVIOURAL INSIGHTS 
FOR INNOVATIVE INTERVENTIONS
A literature review and an overview of the blood donation landscape in the EU 

EU Policy Lab

JRC SCIENCE FOR POLICY REPORT

Joint 
Research 
Centre

 EUR 31959 EN

BEHAVIOURAL SCIENCEHEALTHCARE SYSTEMSBLOOD DONATIONThis is a re-edition of Vuletić Čugalj, D., Ferguson, E., Baggio, M. and Bruns, H., Blood Donation in the EU: Exploring behavioural insights 
for innovative interventions - A literature review and an overview of the blood donation landscape in the EU, Publications Office of the 
European Union, Luxembourg, 2023, doi:10.2760/226289, JRC134207. 

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JRC134207 

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How to cite this report: European Commission, Joint Research Centre, Vuletić Čugalj, D., Ferguson, E., Baggio, M. and Bruns, H., Blood 
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BLOOD DONATION IN THE EU: 
EXPLORING BEHAVIOURAL 
INSIGHTS FOR INNOVATIVE 
INTERVENTIONS

A literature review and an overview of the blood donation landscape in the EU

Authors:

Vuletić Čugalj, D. 

Ferguson, E. 

Baggio, M. 

Bruns, H.

EU Policy Lab
The EU Policy Lab is a space for cross-disciplinary exploration and innovation in 
policymaking. We apply collaborative, systemic and forward-looking approaches 
to help bringing the scientific knowledge of the Joint Research Centre into EU 
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augment our understanding of the present, challenge and reinvent the way we think 
about the future. 

The EU Policy Lab is also a mindset and a way of working together that combines 
stories and data, anticipation and analysis, imagination and action. We bring new 
practical and radical perspectives to tackle complex problems in a collaborative 
way. Together, we explore, connect and ideate to create better policies.

policy-lab.ec.europa.eu

Contents 

Abstract ....................................................................................................................................................................................................................................................................... 1

Foreword ..................................................................................................................................................................................................................................................................... 2

Acknowledgements .......................................................................................................................................................................................................................................... 3

Executive summary .......................................................................................................................................................................................................................................... 4

1.

Introduction..................................................................................................................................................................................................................................................... 7

2. Methodology .................................................................................................................................................................................................................................................. 9

2.1.  Identification of studies to be included in the literature review .................................................................................................... 9

2.2.  Data collection for the EU-27 blood donation overview .................................................................................................................... 13

3. Typology of blood donors based on the frequency and proximity of last donation.............................................................. 14

4. Social science research agendas ............................................................................................................................................................................................ 16

4.1.  Theory of planned behaviour ........................................................................................................................................................................................ 16

4.2.  Stage models ............................................................................................................................................................................................................................... 17

4.3.  Self-determination theory ............................................................................................................................................................................................... 17

4.4.  Empirical evidence on motivation that leads to intention to donate blood and to actual blood donation 
behaviour ....................................................................................................................................................................................................................................................... 17

5. Behavioural science research agendas ............................................................................................................................................................................. 20

5.1.  Interventions testing the effectiveness of non-incentives ............................................................................................................... 21

5.1.1.

Reminders to retain and recruit donors ............................................................................................................................................ 21

5.1.2.

Active decision elicitation mechanisms ............................................................................................................................................ 22

5.1.3.

Private and public pledges to donate blood ................................................................................................................................. 23

5.1.4.

Informing donors once their blood is used .................................................................................................................................... 23

5.1.5.

Informing deferred donors about deferral policies ............................................................................................................... 24

5.2.  Interventions testing the effectiveness of non-monetary incentives .................................................................................... 25

5.2.1.

Paid days off work ................................................................................................................................................................................................ 25

5.2.2.

Health checks ............................................................................................................................................................................................................. 25

5.3.  Interventions testing the effectiveness of monetary incentives ................................................................................................ 25

5.3.1.

Vouchers and gift cards ................................................................................................................................................................................... 25

5.3.2.

Cash payments ......................................................................................................................................................................................................... 26

5.4.  Mixed interventions ................................................................................................................................................................................................................ 26

5.5.  Other behavioural interventions ................................................................................................................................................................................ 28

6. Ethical considerations in behavioural interventions to promote blood donation ..................................................................... 29

7. EU-27 blood donation overview .............................................................................................................................................................................................. 31

7.1.  Austria ................................................................................................................................................................................................................................................. 32

7.2.  Belgium .............................................................................................................................................................................................................................................. 33

7.3.  Bulgaria .............................................................................................................................................................................................................................................. 34

7.4.  Croatia ................................................................................................................................................................................................................................................. 35

7.5.  Cyprus .................................................................................................................................................................................................................................................. 36

i 

7.6.  Czechia ............................................................................................................................................................................................................................................... 37

7.7.  Denmark ............................................................................................................................................................................................................................................ 38

7.8.  Estonia ................................................................................................................................................................................................................................................ 39

7.9.  Finland ................................................................................................................................................................................................................................................ 40

7.10. France .................................................................................................................................................................................................................................................. 41

7.11. Germany ............................................................................................................................................................................................................................................ 42

7.12. Greece ................................................................................................................................................................................................................................................. 43

7.13. Hungary ............................................................................................................................................................................................................................................. 44

7.14. Ireland ................................................................................................................................................................................................................................................. 45

7.15. Italy ........................................................................................................................................................................................................................................................ 46

7.16. Latvia ................................................................................................................................................................................................................................................... 47

7.17. Lithuania ........................................................................................................................................................................................................................................... 48

7.18. Luxembourg ................................................................................................................................................................................................................................... 49

7.19. Malta..................................................................................................................................................................................................................................................... 50

7.20. Netherlands .................................................................................................................................................................................................................................... 51

7.21. Poland .................................................................................................................................................................................................................................................. 52

7.22. Portugal ............................................................................................................................................................................................................................................. 53

7.23. Romania ............................................................................................................................................................................................................................................ 54

7.24. Slovakia ............................................................................................................................................................................................................................................. 55

7.25. Slovenia ............................................................................................................................................................................................................................................. 56

7.26. Spain ..................................................................................................................................................................................................................................................... 57

7.27. Sweden ............................................................................................................................................................................................................................................... 58

7.28. Summary of the EU-27 blood donation landscape findings .......................................................................................................... 59

8. Conclusions .................................................................................................................................................................................................................................................. 67

8.1.  Final thoughts and future direction ........................................................................................................................................................................ 69

8.1.1.

Early-stage trials .................................................................................................................................................................................................... 69

8.1.2.

Considering heterogeneity and ethnicity ......................................................................................................................................... 69

8.1.3.

Emotions, transitions and cognitions .................................................................................................................................................. 69

8.1.4.

Exploring mechanisms ...................................................................................................................................................................................... 70

8.1.5.

Caveats ............................................................................................................................................................................................................................ 70

8.2.  Policy implications ................................................................................................................................................................................................................... 70

Bibliography .......................................................................................................................................................................................................................................................... 72

Abbreviations ...................................................................................................................................................................................................................................................... 82

List of figures ..................................................................................................................................................................................................................................................... 83

List of tables ........................................................................................................................................................................................................................................................ 84

ii 

Abstract 

This Science for Policy report contributes to the policy debate on the importance of securing enough blood and 
blood products to maintain a functional healthcare system. It outlines recent progressions in the field of blood 
donation,  offering  new  perspectives  on  factors  associated  with  blood  donor  motivations,  intentions  and 
behaviour.  It  also  summarises  the  findings  from  research  following  social  science  and  behavioural  science 
research agendas in the field of blood donation, including theoretical models and evidence on motivation that 
leads  to  blood  donor  intentions  and  behaviour.  In  addition,  it  encompasses  studies  testing  the  effects  of 
behavioural  interventions  to  increase  blood  donations,  such  as  reminders,  active  decision  elicitation 
mechanisms (methods or techniques used to actively prompt or solicit a decision from someone) and public 
pledges to donate blood. Finally, it describes and reports on the current practices used in blood services across 
the EU-27. 

1 

“By better understanding the 
factors that drive blood 
donors to participate and 
tailoring interventions to the 
needs of specific donor 
groups, the EU can help ensure 
a reliable and sustainable 
supply of blood and blood 
products, improving 
healthcare outcomes for 
patients across the continent”. 

Foreword 

Blood  donation  is  a  critical  component  of  healthcare  systems  around  the  world,  including  in  the 
European  Union,  and  it  is  essential  for  maintaining  adequate  supplies  of  blood  and  blood  products  to  treat 
patients  with  a  range  of  conditions,  from  cancer  to  blood  disorders  to  trauma.  However,  despite  the 
importance of blood donation, there are ongoing challenges in securing sufficient supplies of blood, due, 
for  example,  to  the  implications  of  the  projected  demographic  context,  or  to  disruptive  crises  such  as  the 
COVID-19 pandemic. Moreover, there are notable variations in donor motivations and behaviour and barriers 
to  donation  that  affect  the  success  of  blood  donation  programmes,  making  it  an  interesting  field  to 
investigate and in which to implement strategies that could lead to positive outcomes. 

In the EU, blood donation and transfusion services operate at the national and regional levels, and the blood 
supply chain can be organised as a nationwide system, a hospital-based system or a mixed system (Gorleer, 
Bracke and Hustinx, 2020). Blood and blood products are regulated and monitored to ensure that they meet 
strict  quality  and  safety  standards  set  by  EU  legislation.  These  standards  include  the  testing  of  blood 
donations  for  infectious  diseases,  such  as  HIV,  hepatitis  B  and  C  and  West  Nile  virus.  However,  despite  the 
importance of blood donation, there are ongoing challenges in securing sufficient supplies of blood and blood 
products across the EU. Factors such as ageing populations, changing lifestyles and the COVID-19 pandemic 
have affected donor behaviour and availability, making it a complex area for study and intervention. 

Therefore,  research  on  donor  motivations,  intentions  and 
behaviour,  and  the  effectiveness  of  various  interventions  to 
increase blood donations, is crucial for the EU’s healthcare system. 
By  better  understanding  the  factors  that  drive  blood  donors  to 
participate and tailoring interventions to the needs of specific donor 
groups, the EU can help ensure a reliable and sustainable supply of 
blood  and  blood  products,  improving  healthcare  outcomes  for 
patients across the continent. 

The  EU  blood  legislation  adopted  in  2002  (Directive  2002/98/EC) 
obliges  Member  States  to  take  the  necessary  measures  to 
encourage  voluntary  and  unpaid  blood  donation,  with  a  view 
to  ensuring  that  blood  and  blood  components  are,  as  far  as 
possible, provided from such donations. As explained in a recital of 
that  directive,  voluntary  and  unpaid  donation  is  a  factor  that  can 
contribute to high safety standards and, therefore, to the protection of human health; the importance of 
the  work  of  the  Council  of  Europe  in  this  area  is  also  pointed  out.  In  July  2022,  the  European  Commission 
published a proposal for a revision of the blood legislation, as part of a broader proposal for a regulation on 
substances of human origin. This proposal strengthens that approach, clarifying that financial incentives or 
inducements  to  donors  are  not  permissible.  The  proposal  does,  however,  allow  for  Member  States  to 
compensate  or  reimburse  donors  through  fixed-rate  allowances,  as  long  as  national  legislation  has  set  an 
upper  limit  for  such  allowances  that  ensures  that  they  are  financially  neutral.  This  approach  is  in  line  with 
Article 3 of the EU Charter of Fundamental Rights, which prohibits the commercialisation of the human body, 
and is aligned with the principle of ‘financial neutrality’ recently recommended by the Council of Europe( 1). 

This  literature  review  contributes  to  the  ongoing  debate  around  blood  donation  incentives  (referring  to 
affirmative measures that stimulate individuals to donate blood) by providing a comprehensive review of 
the  current  state  of  research  on  donor  motivations  and  behaviour  and  the  effectiveness  of 
various interventions to increase blood donations. This Science for Policy report offers insights into the 
factors that drive blood donors to participate, and also the barriers and challenges that limit donation rates. In 
addition,  it  explores  the  impact  of  various  types  of  incentives,  both  monetary  and  non-monetary,  on  donor 
behaviour and provides a closing overview of best practices in blood donation recruitment and retention. 

Overall,  this  review  provides  a  valuable  resource  for  blood  donation  practitioners,  policymakers  and 
researchers  alike,  offering  insights  into  the  latest  thinking  on  donor  motivations  and  behaviour  and 
highlighting key areas for future research and intervention.  

(1) 

Council  of Europe Committee  on  Bioethics  (DH-BIO),  Guide  for  the  implementation of  the  principle  of  prohibition  of  financial  gain 
with  respect  to  the  human  body  and  its  parts  from  living  or  deceased  donors,  2018  (https://rm.coe.int/guide-financial-
gain/16807bfc9a). 

2 

                                                        
Acknowledgements 

The authors of this report extend their  heartfelt  gratitude to their  colleagues at the Directorate-General for 
Health and Food Safety –  particularly those from Unit D2, Medical products:  quality, safety, innovation – for 
their valuable inputs and support throughout the preparation of this report. Their expertise and guidance were 
instrumental in shaping the report and ensuring that it met high standards. 

We  also  express  our  sincere  thanks  to  all  Member  State  national  competent  authorities  for  blood  for  their 
contribution  to  this  project,  namely  the  Federal  Ministry  of  Social  Affairs,  Health,  Care  and  Consumer 
Protection  (Austria),  Federal  Agency  for  Medicines  and  Health  Products  (Belgium),  Bulgarian  Drug  Agency 
(Bulgaria),  Croatian  Institute  of  Transfusion  Medicine  (Croatia),  Fakultní  Thomayerova  nemocnice  (Czechia), 
Danish  Patient  Safety  Authority  (Denmark),  State  Agency  of  Medicines  (Estonia),  Finnish  Medicines  Agency 
Fimea  (Finland),  ANSM  Haemovigilance  (France),  Paul-Ehrlich-Institut,  Federal  Institute  for  Vaccines  and 
Biomedicines  (Germany),  Health  Products  Regulatory  Authority  (Ireland),  Centro  Nazionale  Sangue  (Italy), 
State Agency of Medicines of the Republic of Latvia and Latvia State Blood Donor Centre (Latvia), Ministry of 
Health of the Republic of Lithuania (Lithuania), Centre de Transfusion Sanguine (Luxembourg), Ministerie van 
Volksgezondheid,  Welzijn  en  Sport  (the  Netherlands),  National  Blood  Center  (Poland),  Instituto  Português  do 
Sangue e da Transplantação (Portugal), Ministry of  Health (Cyprus), Centrul Regional de Transfuzii Sanguine 
(Romania), Národná Transfúzna Služba SR (Slovakia), Agency for Medicinal Products and Medical  Devices of 
the Republic of Slovenia (Slovenia), Transfusional Medicine, Ministry of Health (Spain) and the National Board 
of  Health  and  Welfare,  Department  for  Knowledge-Based  Policy,  National  Donation  Center  (Sweden).  Their 
insights and feedback were essential in drafting accurate Member State profiles for the EU-27 blood donation 
overview. 

We  extend  our  appreciation  to  the  colleagues  at  the  EU  Policy  Lab  for  their  invaluable  role  in  nurturing 
innovation in policy-making, which has facilitated the publication of this report. 

Finally, we acknowledge all the researchers and practitioners whose work on blood donation and related areas 
has  contributed  to  our  understanding  of  this  critical  healthcare  issue.  Their  dedication  and  commitment  to 
improving blood donation programmes have inspired us to produce this report, and we hope that our efforts 
will help to advance this field further. 

Authors 

Danijela Vuletić Čugalj (Economics Institute of the Czech Academy of Sciences (CERGE-EI)) 

Eamonn Ferguson (Private expert advisor – Professor at the University of Nottingham) 

Marianna Baggio (Joint Research Centre) 

Hendrik Bruns (Joint Research Centre) 

Opinions  expressed  herein  are  those  of  the  authors  only  and  do  not  reflect  the  views  of,  or  involve  any 
responsibility for, the institutions to which they are affiliated. Any errors are the fault of the authors only. 

3 

 
Executive summary 

The EU has established a comprehensive legal framework that ensures the safety and quality of blood and its 
components  in  all  stages  of  the  transfusion  process,  from  donation  to  distribution.  This  report  provides 
insights on factors that drive blood donation and barriers to donation to help policymakers and practitioners 
across the EU-27 develop or reinforce effective strategies for a sustainable supply. 

Policy context 

The  EU  has  a  comprehensive  regulatory  framework  for  ensuring  the  safety  and  quality  of  blood  and  blood 
products used in healthcare. The legal framework defining the quality and safety standards for blood and its 
components is set out in Directive 2002/98/EC, also referred to as the European blood directive. It covers all 
steps  in  the  transfusion  process,  from  donation,  collection,  testing,  processing  and  storage  to  distribution. 
Donated  plasma,  a  component  of  blood,  can  also  be  used  to  manufacture  medicinal  products  such  as 
immunoglobulins  or  clotting  factors.  The  manufacture  of  these  products  is  subject  to  pharmaceutical 
legislation, whereas the donation, collection and testing of plasma is regulated by blood legislation. 

The  EU  also  supports  research  and  innovation  in  the  field  of  blood  donation  and  promotes  international 
cooperation to address global challenges in blood supply and safety( 2). In addition, the EU has established a 
coordinated  system  for  monitoring  the  safety  and  availability  of  blood  and  blood  products  across  Member 
States. However, an evaluation of the blood legislation and tissues and cells legislation revealed shortcomings 
in  the  light  of  scientific  and  technical  advancements,  and  also  sociodemographic  trends  and  new 
epidemiological risks(3). As a result, the EU recognised the need to update certain provisions of the legislation 
to  better  align  with  the  current  landscape  and  to  strengthen  the  protection  of  donors  as  well  as  that  of 
recipients.  To  address  these  issues,  in  July  2022  the  European  Commission  adopted  its  proposal  for  a 
regulation  on  standards  of  quality  and  safety  for  substances  of  human  origin  intended  for  human 
application(4). 

This review of the literature  on blood  donation behaviour and the EU-27 blood donation overview aimed to 
provide insights into the factors that drive blood donation behaviour, identify barriers to blood donation and 
explore  best  practices  for  increasing  donation  rates.  This  information  can  help  policymakers  and  blood 
donation practitioners in the EU to develop effective strategies for ensuring a sustainable supply of safe and 
high-quality blood and blood products for patients in need. 

Key conclusions 

This Science for Policy report has produced a comprehensive review of the EU-27 blood donation landscape 
and  contextualised  it  with  a  literature  review  on  the  key  factors  that  drive  blood  donation  behaviour.  The 
literature  review  identified  a  number  of  relevant  studies  from  social  and  behavioural  science  research, 
including  interventions  that  tested  different  strategies  for  promoting  blood  donation.  This  report  also 
describes  the  current  practices  used  in  each  Member  State’s  blood  service  and  found  considerable 
organisational  variation  across  Member  States.  The  literature  review  also  shows  that  understanding  donor 
motivations is essential for developing effective and targeted interventions for different categories of donors. 
In  addition,  it  suggests  that  more  research  is  needed  to  explore  the  potential  effects  of  advancements  in 
information  technology  on  blood  donor  recruitment  and  retention.  In  conclusion,  the  review  provides  a 
foundation for understanding the current state of research in blood donation and provides insights for future 
research and interventions. 

It is hoped that this work will serve as a valuable resource for those interested in further research and policy 
development in the behavioural drivers in blood donation. 

(2) 

(3) 

(4) 

For further information on ongoing and completed EU-funded actions, see https://health.ec.europa.eu/blood-tissues-cells-and-
organs/blood_en. 
European  Parliamentary  Research  Service  (EPRS)  (2022),  Revision  of  the  EU  legislation  on  blood,  tissues  and  cells 
(https://www.europarl.europa.eu/RegData/etudes/BRIE/2022/699492/EPRS_BRI(2022)699492_EN.pdf). 
For further information on the proposal for a regulation on substances of human origin, see https://health.ec.europa.eu/blood-
tissues-cells-and-organs/overview/proposal-regulation-substances-human-origin_en. 

4 

 
                                                        
Main findings 

The  primary  objective  of  this  narrative  literature  review  was  to  provide  a  comprehensive  overview  of  the 
latest  research  in  the  field  of  blood  donation,  highlighting  new  perspectives  on  factors  strongly  associated 
with blood donor motivations, intentions and behaviour. 

Several take-home messages emerged from this review. 

  Blood donors can be classified based on their donation frequency and recency. Donors are 
divided  into  two  categories:  new  donors  (who  have  donated  for  the  first  time  and  only  once)  and 
repeat donors (who have donated more than once). Repeat donors are further divided into novice 
donors (who have donated two to four times) and experienced donors (who have donated five or 
more times). Based on the combination of donation frequency and recency, donors can be classified 
into  six  groups:  quitters,  lapsed  weak  habit  donors,  lapsed  strong  habit  donors,  active  new  donors, 
habit-forming donors (occasional donors) and habitual donors (regular donors). 

  Understanding  donor  motivations  is  essential  for  developing  effective  and  targeted 
interventions for different categories of donors. General principles can provide a starting point 
when  considering  the  challenges  facing  blood  services,  such  as  the  need  to  recruit  donors  with 
specific blood phenotypes and replace the loss of older donors with younger donors. 

  The  use  of  behavioural  interventions  such  as  solicitation  letters,  phone  calls,  ‘warm  glow’ 
messages, donor registries, reminders, active decision elicitation mechanisms, and gift vouchers can 
be effective in increasing blood donations. 

  More  research  is  needed  on  the  effects  of  technology  advancements,  applications  and  donor 

management technology on blood donor recruitment and retention. 

  Paid days or time off work, refreshments, and small tokens or symbolic gifts are the most common 

strategies to recognise, reward and incentivise blood donors across EU Member States. 

  There  is  considerable  organisational  variation  across  EU  Member  States  in  terms  of  blood 
donation  practices,  with  national  health  services,  hospitals,  community  blood  banks  and  non-profit 
organisations being responsible for collections of blood and blood components. 

  To increase the rate of current blood donors, blood services need to adopt a multifaceted approach 
that involves a better understanding of donor motivations, the use of effective interventions and the 
implementation of appropriate organisational structures and practices. 

  Future  research  should  focus  on  exploring  the  cognition,  motivations  and  emotions  that  different 
incentives  and  interventions  afford  relative  to  each  other,  and  on  identifying  innovative  ways  to 
increase blood donor behaviour, such as the use of technology and social media. 

Related and future Joint Research Centre work 

This  Science  for  Policy  report  is  part  of  the  work  programme  of  the  Competence  Centre  on  Behavioural 
Insights and will play a critical role in informing the feasibility study of an EU-wide randomised controlled trial 
aiming to test the findings of the literature review on how to retain and increase the number of blood donors. 
This  trial  and  its  successful  implementation  has  the  potential  to  significantly  improve  blood  donation  rates 
across the EU. The insights and recommendations presented in this report will serve as a valuable reference 
for  designing  the  trial,  including  identifying  effective  interventions  to  encourage  blood  donations.  Moreover, 
the  results  of  the  trial  will  provide  valuable  information  for  policymakers  and  practitioners  on  the  most 
effective  ways  to  increase  blood  donation  rates  and  ensure  a  sustainable  supply  of  these  substances  for 
healthcare systems. 

Disclaimer 

The  literature  review  presented  herein  includes  studies  that  investigate  the  use  of  incentives  to  stimulate 
blood donations, including those that may not be in line with EU legislation. The inclusion of such incentives in 
this review was motivated by the goal of providing a comprehensive and exhaustive overview of the literature 
from a scientific standpoint. However, it is important to note that the inclusion of these studies in the review 
does  not  imply  endorsement  or  support  of  such  practices.  Readers  are  encouraged  to  use  their  own 
judgement and consult with relevant authorities regarding the possible use of incentives for blood donations. 

5 

The  authors  of  this  literature  review  cannot  be  held  responsible  for  any  decisions  made  based  on  the 
information  presented.  The  information  presented  in  the  EU-27  blood  donation  overview  is  intended  for 
general information purposes only. The authors have made reasonable efforts to ensure that the information 
provided is accurate and  up  to date to the best of their  knowledge. However, the authors do not  make any 
representation  or  warranty,  express  or  implied,  as  to  the  completeness,  accuracy,  reliability,  suitability  or 
availability of the information presented in the EU-27 blood donation overview. Therefore, the authors shall 
not be held liable for any errors, omissions or damages arising from the use or reliance on this information. 
Users  of  the  EU-27  blood  donation  overview  are  advised  to  verify  the  accuracy  of  the  information  before 
acting on it and to seek advice where necessary.  

6 

1.  Introduction 

Securing enough blood and blood products is vital for maintaining well-functioning health systems (Bruhin et 
al., 2020; Ferguson, Murray and O’Carroll, 2019; Healy, 2000). In Europe, each year around 15 million blood 
donors provide on average 25 million blood units ( 5), which are needed for treatments – often life-saving – in 
patients  undergoing  surgery,  in  premature  babies,  in  victims  of  accidents  and  in  patients  with  leukaemia, 
sickle  cell  anaemia  or  thalassaemia  (Ferguson,  Murray  and  O’Carroll,  2019;  Lacetera,  Macis  and  Slonim, 
2012).  Equally  significant  is  plasma,  collected  from  plasma  donors  and  used  to  produce  plasma-derived 
medicinal products, which are essential for people with critical conditions such as haemophilia, congenital and 
acquired immunodeficiencies and other inherited protein disorders (Hartmann and Klein, 2020). The COVID-19 
pandemic has caused a decline in the supply of whole-blood donations in many countries, including France (6), 
Germany (7),  Ireland ( 8)  and  the  United  Kingdom ( 9)  (Chell  et  al.,  2022).  In  parallel,  demand  for  plasma 
collections increased because plasma
derived medicinal products were proposed for experimental treatment 
of COVID

19 (Hartmann and Klein, 2020). 

‐

Because many people’s lives depend on a constant supply of blood products, which in the EU depends solely 
on voluntary donors, it is important to understand the nature of donor motivations and behaviour and barriers 
to  donation.  Interestingly,  there  are  some  enhancements  in  the  blood  donation  field,  such  as  improved 
procedures  in  hospitals  for  cell  salvage  and  more  efficient  use  of  blood,  that  have  helped  to  decrease  the 
demand for blood in the past 10 years. Furthermore, there is a growing need within blood services to enhance 
donor–recipient matching for more effective treatment of diseases such as sickle cell anaemia and, therefore, 
the need to target recruitment to encourage potential donors with specific blood phenotypes, for example Ro 
Kell (Ferguson, Murray and O’Carroll, 2019; Ferguson et al., 2022; Josephson et al., 2007; Shaz et al., 2008). 
There are also changes in the blood donor demography that affect supply negatively, in particular the loss of 
older donors who are not replaced by younger donors (Carter et al., 2011; Greinacher, Fendrich and Hoffman, 
2010). Therefore, it is essential to understand donor motivation to develop targeted interventions to address 
such  changes.  This  review  will  help  understand  the  current  state  of  play  in  this  area.  The  main  aim  of  this 
literature review is to summarise the most recent progressions in the field of blood donation that offer new 
perspectives on factors that are strongly associated with blood donor motivations, intentions and behaviour. 

‐

To build on previous reviews on blood donor motivations (Bednall and Bove, 2011; Carver et al., 2018), this 
review  examines  studies  testing  the  effects  of  behavioural  interventions  to  increase  blood  donations. 
Grounded  in  the  work  of  Godin  et  al.  (2012),  we  review  an  additional  11 years  of  studies  on  interventions 
testing the effects of non-incentives (i.e. reminders, active decision elicitation mechanisms, public pledges to 
donate  blood,  and  similar),  non-monetary  incentives  with  some  material  component  (e.g.  paid  days  off 
work (10) and health checks) and monetary incentives (i.e. cash payments, vouchers, gift cards (11) and similar) 
on promoting blood donation. In contrast to Bagot, Murray and Masser (2019), who concentrated on studies 
related to the retention of first-time donors, we included studies that concentrate on blood donor recruitment 
(attracting  new  donors)  and/or  blood  donor  retention  (keeping  return  donors  motivated  to  donate  because 
return donors have lower levels of transfusion-transmissible infections and are easier and are less costly to 
process). As a major contribution to the literature of blood donor recruitment and retention, we describe and 
report on the current practices used in blood services across the EU Member States (the EU-27 blood donation 
overview),  thus  establishing  a  link  between  the  reality  of  EU  blood  donation  systems  and  the  behavioural 
science findings related to blood donation interventions. 

To identify papers that were relevant for this review, we searched Google Scholar, Scopus and PubMed using 
the software Publish or Perish ( 12) and we applied search forwards and search backwards approaches ( 13). A 

(5) 
(6) 
(7) 
(8) 

(9) 

(10) 

(11) 

For more information, consult https://europeanbloodalliance.eu/press-release-donating-blood-is-an-act-of-solidarity/. 
For more information, consult https://www.aa.com.tr/en/europe/france-issues-emergency-call-for-blood-donation/2496374. 
For more information, consult https://www.politico.eu/article/blood-donation-squeeze-coronavirus-crisis/. 
For  more  information,  consult  https://www.irishtimes.com/news/health/blood-transfusion-service-seeks-donations-as-covid-hits-
attendance-1.4710763. 
For  more  information,  consult  https://www.blood.co.uk/news-and-campaigns/news-and-statements/extra-safety-measures-after-
coronavirus-uncertainty-causes-drop-in-donations/. 
According to World Health Organization guidelines, offering a paid day off from work as an incentive could render a donation non-
voluntary if the incentive is considered excessively large. 
These vouchers or gift cards may be considered acceptable under World Health Organization guidelines if they are given as a gift or 
token of appreciation rather than as a form of payment. 

(12)  Harzing, A.-W. (2007), ‘Publish or Perish’ (https://harzing.com/resources/publish-or-perish). 
(13) 

As  part of  a  search  backwards  approach,  we  identified  and  examined  the  references  of  studies  cited  in this  review.  Similarly,  we 
used a search forwards approach to identify and examine the papers that cited studies included in this review. 

7 

                                                        
total of 6 161 studies were identified, out of which 78 studies were included. The data for the EU-27 blood 
donation  overview  were  collected  from  a  reference  search  and  a  Google  search.  Member  State-specific 
reports compiled based on these data were sent for fact checking and the integration of missing information 
to the national competent authorities for blood of the EU Member States. 

We distinguish between categories of blood donors, for example new donors, novice donors and experienced 
donors  (Charng,  Piliavin  and  Callero,  1988;  Thomson  et  al.,  1998).  Because  blood  donors  are  not  a 
homogeneous  group,  we  need  to  appreciate  the  differences  between  groups  of  donors  to  get  a  better 
understanding  of  which  motivations  and  interventions  are  likely  to  be  most  effective  for  each  group.  This 
enables more targeted or personalised approaches to donor recruitment and retention. 

We summarise the findings from research following social science or behavioural science research agendas in 
the field of blood donation. First, we introduce the theoretical models (e.g. the theory of planned behaviour, 
stage models and self-determination theory) that serve as a foundation for social science research agendas. 
Second, we review the evidence on motivations that lead to blood donor intentions and behaviour. As regards 
behavioural science research agendas, we categorise studies into the following groups based on the type of 
strategies  for  promoting  blood  donation:  (1)  financially  based  incentives  (i.e.  cash  payments,  vouchers,  gift 
cards and similar), (2) non-monetary incentives (i.e. medals, paid days off work, health checks and similar), (3) 
non-incentives (i.e. text messages, public pledges to donate blood, and similar), (4) mixed incentives and (5) 
other  behavioural  interventions,  including  applied  muscle  tension  (the  intentional  contraction  of  certain 
muscles in the body, typically the arm muscles, during the donation process). 

In addition, we describe the blood donation systems in the EU-27, offering a comprehensive review of their 
organisation,  blood  donation  models,  types  of  incentives  offered  to  blood  and  plasma  donors,  and  donor 
statistics for 2021. For example, we show that there is considerable organisational variation across Member 
States.  In  some  Member  States,  a  national  health  service  is  responsible  for  collections  of  blood  and  blood 
components;  in  other  Member  States,  hospitals  or  community  blood  banks  have  this  responsibility  solely  or 
share it with the Red Cross. In one Member State, blood collection is organised by a non-profit organisation. 
Furthermore, we found that  the most  common strategies to recognise, reward and incentivise blood donors 
among the EU Member States are (1) paid days and/or time off work (used by 63 % of Member States), (2) 
refreshments  (used  by  56 %  of  Member  States)  and  (3)  small  tokens  or  symbolic  gifts  (used  by  52 %  of 
Member States). This allows us to link theory and practice directly: Blood centres can inform theory by testing 
the  effectiveness  of  their  strategies,  and,  conversely,  theoretically  grounded  research  can  recommend  to 
blood  centres  the  use  of  strategies  that  have  been  tested  and  found  to  be  effective,  explaining  the 
mechanisms through which they work. Similarly, reports on theoretically grounded research can recommend 
to blood centres the use of strategies that have already been tested and found to be effective, explaining the 
mechanisms through which they work. Lastly, we calculated that the average reported rate of blood donors in 
the  general  population  (not  the  average  rate  of  the  population  that  are  eligible  to  donate)  for  22  Member 
States is 2.41 %, with Ireland having the lowest rate (1.43 %) and Cyprus the highest (6.46 %). 

This  literature  review  is  structured  as  follows:  Section 2  outlines  the  methodologies  used  to  identify  and 
describe the relevant literature and the data underlying the EU-27 blood donation overview. Section 3 outlines 
a  typology  of  blood  donors.  Sections 4  and  5  describe  social  science  and  behavioural  science  research 
agendas  and  their  main  findings.  Section 6  addresses  ethical  considerations  in  behavioural  interventions. 
Section 7 presents the blood donation country profiles for individual Member States, and Section 8 concludes. 

8 

 
 
2.  Methodology 

2.1.  Identification of studies to be included in the literature review 

Although  our  review  may  not  strictly  adhere  to  the  classification  of  a  systematic  review,  we  thoroughly 
followed a systematic workflow, drawing inspiration from the methodologies employed by Godin et al. (2012), 
Bednall et al. (2013) and Chell et al. (2018) in the selection of studies to incorporate into our review. With the 
aim of identifying the factors that are associated with  blood donation intentions and behaviour, one author 
performed a literature search between 14 December 2021 and 10 March 2022 and collected 6 161 studies 
using the following methods. 

  6 123 studies were identified by searching (14) Google Scholar, Scopus and PubMed using the 

software Publish or Perish for studies published after 2000. The year 2000 was chosen as a start 
year for this review to avoid overlap with the studies included in the review conducted by Godin et al. 
(2012). 

  38 studies were identified using search forwards and search backwards approaches. There were 
three studies that were published prior to the year 2000 and that were included in this review 
because of their major contribution (i.e. number of citations or reputation) to the field of blood donor 
behaviour. 

All  the  papers  that  matched  the  search  terms  were  assessed  based  on  title  and/or  abstract.  The  schematic 
representation of the identification, screening and selection process is presented in Figure 1. 

A total of 5 246 studies were excluded based on the following exclusion criteria: 

  duplicate studies, 

  opinion pieces, 

  studies not published in English, 

  studies from different fields (i.e. haematology, diabetology, transplantation, biology, animal health 

and similar) that assessed heath rather than behavioural outcomes. 

The remaining 915 studies were assessed based on their abstracts and 100 studies were chosen to be read in 
more detail. The studies that were excluded (815) had at least one of the following characteristics. 

  The sample size was smaller than 100 (this rule concerns empirical studies only). 

—  They were one of several studies with similar research questions and consistent findings that were 
conducted in different countries (e.g. Cameroon, Greece, Saudi Arabia and Trinidad and Tobago). In 
such cases, the study from an EU Member State was given priority because of our aim to generate 
insights for the EU, and the similar studies from other countries were excluded. 

  They were related to the creation and implementation of a specific blood donation database system 

or to questionnaires for donors prior to donating. 

From the 100 studies that were chosen to be read in more detail, all authors independently identified studies 
to include in this review and jointly agreed on 78 studies (15) based on their contribution to the field of blood 
donor behaviour and their recency (a detailed description can be found below). The remaining 22 studies were 
excluded  owing  to  the  narrowness  of  their  research  scope,  for  example  focusing  solely  on  demographic 
characteristics  or  investigating  attitudes  and  knowledge  in  undergraduates  with  roles  in  health  education 
(rather than in the general population). 

We  acknowledge  the  importance  of  considering  under-represented  groups  in  research  and  reports  from  the 
perspective of inclusion, diversity and equality. Although our literature review has a generalist perspective, we 
recognise  that  there  are  under-represented  groups  that  may  also  be  excluded  from  research  and  reports. 
However, owing to the scope and focus of this review, we are unable to cover all under-represented groups 
comprehensively.  We  recognise  that  the  exclusion  of  certain  groups  from  research  and  reports  may  have 

(14)  We  applied  the  following  Boolean  combination  of  key  terms  in  our  search:  (blood)  AND (donor  OR  donation)  AND  (motivation  OR 

attitude OR behavi* OR incentive OR intervention OR retention OR recruitment). 
Any disagreements were resolved through peer in depth discussion. 

(15) 

9 

                                                        
significant  implications  for  our  understanding  of  the  social  world  and  for  promoting  greater  equity  and 
inclusion. We acknowledge that exclusion criteria should not be based on factors such as cultural identity or 
immigrant status, and we have taken steps to ensure that our inclusion criteria are based on the relevance of 
the study to the research question and the quality of the research design. While we recognise the importance 
of considering under-represented groups more broadly, our general approach is an important contribution to 
the literature. 

We made an effort to include a comprehensive spectrum of studies, including both published and unpublished 
sources. However, publication bias might exist within the body of research, and it is advisable to interpret the 
findings of our review with this consideration in mind. 

Figure 1 – Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 flow diagram (Page et al., 
2021) – databases, websites, reference lists and other sources searched to identify studies 

Note: This figure outlines the identification and screening of studies that were included in this literature review and the categorisation of 
selected studies based on the research question that the study aimed to answer. 

10 

 
We use the following criteria to describe and categorise studies included in this literature review: research 
question, targeted population, methodology and the country or countries in which the study was conducted. 

Based on the research question that a study aims to answer, we divide the selected studies into: 

  studies investigating blood donor motivation associated with intentions ( 16) (16 studies), 

  studies using cross-sectional data and survey data to investigate blood donor motivation associated 

with actual behaviour (9 studies), 

  studies that include behavioural interventions ( 17) (27 studies), 

  studies describing donors’ characteristics and types of donor (3 studies), 

  reviews, guidelines, theoretical studies, studies on blood donation trends and observations (23 

studies). 

We  can  categorise  studies  included  in  this  literature  review  as  follows,  according  to  targeted  population: 
recruitment  studies  (general  population),  retention  studies  (blood  donors),  studies  that  include  both  the 
general  population  and  blood  donors  and  studies  that  did  not  specify  the  targeted  population  (Figure 2 
provides the number of studies per category). 

Figure 2 – Categorisation of studies based on targeted population 

Note: This figure shows the number of studies per category, with the targeted population being the general population, blood donors, both 
or not specified. 

(16) 

This group includes studies that investigate people’s attitudes towards specific motivation devices and whether they would change 
their intentions to donate blood if they were offered some specific incentive. A great majority of these studies use survey data. 

(17)  Behavioural intervention studies use interventions designed to affect people’s actions (e.g. donating blood). 

11 

 
 
 
 
                                                        
Figure 3 shows the distribution of selected studies based on the methodology used to answer the research 
question. 

Figure 3 – Classification of studies based on methodology 

Note: This figure shows the number of studies per category, with each category based on the methodology used to answer the research 
question. The blue line surrounds the methodologies that commonly allow for testing causal relationships, whereas those outside this line 
are commonly used to establish correlations. 

According  to  the  country  or  countries  in  which  the  study  was  conducted,  the  majority  of  selected 
studies  were  conducted  in  at  least  one  EU  Member  State  (31  studies).  The  other  studies  collected  data  in 
Argentina  (one  study),  Australia  (three  studies),  Bosnia  and  Herzegovina  (two  studies),  Brazil  (two  studies), 
Canada  (five  studies),  China  (one  study),  New  Zealand  (one  study),  Switzerland  (five  studies),  Thailand  (one 
study), the United Kingdom (one study) and the United States of America (nine studies). In the remaining 16 
studies, the country was not specified. A study conducted outside the EU was excluded if it was similar to a 
study conducted in the EU. 

12 

2.2.  Data collection for the EU-27 blood donation overview 

The  EU-27  blood  donation  overview  was  developed  through  a  comprehensive  data  collection  process  that 
involved gathering information on various aspects of blood donation systems in the EU Member States. This 
comprehensive overview includes the following information about the EU Member States: 

• 

• 
• 

• 
• 
• 

blood  donation  systems  (i.e.  their  organisation,  when  applicable –  the  responsibilities  of  the  national 
blood centres and Red Cross societies, the number of blood establishments and blood banks, the number 
of fixed locations and mobile sessions, and similar), 
blood donation model (i.e. donor recruitment strategies), 
donor  statistics –  the  most  recent  statistics  on  blood  donations  and  donors ( 18)  (i.e.  number  of  donors, 
donor gender and age distribution, distribution based on the frequency of donation, and similar), 
the types of incentives offered to blood donors, 
the types of incentives offered to plasma donors, 
the information system used (i.e. technology used to gather, process and store donor data, applications 
used to inform and remind donors about the upcoming blood drive, and similar). 

To  get  this  information,  we  used  Google  to  search  for  the  websites  of  the  national  blood  centres,  blood 
establishments, Red Cross societies in the EU and statistical offices of the EU Member States, the European 
Blood Alliance and the European Directorate for the Quality of Medicines & HealthCare (EDQM). Furthermore, 
we  searched  for  newspaper  articles  and  research  studies  related  to  the  functioning  of  the  blood  donation 
systems in the EU Member States. 

Once  the  data  had  been  collected,  we  produced  country-specific  reports,  which  were  sent  to  the  national 
competent  authorities  for  blood  in  each  of  the  EU  Member  States  via  the  Communication  and  Information 
Resource  Centre  for  Administrations,  Businesses  and  Citizens  (CIRCABC)  and  with  the  intermediation  of  the 
Directorate-General  for  Health  and  Food  Safety.  We  received  feedback  that  included  fact  checking  and  the 
integration  of  missing  information  from  22  of  the  27  Member  States.  The  aggregated  report,  updated  with 
Member States’ feedback, was sent for another round of feedback before publication. 

(18)  We collected blood donation statistics for 2021, with the exception of those from Germany and Slovakia, for which we used data for 

2020. 

13 

 
 
                                                        
3.  Typology of blood donors based on the frequency and proximity of last 

donation 

Blood  is  classified  as  an  essential  medicine  (WHO,  2019 (19)),  and  in  European  countries  it  is  supplied  by 
volunteer  donors.  The Council Recommendation of 29 June 1998 on the suitability of blood  donors and the 
screening of  donated blood in the European Community (98/463/EC) (20), and also the  most recent Guide to 
the preparation, use and quality assurance of blood components by the EDQM (also known as the EDQM Blood 
Guide)  (EDQM,  2020) ( 21),  define  a  donor  as  ‘a  person  in  normal  health  with  a  good  medical  history  who 
voluntarily gives blood or plasma for therapeutic use’. 

Recommended  limits  on  blood  donation  frequency  and  the  time  that  needs  to  elapse  between  donations 
primarily exist to protect the health of  donors.  According  to the EDQM  Blood Guide,  male and female blood 
donors can donate whole blood a maximum of six times and four times, respectively, per year, with at least 
2 months between any two donations. 

In addition to protecting donors’ health, the information about blood donation frequency (the number of times 
a donor gave blood or attended to give blood) and recency (how long ago the last donation took place or last 
attendance  to  donate)  may  reflect  the  habitual  strength  of  a  donor’s  behaviour  (Ferguson,  2004;  Ferguson 
and  Bibby,  2002).  In  other  words,  the  information  about  past  donor  behaviour  (donation  frequency  and 
recency) can help predict a donor’s future behaviour, especially in the case of donors who donate blood on a 
regular  basis;  for  those  who  donate  less  regularly,  intention  to  donate  is  a  better  predictor  of  donation 
(Ferguson and Bibby, 2002; Ouellette and Wood, 1998). In addition, a higher frequency of blood donation will 
enable a donor to identify with the role of being a blood donor (Chell et al., 2021). Thorpe et al. (2020) argue 
that  donor  identity  becomes  a  key  motivation  after  a  donor’s  fifth  donation.  Lastly,  research  indicates  that 
donors should not be treated as a homogenous group when conducting research in the field of blood donation 
and  that  donors’  blood  donation  frequency  and  recency  should  be  taken  into  account  (Ferguson  and  Bibby, 
2002; Ferguson et al., 2007). 

Based on blood donation frequency, donors can be categorised as new donors (donors who have donated for 
the first time and only once) or repeat donors (donors who have donated more than once). Repeat donors 
can be categorised further as novice donors (donors who have donated two to four times) or experienced 
donors  (donors  who  have  donated  more  than  five  times).  With  this  information  in  combination  with  the 
information on blood donation recency (see Table 1), we can further classify donors into the following groups. 

—  Quitters. New donors who have not donated in the last year. 

—  Lapsed weak habit donors. Novice donors who have not donated blood in the last year. 

—  Lapsed strong habit donors. Experienced donors who have not donated blood in the last year. 

—  Active new donors. New donors who have donated blood recently (i.e. in the last year). 

—  Habit-forming donors. Occasional donors – novice donors who have donated recently (i.e. in the 

last year). 

—  Habitual donors. Regular donors – experienced donors who have donated blood recently (i.e. in the 

last year). 

This is of course a cyclical, dynamic, interactive process whereby a new active donor can become a quitter or 
a habit-forming donor, and a habit-forming donor can become a lapsed donor, and so on. Lapsed donors can 
be ‘reactivated’. 

See the World Health Organization website (https://www.who.int/publications/i/item/WHO-MHP-HPS-EML-2021.02). 

(19) 
(20)  98/463/EC: Council Recommendation of 29 June 1998 on the suitability of blood and plasma donors and the screening of donated 
blood  in  the  European  Community  (OJ  L 203,  21.7.1998,  p. 14)  (https://op.europa.eu/en/publication-detail/-/publication/11e3e019-
12ea-4b04-bf49-ad055158ae74). 
For  more  information  on  the  EDQN  Blood  Guide,  see  https://www.edqm.eu/en/-/20th-edition-of-the-edqm-blood-guide-now-
available. 

(21) 

14 

 
                                                        
Figure 4 – Typology of blood donors based on frequency and recency of last donation (adapted from Ferguson, 2004) 

Note: This figure outlines categorisation of blood donors based on donation frequency and recency (proximity of last donation). 

15 

  
 
4.  Social science research agendas 

Social science research agendas in the field of blood donation have focused primarily on theoretical models to 
explore  how  cognitive,  motivational  and  emotional  factors  contribute  to  predicting  donor  intentions  and 
behaviour.  Overall,  these  theoretical  models  have  been  instrumental  in  advancing  our  understanding  of  the 
psychological  factors  that  contribute  to  blood  donation  behaviour  and  have  provided  a  foundation  for  the 
development of interventions aiming to increase donation rates. However, more research is needed to further 
validate and refine these models and to explore additional factors that may affect donation behaviour. In this 
section,  we  present  three  theoretical  models –  (1)  the  theory  of  planned  behaviour  (TPB),  (2)  stage  models 
and  (3)  self-determination  theory –  to  explore  how  cognitive,  motivational  and  emotional  factors  help  to 
predict donor intentions and behaviour (Ferguson et al., 2007). 

4.1.  Theory of planned behaviour 

There is a long line of research demonstrating that the intention to perform an act is the best predictor of the 
action. This is the main postulate of the TPB (Fishbein and Ajzen, 1975), with extensive supporting evidence 
(Biddle, Bank and Slavings, 1987; Lee, Piliavin, and Call, 1999; Randall and Wolff, 1994; Sheppard, Hartwick 
and Warshaw, 1988). According to the TPB, behaviour can be predicted by intentions, which are influenced by 
attitudes, subjective norms and perceived behavioural control (Ajzen, 2012; Ajzen and Fishbein, 2000; Fishbein 
and  Ajzen,  1975;  Fishbein  and  Ajzen,  2010).  This  theory  has  been  applied  widely  to  understand  health  and 
prosocial behaviour, including blood donation (Masser et al., 2008). 

When applied to the field of blood donation, it has been shown that the intention to give blood is a credible 
predictor of future donation activity (Bednall et al., 2013; Callero, Howard and Piliavin, 1987). The intention to 
give  blood  itself  is  determined  by  a  blood  donor’s  attitude  towards  donating  blood,  their  perception  of 
subjective  norms  related  to  blood  donation  and  their  perception  of  being  sufficiently  in  control  to  donate 
blood  (as well as their actual sufficiency of control) (Ferguson,  Murray and O’Carroll,  2019; Ferguson et al., 
2012; Masser et al., 2008; Masser et al., 2012; Masser et al., 2019; Williams, Sun and Masser, 2019). 

In the context of blood donation, attitude relates to what the donor thinks will happen if he or she donates 
blood (anticipation of consequences of blood donation: cognitive attitudes) and how he or she is going to feel 
about donating (evaluation of consequences: affective attitudes) (Conner et al., 2013). Subjective norms are 
related to perceived social approval (of the people who are important to the donor) of their decision to donate 
or not donate. Perceived behavioural control relates to how feasible the decision to donate blood is and if it is 
under  the  donor’s  own  control.  Masser  et  al.  (2009)  compared  several  research  studies  that  included  both 
blood donors and non-donors and concluded that the three main predictors of the TPB combined could explain 
between 31 % and 72 % of the variance in blood donation intentions and between 54 % and 56 % in blood 
donation behaviour. 

Furthermore,  a  meta-analytic  review  by  Bednall  et  al.  (2013)  showed  that,  after  intentions,  perceived 
behavioural control is the strongest predictor of blood donor behaviour. 

The TPB can be extended and include descriptive norms, self-efficacy, donor role identity and prosocial factors 
(Ferguson,  Murray  and  O’Carroll,  2019).  Descriptive  norms  refer  to  the  perception  of  how  many  people 
actually donate blood (Ferguson, Murray and O’Carroll, 2019). Self-efficacy includes perceived confidence to 
give  blood  successfully  (van  Dongen,  2015).  Donor  role  identity  describes  a  set  of  characteristics  or 
expectations that is defined by a donor’s position in society and becomes a dimension of a donor’s sense of 
self (Charng, Piliavin and Callero, 1988). Prosocial factors including pure altruism (incurring pain and costs in 
terms of time and energy without having any personal benefits for the sake of another person’s benefit, i.e. 
the  blood  recipient’s  benefit),  personal  moral  norms  (the  donor’s  belief  that  they  need  to  donate  and  help 
someone  in  need  of  blood)  and  ‘warm  glow’  (feelings  of  positive  affect  that  arise  after  donating  blood 
(Andreoni, 1990)) are important predictors of donor behaviour. 

16 

 
 
 
4.2.  Stage models 

The transtheoretical model (TTM) of behavioural change describes processes and stages of change (Prochaska 
and  DiClemente,  1983;  Prochaska  and  DiClemente,  1986).  According  to  the  authors,  processes  of  change 
include consciousness-raising, self-liberation, social liberation, self-reevaluation, environmental re-evaluation, 
counter-conditioning, stimulus control, reinforcement management, dramatic relief and helping relationships. 
Stages  of  change  include  pre-contemplation,  contemplation,  action  and  maintenance.  Processes  enable  the 
transition  from  one  stage  to  another.  A  key  aspect  of  this  model  is  the  way  in  which  specific  processes  of 
change are hypothesised to be more effective in transitioning people from one stage to another. 

The  TTM  of  behavioural  change  has  been  applied  widely  to  different  types  of  health-related  behaviours, 
including  donating  blood.  In  particular,  Ferguson  (1996)  adapted  and  applied  the  TTM  in  the  field  of  blood 
donation  to  explain  the  stages  of  donor  decision-making  as  follows:  (1)  pre-contemplative  stage  (the  non-
donor who does not plan to donate blood), (2) contemplative stage (the non-donor who becomes aware of the 
need  for  blood  donations),  (3)  preparation  stage  (the  potential  donor  who  is  prepared  to  donate  blood),  (4) 
action stage (the first-time donor or novice donor) and (5) maintenance stage (the committed and repeated 
donor). Each person is a non-donor before first donating. After the first donation, they become a new donor, 
after  a  second  donation  a  novice  donor  and  after  five  donations  an  experienced  donor  (Ferguson,  2004). 
Indeed, Ferguson and Chandler (2005) identified three stages of change associated with blood donation: (1) a 
pre-contemplative  stage, 
(3)  a  combined 
action/maintenance stage. Because the decision-making process differs in each of those stages, it is advised 
to  tailor  stage-specific  interventions  when  encouraging  blood  donations  (Ferguson,  Murray  and  O’Carroll, 
2019). Indeed, the TTM has subsequently been applied successfully to understand blood donor behaviour (e.g. 
Sardi  et  al.,  2019)  and  as  the  basis  of  an  intervention  to  encourage  people  from  the  Black  community  to 
donate blood (Amoyal et al., 2013). 

(2)  a  combined  contemplation/preparation  stage  and 

4.3.  Self-determination theory 

Self-determination  theory  describes  human  personality  and  motivation  and  suggests  that  a  person  can 
become  self-determined  (understood  as  being  able  to  make  choices  and  exert  control  over  their  life)  once 
their needs for competence, relatedness or connection, and autonomy are fulfilled (Deci and Ryan, 2012). This 
theory emphasises the role of intrinsic motivation in fulfilling self-determination. Intrinsic motivation refers to 
the  motivation  to  perform  an  act  for  the  sake  of  the  act  being  interesting  and/or  enjoyable.  Intrinsic 
motivation  is  opposite  to  extrinsic  motivation  (e.g.  performing  an  act  because  of  a  potential  monetary  or 
reputational  reward).  According  to  self-determination  theory,  intrinsically  motivated  behaviour  has  a  higher 
chance of being persistent than extrinsically motivated behaviour (Hagger, Chatzisarantis and Harris, 2006). 

Applied to blood donation, self-determination theory predicts that donor motivation to donate blood depends 
on whether their needs for competence, relatedness or connection, and autonomy are fulfilled (France et al., 
2017).  Therefore,  promoting  donor  competence,  relatedness  or  connection,  and  autonomy  could  enhance 
internal motivation for giving blood. For example, providing donors with information on how to cope with fears 
and doubts can enhance their feeling of competence (France et al., 2011). Similarly, motivational interviewing 
can  enhance  donors’  perceived  autonomy  (Livitz  et  al.,  2017;  Livitz  et  al.,  2019).  Lastly,  relatedness  can  be 
enhanced using social media to promote feelings of belonging or connectedness among donors (France et al., 
2016). 

4.4.  Empirical  evidence  on  motivation  that  leads  to  intention  to  donate  blood 

and to actual blood donation behaviour 

This  section  explores  attitudes  of  non-donors  and  donors  towards  specific  motivation  devices  and  whether 
they would change their intentions to donate blood if they were offered a specific incentive. In addition, this 
section summarises findings of cross-sectional and survey studies on donor motivation to donate blood (blood 
donation behaviour). 

Determinants  of  donors’  willingness  to  donate.  Willingness  to  donate  blood  is  influenced  by  personal 
characteristics,  beliefs,  motivations  and  cultural  context  (De  Kort  et  al.,  2010;  Gorleer,  Bracke  and  Hustinx, 
2020; Healy, 2000; Piersma et al., 2017). Using the data from the 2014 Eurobarometer survey that was sent 
to 27 868 participants from the EU-28, Huis in ‘t Veld, de Kort and Merz (2019) showed that willingness to 

17 

 
 
donate  varied  significantly  across  Member  States.  Furthermore,  willingness  to  donate  was  positively 
associated with perceived blood transfusion safety and the possibility of helping family or people in need of 
donated blood. In addition, these two motivators were generating stronger responses than incentives such as 
refreshments, health tests and reimbursement of travel costs. In terms of the cultural context in which donors 
were brought up, there is a higher probability that individuals who grew up in a family where blood donation 
was a common practice will also choose to become blood donors (Pedersen et al., 2015). 

Blood  donor  characteristics.  Blood  donor  characteristics  refer  to  a  variety  of  individual  factors  that  can 
influence  blood  donation  behaviour,  including  demographic,  health-related  and  psychological  factors.  For 
example, studies have shown that older individuals are more likely to donate blood than younger individuals, 
older  first-time  donors  are  more  likely  to  donate  again  than  middle-aged  first-time  donors  (Masser  et  al., 
2020) and men are more likely to donate than women (France, France and Himawan, 2007). Socioeconomic 
status,  including  income  and  education  level,  has  also  been  found  to  be  positively  associated  with  blood 
donation behaviour (Kessler, Grillberger and Brouwer, 2007). Health-related factors, such as perceived health 
status  and  knowledge  about  blood  donation,  are  also  important  predictors  of  blood  donation  behaviour. 
Individuals  who  perceive  themselves  to  be  in  good  health  and  who  have  knowledge  about  the  benefits  of 
blood  donation  are  more  likely  to  donate  blood  than  those  who  do  not  (Kessler  et  al.,  2007).  Interestingly, 
Sirven,  Chopard  and  Errea  (2018)  showed  that  risk-averse  individuals  are  less  prone  to  give  blood.  Risk 
aversion refers to the tendency of individuals to avoid risky situations and to prefer safe options, even if the 
potential rewards of risky options are higher. In the context of blood donation, risk aversion can manifest in 
the form of concerns about the potential health risks associated with the donation process. These risks can 
include physical discomfort, adverse reactions and the possibility of contracting infectious diseases. 

Incentives. One of the earliest large-scale studies on the role of incentives as motivation devices in  blood 
donation  was  that  of  Glynn  et  al.  (2003).  The  authors  evaluated  potential  responses  to  future  incentives  in 
45 588 American whole-blood donors. The results showed that incentives encouraging donors to donate were 
cholesterol screening (for 61 % of donors), blood credits, a scheme to recognise donors for reaching donation 
milestones  (for  61 %  of  donors)  and  prostate-specific  antigen  screening  (for  73 %  of  male  donors). 
Furthermore, incentives were shown to be effective in generating more donations if donations were made in 
the relative anonymity of donation centres (Goette, Stutzer and Frey, 2010). 

Social  media  and  blood  donation.  Social  media  has  been  shown  to  be  a  significant  tool  for  changing 
behaviour  (Ramondt,  Kerkhof  and  Merz,  2022).  The  question  has  been  raised  if  social  media  can  promote 
blood donation successfully and help in recruiting and retaining blood donors. Sümnig et al. (2018) conducted 
a  study  with  the  aim  to  evaluate  the  impact  of  different  strategies,  including  the  use  of  social  media,  on 
donor motivation. This study included sending a questionnaire about demographic characteristics, the number 
of prior donations and 14 potential motivators for blood donation to whole-blood donors in Germany. A total 
of  2 920  whole-blood  donors  participated  in  the  survey.  The  results  showed  that  more  than  7 %  of  donors 
reported that they were attracted to donation by social media. Most of these donors were young and female. 
Importantly,  social  media  was  rated  as  the  second  most  effective  motivator  to  recruit  first-time  donors, 
friends and relatives. 

To  understand  barriers  to  blood  donation  and  associated  emotions,  Ramondt  et  al.  (2021)  conducted  a 
semantic  network  analysis  of  messages  posted  by  Dutch  non-donors  and  donors  on  Facebook  and  Twitter. 
Digital data were collected through Coosto and messages including the terms related to blood donors, blood 
donation  and  blood  collection  agencies  were  searched  for.  The  authors  identified  the  following  donation 
barriers:  lifestyle,  donation  location,  medical  reasons,  no  invitation,  opening  times,  physical  reactions, 
pregnancy,  blood  bank  top  management  remunerations,  sexual  risk  behaviour,  time  constraints,  travel,  and 
waiting times. The results of this study supported some results from other studies, for example that the main 
barriers  for  non-donors  and  lapsed  donors  were  medical  reasons  and  associated  emotions  (mainly 
disappointment).  However, this approach  helped in identifying a new barrier: there  was a strong association 
between blood bank policy on sexual risk behaviour and associated deferral (i.e. exclusion of men who have 
sex with men) and involuntary non-donation. 

Blood  donation  and  COVID-19.  Blood  donation  systems  faced  another  challenge  with  the  COVID
19 
pandemic. In addition to governments imposing  different  types of restrictions, including limited movements, 
contact  tracing,  physical  distancing  and  other  measures  that  deterred  donors  from  donating,  some  donors 
decided  not  to  donate  because  they  felt  unsafe  regarding  the  risk  of  COVID-19  infection  (Bilancini  et  al., 
2022).  This  led  to  a  decline  in  the  supply  of  whole-blood  donations  in  many  countries,  including  Ireland, 
France,  Germany  and  the  United  Kingdom  (Chell  et  al.,  2022).  In  one  of  the  earliest  studies  related  to 
intentions and donation-related behaviour during the COVID 19 pandemic, Masser, Hyde and Ferguson (2020) 

‐

18 

showed  that  Australian  donors’  donation  intentions  were  driven  by  elements  of  rational  decision-making, 
despite  the  sometimes  irrational  level  of  fear  of  contracting  COVID-19  from  donating  blood.  Furthermore, 
their recommendation to blood donation agencies was to build trust with donors though communication and 
assurance of minimal risk of contracting COVID-19 from donating blood. Using the European setting, Chandler 
et al. (2021) provided similar evidence of the need for clear communication to donors about safety measures 
and the minimal risk of contracting COVID-19 when donating blood. Furthermore, donors reported changes in 
their donation behaviour during the COVID-19 pandemic. Namely, they were donating less than normally, and 
they had to invest additional effort to donate. The authors show that, among the donors in their sample, the 
perceived risk of contracting COVID-19 while donation was low; however, the donors for whom this perceived 
risk was high were less likely to donate. 

Reasons why donors lapse or cease donating. It has already been noted that recruiting new donors and 
retaining  experienced  donors  are  equally  important  activities,  with  a  difference  being  that  the  latter  is  less 
costly.  Therefore,  it  is  important  to  understand  what  makes  donors  lapse  or  cease  donating.  The  empirical 
evidence  suggests  that  medical  reasons,  fear  of  needles,  negligence,  lifestyle  barriers,  perceived 
inconvenience, lack of marketing communication, lack of knowledge about donating, and negative experiences 
are the main barriers to donation for lapsed blood donors (Charbonneau, Cloutier and Carrier, 2016). Similarly, 
Merz, Ferguson and van Dongen (2018) showed that the primary reasons for donors lapsing were anxiety and 
a lack of information about  the donation procedure. Furthermore, among the main life events that increase 
the  chances of donors lapsing, Piersma et al. (2019) found childbirth and losing or starting a job to be the 
most significant. Conversely, blood transfusion in a family member or the death of a family member reduced 
the chances of donor lapsing. 

Klinkenberg et al. (2018) found reasons for blood donors ceasing to donate to be gender-specific, age-specific 
and  dependent  on  donor  donation  frequency.  Donors  who  had  ceased  donating  reported  negative  physical 
experiences (predominant in  the case of  women, younger donors and  donors with less experience donating) 
and inconvenient opening times (mostly reported by male, older and experienced donors) as the main reasons 
for ceasing to donate blood. 

19 

 
5.  Behavioural science research agendas 

This section examines the impact of interventions on donor recruitment and retention (Ferguson et al., 2007). 
The  most  common  methods  used  in  the  behavioural  sciences  to  measure  this  impact  are  laboratory-  and 
field-based experiments ( 22). In this review, we concentrate on the interventions that use incentives and non-
incentives. Chell et al. (2018) define an incentive as ‘an extrinsic reward (monetary or nonmonetary) designed 
to motivate a specific behavioural action (e.g. recruitment, retention, or reactivation) that is offered before an 
action occurs’. In addition to interventions that tested monetary incentives (i.e. cash payments, vouchers, gift 
cards ( 23) and similar) and non-monetary incentives with some material component (e.g. paid days or time off 
work,  or  a  health  check (24)),  we  included  non-incentives,  including  social/community  recognition  (i.e. 
solicitation letters, public pledges to donate blood, and similar) for promoting blood donation. 

It  is  essential  to  stress  once  more  the  importance  of  understanding  the  differences  in  how  monetary 
incentives are treated in the  scientific literature, investigating EU and non-EU  countries, and in the EU legal 
framework  in  the  context  of  blood  donation.  Whereas  the  EU  Charter  of  Fundamental  Rights  requires  non-
commercialisation of the human body, which translates into a principle of voluntary and unpaid donation in 
EU legislation, the scientific literature explores a variety of incentives, including those that may be prohibited 
by EU legislation. In EU legislation, compensation to ensure that donors are not financially disadvantaged by 
their  donation  can  be  acceptable.  However,  such  compensation  should  never  constitute  an  incentive  per  se; 
nor  should  it  constitute  an  incentive  that  could  cause  donors  to  be  dishonest  about  their  medical  or 
behavioural history or to donate more frequently than is allowed, which could pose risks to their own health 
and that of potential recipients. It is important to note that the inclusion of incentives that are not permitted 
by  EU  legislation  in  this  document  is  solely  for  scientific  purposes  and  does  not  imply  any  form  of 
endorsement.  Rather,  it  is  conducted  to  explore  their  potential  impact  on  the  behaviours  and  decisions  of 
individuals in  various  contexts and it reflects a scientific interest in  understanding the complex factors that 
influence blood donation decisions. 

Table 1 – Interventions investigated in this review and their associated categories 

Non-incentives 

Other behavioural 
interventions 

Monetary 

Incentives 

Non-monetary with 
some material 
component 
  Paid days or time off 

  Reminders (e.g. 

  Applied muscle 

  Vouchers and gift 

cards 

work 

  Cash payments 

  Health checks 

tension 
  Distraction 

techniques (e.g. 
watching videos or 
listening to music) 
  Relaxation  techniques 
(e.g. deep breathing) 

solicitation letters, 
phone calls, email 
messages, WhatsApp 
messages, donor 
registry) 

  Active decision 
elicitation 
mechanisms 
  Private and public 

pledges to give blood 
  Information on blood 

use 

  Information about 
deferral policies 

(22) 

An experiment in social sciences refers to a research method that involves the manipulation of one or more independent variables in 
order to observe and measure the effect on one or more dependent variables, while controlling for extraneous variables. In other 
words,  the  experiment  involves  systematically  varying  the  conditions  under  which  observations  are  made  in  order  to  determine 
causality between variables. The purpose of conducting experiments in social sciences is to test hypotheses and make inferences 
about cause-and-effect relationships between variables. These experiments are often conducted in controlled settings and aim to 
establish  a  cause-and-effect  relationship  between  the  independent  and  dependent  variables  while  minimising  the  influence  of 
extraneous factors. 

(23)  Vouchers and gift cards also have a potential monetary value, but not in the form of a direct cash payment. Their value has to be 

such that they are not coercive. 

(24)  Health checks can have a monetary value if healthcare is private and costly. 

20 

                                                        
5.1.  Interventions testing the effectiveness of non-incentives 

Non-incentives  are  designed  to  increase  the  salience  of  donating  blood  and  boost  blood  donors’  intrinsic 
motivation  (Irving  et  al.,  2020).  These  interventions  can  take  different  forms,  including  reminders,  active 
decision elicitation mechanisms, public or private pledges to donate blood, and informing the donor once his 
or her blood is used. Explanations of each of the categories are provided in this section. 

5.1.1.  Reminders to retain and recruit donors 

Reminders, such as emails, letters, text messages, phone calls and similar, are used to inform donors (donor 
retention)  and  non-donors  (donor  recruitment)  of  blood  drive  details.  They  have  been  shown  to  be  cost-
effective tools for encouraging blood donations (Godin et al., 2012, Vuletić Čugalj, 2015). Numerous studies 
have  tested  and  compared  the  effectiveness  of  different  types  of  reminders  on  increasing  blood  donation; 
some of these are detailed below. 

Solicitation letters. Specifically, Chamla, Leland and Walsh (2006) tested the effect of a recruitment letter 
on donor return rate in Dunedin, New Zealand. A total of 318 donors who had donated blood for the first or 
second  time  received  either  a  recruitment  letter  that  included  information  about  donor  blood  type  and  the 
percentage  of  the  general  population  with  the  same  blood  type  or  a  recruitment  letter  with  general 
information. The results of this study showed that donors receiving the more detailed solicitation letter were 
34 %  more  likely  to  return  to  donate  blood  than  donors  receiving  the  general  information.  Using  a 
considerably larger sample size, Vuletić Čugalj (2015) conducted a field experiment with 3 236 blood donors 
from  Sarajevo,  Bosnia  and  Herzegovina,  to  test  the  effect  of  a  letter  informing  donors  about  potential 
summer shortages and asking them to donate blood. In addition, the author varied the letter in terms of goal 
framing ( 25), whether a specific victim (26) was identified and the gender of the victim. Interestingly, although 
the framing of the letter had relatively little effect when donors were allowed to make their donation decision 
1 month later, receipt of the letter increased the likelihood of donating by 6.44 percentage points. Similarly, 
Vuletić Čugalj (2019) showed that when the information on potential blood recipient gender was identified in 
the blood soliciting letters, 74 % more blood donors donated if the potential blood recipient’s gender matched 
their own. This evidence suggests that blood donation services may use letters soliciting blood donations as a 
cost-effective  policy  tool  for  donor  retention.  Importantly,  special  attention  should  be  dedicated  to  the 
framing of those letters, taking into consideration the donor’s gender to increase effectiveness. 

Phone  calls.  Despite  extensive  evidence  on  the  short-term  effect  of  reminders  on  blood  donation,  little  is 
known about their long-term effects. In an interesting study on the short-term and long-term effects of phone 
call reminders ( 27),  Bruhin et al. (2015) tested their effect on the behaviour of  different  categories of  blood 
donors  (highly  motivated  donors  v  donors  with  a  low  baseline  donation  rate).  This  large-scale  study 
encompassed  40 653  donors  from  Zurich,  Switzerland,  who  received  either  a  phone  call  conveying  the 
message that their blood type was needed or no phone call. Results showed that the effect of a phone call 
reminder had different short-term and long-term effects on highly motivated and irregular donors. The phone 
call raised the probability of attending a blood drive in highly motivated donors in the short-term by 9.9 %. 
However, in the long-term this effect decreased by 2.3 % at each future blood drive. For irregular donors the 
phone  call reminder increased their  probability to donate  by 5.8 % at the upcoming  blood drive (short-term 
effect) and by 2.1 % at the  next blood  drive  (long-term  effect). The  policy recommendation of this study is 
that the effects of behavioural interventions on donation rates could vary both over time and across donors 
and  that  blood  services  should  take  this  into  account  when  designing  interventions  for  blood  donor 
recruitment and retention. 

Email messages. Ferguson et al. (2023) conducted a field experiment with 5 821 blood donors to test the 
effectiveness of  warm-glow  messages in predicting  donation within a 3-month  period. They also varied the 
priming of the cooperative identity in their treatments. The results of their intention-to-treat analysis showed 

(25) 

(26) 

(27) 

In the framing literature, goal frames refer to frames that focus on a motivated goal (Levin, Schneider, Gaeth, 1998). The authors 
used this framework to test the differences in the perception of loss and gain framing (goal framing) of the letters (Kahneman and 
Tversky, 1979). In particular, donors were asked to either ‘save lives’ or ‘prevent deaths’ by donating blood. 
Letters soliciting blood donation mentioned either ‘a single person in need of blood’ (there was a male and a female patient in real 
need of blood) using their picture and name and why they need blood (identified victim) or ‘unidentified people in need of blood’ 
(statistical victims) to test the occurrence of the ‘identifiable victim effect’ in blood donations (Schelling, 1968; Seyoung and Feeley, 
2016). 
This phone call was made by an administrative assistant, informing the donors that it was important to come and donate at the 
upcoming  blood  drive  (which  happened  2 days  later)  because  there  was  a  scarcity  of  blood  of  the  donor’s  blood  type  on  that 
particular day. 

21 

                                                        
that the message in which they combined warm-glow messaging and priming donor identity was 1.279 times 
more  effective  in  motivating  donors  to  return  to  donate  blood  than  the  control  scenario  (no  message).  The 
authors further performed an implementation study in which they compared donation attendance in a 3-year 
period  prior  to  the  warm-glow  message  being  sent  to  all  first-time  donors  in  Australia  to  a  2-year  post-
implementation  period.  The  warm-glow  message  induced  an  increase  in  the  overall  donor  return  rate, 
especially in those who had not booked their next appointment, suggesting that blood donation services can 
use this cost-effective approach to sustain the long-term cooperative behaviour of their repeat donors. 

WhatsApp messages. Recent advancements in mobile technology have enabled the use of applications for 
communication with blood donors. Rodrigues Lucena et al. (2020) tested the effectiveness of WhatsApp as a 
communication tool on blood donor return rates. Authors randomly assigned 548 blood donors who donated 
blood  in  one  private  blood  bank  in  Brazil  to  either  a  treatment  group  (four  messages,  designed  following  a 
strategy of persuasive communication, sent at different time points (28) using WhatsApp) or a control  group 
(no  message).  The  authors  did  not  find  any  effect  of  WhatsApp  messages  on  donor  return  rates.  To  our 
knowledge,  this  is  the  only  study  that  has  experimentally  tested  the  effect  of  a  message  via  WhatsApp  on 
encouraging blood donations. This implies that there is a need for further research with treatments designed 
to  enable  testing  the  effectiveness  of  the  mode  of  delivery  (WhatsApp)  independently  of  the  content  of 
delivery (the message itself). 

Donor  registry.  Heger  et  al.  (2020)  showed  that  an  invitation  to  join  the  Australian  Red  Cross  donor 
registry ( 29),  which  included  critical  shortage  appeals,  increased  the  response  rate  of  long-lapsed  donors  by 
66 % in comparison with long-lapsed donors who had not been invited to join this registry. Yet, long-lapsed 
donors were no more likely to donate when there were no shortages. This result suggests the use of a registry 
of this type to improve the coordination between donors and blood collection centres and to increase supply 
during critical shortage periods. 

Combining different types of reminders. In a large-scale field experiment encompassing 11 880 Chinese 
inactive  donors  (those  who  had  made  at  least  one  donation  but  had  not  donated  within  the  previous 
24 months),  Ou-Yang  et  al.  (2020)  tested  the  effect  of  phone  call  reminders  versus  text  message 
reminders  on  inactive  donors’  redonation  rates.  They  additionally  included  an  altruistic  appeal  in  the  text 
message  reminders.  The  estimated  average  treatment  effect  showed  that  phone  calls  increased  the  re-
donation rate by 2.3 percentage points compared with text messages among compliers (inactive donors who 
received the treatment and came to donate). Another study with a similar experimental design was conducted 
in Brazil by Porto-Ferreira et al. (2017). The authors used a non-standard donor pool – non-responding first-
time blood donors with reactive serological tests – to test the effectiveness of text messages, letters and 
phone calls requesting return  for notification and counselling on  return  rates. They found that  phone  calls 
were more effective than text messages (39.8 %  v  28.4 %) in increasing the return rate of non-responding 
first-time blood donors with reactive serological tests; however, when compared with a letter, the difference 
in  effectiveness  was  not  significant  (39.8 %  v  34.4 %).  The  results  of  these  two  studies  suggest  to  blood 
donation centres that, when deciding about the mode of the delivery of a blood donation reminder message, it 
is more effective to use phone calls than text messages. 

5.1.2.  Active decision elicitation mechanisms 

For  many  non-donors,  donating  blood  might  look  like  a  costly  and  unpleasant  activity.  As  a  result  of  not 
reflecting on the  prosocial aspect of this activity,  potential donors may not decide to donate blood. Stutzer, 
Goette  and  Zehnder  (2006)  hypothesised  that  engaging  people  who  were  not  well  informed  about  blood 
donation  in  an  active  decision  to  donate  can  convince  them  to  donate.  They  tested  this  hypothesis  using  a 
field experiment conducted in cooperation with the Red Cross in Zurich, Switzerland. Participants in the control 
group  filled  in  a  questionnaire  and  received  information  about  the  blood  drive.  Participants  in  the  ‘strong 
active decision treatment’ were additionally asked to decide, on the spot, if they were willing to donate blood. 
Participants in the ‘weak active decision treatment’ had the option to make or postpone the decision to donate 
blood. Results showed that the donation rate of participants who were not sufficiently informed about blood 
donation increases by 8 percentage points after being asked to make an active decision to donate blood (i.e. 
those in the ‘strong active decision treatment’ group). In contrast, there was no effect of being asked to make 

(28) 
(29) 

The time points were 1 week after donation, 2 weeks after donation, 3 months after donation and 4 months after donation. 
The main purpose of this registry was to help coordinate the supply and demand of blood. Long-lapsed donors on the registry were 
told that the blood service is creating a register and that the donor will be contacted only when there is a need for their blood type 
and only once or twice per year. It was assumed that this would encourage the donors to make an implicit commitment to donate. 

22 

                                                        
an  active  decision  on  participants  who  were  sufficiently  informed.  Similarly,  the  ‘weak  active  decision 
treatment’  did  not  have  a  significant  effect  on  participants  regardless  of  whether  or  not  they  were  well 
informed. The results of this study recommend interventions using active decision elicitation mechanisms to 
target  non-donors  and  early-career  donors,  especially  those  who  lack  sufficient  information  about  blood 
donation. 

5.1.3.  Private and public pledges to donate blood 

Based on the premise that  people tend to  behave in socially desirable ways, in  particular incurring costs or 
forgoing benefits to maintain their social image (Bursztyn and Jensen, 2017), Meyer and Tripodi (2021) tested 
whether appealing to the social image concerns of prospective donors ( 30) can motivate them to donate blood. 
The authors used a framed field experiment with a 2 × 2 between-subjects design. They varied the visibility of 
the pledge – private versus public – and the type of the blood collection organisation: the Red Cross versus a 
commercial  blood  bank ( 31).  Participants  were  customers  visiting  a  German  municipal  government  service 
centre, some accompanied by friends or family members. The researchers offered participants the opportunity 
to sign up for blood drives either privately, using a tablet computer visible only to the specific participant, or 
publicly, asking verbally. The results show that 27 % of these participants pledged privately to donate blood in 
the following  months, but only 1 % actually  did so. Making the pledge  publicly in front of friends or family 
members  increased  the  pledge  rate  by  an  estimated  16.8 percentage  points.  Unfortunately,  this  did  not 
increase actual donation rates. Additional evidence on the effect on blood donations of donors’ social image 
concerns is provided by Lacetera and Macis (2010). They used an observational study on a sample of Italian 
blood  donors  and  showed  that  donors  increased  the  frequency  of  their  donations  when  approaching  the 
thresholds at which they would be given a reward only where those rewards would be publicly announced in 
the local newspaper and presented during a public ceremony. This implies that, depending on the mode, public 
pledging can have a positive effect on donation rate. 

5.1.4.  Informing donors once their blood is used 

Following the blood  service  practice of Stockholm, Sweden, several  blood services from  Australia,  Denmark, 
Ireland and the United Kingdom started implementing the strategy of informing blood donors once recipients 
received their blood (Goette and Tripodi, 2020; Moussaoui et al., 2019). Because this strategy drew a lot of 
media attention (32) and started to be used extensively in practice, several research studies tried to measure 
the effectiveness of this type of feedback on blood donation rates ( 33). However, the evidence is inconclusive. 

For  example,  Fosgaard  et  al.  (2020)  conducted  a  field  experiment  with  20 365  Danish  whole-blood  and 
plasma  donors.  Participants  did  or  did  not  receive  a  text  message  when  their  donation  was  used.  The 
researchers  also  varied  the  time  of  the  day  when  the  message  was  sent.  The  results  show  that  the  text 
message increased the number of subsequent donations by 3.6 %. In addition, heterogeneity analysis showed 
that this effect was specific to plasma donors. That is, informing donors by text message that their donation 
had  been  used  did  not  have  a  significant  effect  on  whole-blood  donations,  but  it  had  a  highly  significant 
effect on plasma donations. It is worth noting that Gemelli et al. (2018) found that a non-incentive (a post-
donation text message informing the donor of the hospital or town to which their blood was dispatched) had 
a  similar  effect  on  some  whole-blood  donors –  that  is,  first-time,  novice  and  established  donors,  but  not 
experienced donors. 

Comparably, Pongsananurak et al. (2020) tested the effects of a text message sent to first-time whole-blood 
donors in Thailand once their blood was  dispatched  from  the transfusion service. In a  field experiment with 
1 270 donors receiving the text message and 1 270 donors not receiving the text message, the researchers 
found that the text message significantly increased the donation return rate. 

Using a similar research design, Moussaoui et al. (2019) sent text messages to thank 2 064 donors for their 
donation  and  to  inform  them  that  their  blood  was  ready  to  be  used.  Donors  in  the  control  group  (2 034 
donors)  did  not  get  a  text  message.  When  return  rates  of  donors  from  the  treatment  group  and  from  the 

(30)  Out of 596 study participants, 65 had previously donated either through the German Red Cross or at the commercial blood bank. 
(31) 

In  Germany,  donors  can  donate  blood  voluntarily  and  without  remuneration  through  the  Red  Cross  or  they  can  receive  financial 
remuneration in return for blood donations through private blood banks. 
See, 
someone-is-helped-with-their-blood-10310101.html. 
There were even some concerns that this type of incentive could have negative effects as it might signal to the donor that blood 
supply levels are high and there is no need to give blood again (Daminger and Kimmel, 2015). 

https://www.independent.co.uk/news/world/europe/blood-donors-in-sweden-get-a-text-message-whenever-

(32) 

(33) 

example, 

for 

23 

                                                        
control group in the 6- to 10-month period from the last donation were compared, it was found that the text 
message had a small but significant effect – it generated an additional 37 donations for the blood donation 
centre. 

However,  there  is  also  evidence  for  negative  effects  of  this  type  of  non-incentive  on  blood  donation.  In 
particular, Goette and Tripodi (2020) used a sample of 8 591 Italian donors and a 2 × 2 experimental design 
to test the effect on blood donation rates of providing donors with information once their blood was used ( 34). 
Conducted  in  cooperation  with  a  non-governmental  organisation  responsible  for  blood  collection,  the 
experiment tested the effect of feedback on previous donation utilisation in an email from the organisation. 
Orthogonal  to  this  treatment,  the  authors  also  varied  whether  or  not  the  email  contained  an  invitation  to 
schedule an early appointment for the next donation. In contrast to the previously mentioned studies, this one 
used  email  messages  for  correspondence  with  donors.  The  results  show  that  providing  donors  with  the 
information  that  their  previous  blood  had  been  used  decreased  blood  donations  by  6.9 %  over  the  study 
period. The authors explained that this type of feedback might have reminded the donor of a past donation 
(past  good  action)  and  postponed  the  need  to  engage  again  in  prosocial  activity  (donating  blood).  Lastly, 
asking donors to schedule an early appointment using email correspondence did not have any effect on blood 
donation rates. Because the evidence on the effectiveness of informing donors that their blood has been used 
is inconclusive, it is not feasible to make a general recommendation on the use of this type on non-incentive 
in practice. 

5.1.5.  Informing deferred donors about deferral policies 

To  protect  donor’s  and  patient’s  health  and  to  comply  with  legislation,  blood  banks  follow  strict  deferral 
policies.  For  example,  donors  will  not  be  allowed  to  donate  if  they  travelled  to  a  virus-endemic  area (35),  if 
their  haemoglobin  levels  are  low  or  if  they  are  underweight.  Deferral  has  a  negative  impact  on  donor 
behaviour,  particularly  among  individuals  who  are  donating  blood  for  the  first  time  (Piersma  et  al.,  2017). 
Some reasons for deferrals might be temporary and donors would be able to donate in the future. However, 
not all donors are aware of deferral policies, and they might think or feel that being deferred once prevents 
them from donating ever again. 

With the intention to understand how to increase return rates after deferral, Spekman, van Tilburg and Merz 
(2022)  conducted  a  field  experiment  with  660  deferred  (whole-blood  and  plasma)  donors  from  the 
Netherlands. To measure return within 4 weeks of the donor being invited again and of their deferral expiring, 
the  authors  used  an  experimental  design  with  a  control  group  and  four  treatment  groups.  Donors  in  the 
treatment groups were offered the opportunity to perform an alternative good deed (design a postcard to a 
patient  receiving  a  transfusion  (treatment 1)  or  fill  out  a  questionnaire  (treatment 2))  or  offered  an 
information  brochure  with  additional  information  about  deferral  (treatment 3)  or  given  the  opportunity  to 
choose  one  of  the  good  deeds  (treatment 4).  Their  results  indicate  that  providing  deferred  donors  with 
additional  information  about  deferral  has  a  positive  effect  on  the  return  rate  of  whole-blood  donors.  In 
contrast,  offering  an  alternative  good  deed  (i.e.  designing  a  postcard  for  a  patient  or  filling  out  a 
questionnaire) and allowing a donor to choose between the types of good deed to perform did not have an 
effect  on  deferred  donors’  return  rate.  This  study  suggests  that  blood  donation  centres  should  share 
information about their deferral policies with donors who have been deferred, as this can encourage them to 
return for future donations. 

(34) 

The authors did not inform donors of the exact date when the blood was used; they informed donors that their previous donation 
had been used. 

(35)  Müller-Steinhardt, Weidmann and Klüter (2017) showed that the number of German first-time and repeat donors deferred because 

of travel history increased significantly from 2010 to 2015. 

24 

 
 
                                                        
5.2.  Interventions testing the effectiveness of non-monetary incentives 

Non-monetary incentives with some material component can take the form of goods or services (36) gifted to 
donors in return for a blood donation (Mortimer et al., 2019). 

5.2.1.  Paid days off work 

Even  though  a  paid  day  off  work  is  widely  used  in  practice  to  motivate  donors  to  donate  blood  and  blood 
products,  there  is  a  lack  of  experimental  evidence  on  the  effectiveness  of  this  type  of  incentive.  This  is 
probably because it would be complicated and unfair to offer this incentive to a specific group of donors only. 
Importantly,  there  is  evidence  from  an  observational  study  conducted  by  Lacetera  and  Macis  (2013).  Their 
analysis showed that the incentive of a day off work generates, on average, one extra donation per year from 
employed  donors,  which  is  an  increase  of  around  40 %.  A  paid  day  off  work  can  be  viewed  as  a  form  of 
payment that  has monetary  worth, but  because it is not  a direct  payment of  cash, we classify this as non-
monetary incentive with some material component. Although offering a paid day off work has proven to be an 
effective  incentive  for  encouraging  blood  donations,  it  is  important  to  note  that  this  approach  is  applicable 
only to employed donors (37). 

5.2.2.  Health checks 

Goette and Stutzer (2019) and Goette, Stutzer and Frey (2010) tested if offering cholesterol tests in return 
for blood donations might trigger donor reciprocal behaviour, leading to higher donor response rates (see the 
chapter  ‘Mixed  strategies’  in  Goette  and  Stutzer  (2019)  for  more  detail).  Neither  study  found  a  significant 
effect  of  cholesterol  tests  on  encouraging  blood  donations.  To  test  the  effectiveness  of  offering  a 
comprehensive health check that includes a cholesterol test among other tests (38) on blood donor donation 
behaviour,  Leipnitz  et  al.  (2018)  conducted  two  large-scale  field  experiments  (with  53 257  and  31 522 
previous donors) in cooperation with the German Red Cross blood donation service. The researchers reported 
that offering a comprehensive health test had positive and significant effects on donation rates. In particular, 
it  increased  the  probability  of  donating  blood  by  33 %  in  comparison  with  baseline  (donors  who  received  a 
standard  invitation).  Importantly,  repeated  exposure  to  this  incentive  did  not  deter  donors  from  making 
consecutive donations, suggesting the effectiveness of comprehensive health tests to improve donation rates. 

5.3.  Interventions testing the effectiveness of monetary incentives 

Monetary incentives are financial rewards that blood donors receive in return for donations. Whereas standard 
economic theory predicts that offering monetary incentives should increase the provision of blood donations, 
alternative  theories  indicate  that  this  type  of  incentive  might  crowd  out  blood  donors’  intrinsic  motives  to 
donate (Bénabou and Tirole 2003; Bruers, 2022; Titmuss, 1970). An additional concern that has been raised 
when it comes to offering monetary incentives is that this type of incentive could attract more risk-seeking 
donors  (Goette,  Stutzer  and  Frey,  2010;  Kunin,  1959).  The  empirical  evidence  on  the  effect  of  monetary 
incentives on blood donation is mixed. As a further reminder, the European Commission proposal for revising 
the  EU  blood  legislation  stresses  that  blood  donation  should  be  founded  on  the  principle  of  voluntary  and 
unpaid  donation, and financial incentives and inducements to donors are not  permissible. Compensation, as 
defined by Member States, to remove the risk of donors being financially disadvantaged by their donation can 
be acceptable but should never constitute an incentive, as that may cause donors to be dishonest or behave 
in an unhealthy way (for them or others). 

5.3.1.  Vouchers and gift cards 

Lacetera,  Macis  and  Slonim  (2012)  provide  consistent  evidence  from  an  observational  study  and  a  natural 
field  experiment  that  monetary  incentives  increased  blood  drive  participation.  Their  field  study  involved 
selecting pairs of similar American Red Cross blood drives in Northern Ohio that were randomly assigned to a 

(36)  Note that people can monetise gifts by selling them. 
(37) 

There is another concern that has to be addressed before using this approach. This concern is related to equity, because those blood 
donors  who  are  not  in  employment,  such  as  unemployed  or  retired  donors,  are  not  being  ‘compensated’  whereas  the  employed 
donors are, which is unfair for donors not in employment. 
This health check includes a comprehensive blood test (i.e. a blood level test including testing of cholesterol, creatinine and uric acid 
levels). In Germany, this type of heath check is offered for free (biennially) to individuals aged > 35 years. 

(38) 

25 

 
                                                        
control  condition  (no  incentives)  and  a  treatment  condition  (USD 5,  USD 10  or  USD 15 ( 39)  gift  cards  for  a 
variety of stores, i.e. Walmart, Target, BP, Buehler’s and  Giant Eagle). The results of this study showed that 
blood  drive  participation  rates  and  the  number  of  blood  units  collected  were  significantly  greater  (and 
increasingly  greater  in  correspondence  with  higher  gift  card  value)  for  donors  from  treatment  groups  in 
comparison  to  donors  from  the  control  group.  Notably,  offering  monetary  incentives  did  not  increase  the 
fraction of donors being deferred, and it did not increase the number of ‘risky donors’ coming to donate blood. 
Similarly,  Goette  and  Stutzer  (2019)  showed  that  offering  a  lottery  ticket  in  return  for  blood  donation  was 
effective in increasing the probability of donating blood (see the chapter ‘Mixed strategies’ for more detail). 
The  evidence  suggests  that  providing  monetary  incentives  in  the  form  of  vouchers,  gift  cards  and  lottery 
tickets can be an effective strategy for boosting blood donations. 

5.3.2.  Cash payments 

Empirical evidence on the effectiveness of offering cash payments in improving blood donation rates is not 
unequivocal.  For  example,  the  results  from  an  observational  study  conducted  by  Weidmann  et  al.  (2014) 
suggest that monetary compensation can be used as a short-term strategy to recruit new donors as it may 
increase the probability of donating blood in the first few months after an initial donation. Similarly, using a 
quasi-natural  experiment  in  Germany  in  which  one  blood  donation  centre  stopped  remunerating  donors  for 
blood  donations,  Becker  et  al.  (2019)  reported  that  this  change  in  payment  significantly  reduced  collected 
blood donations. 

The evidence from a field study shows contradictory results, particularly for female donors. To test the effect 
of cash payments, Mellström and Johannesson (2008) conducted a field experiment in which they randomly 
assigned Swedish students to one of the following three conditions: (1) a control group without compensation, 
(2) a treatment  group where students received SEK 50 for  undergoing a  health  check  in order to  become a 
blood donor and (3) a treatment group where students could choose between a SEK 50 payment and donating 
SEK 50  to  charity.  The  effects  were  different  in  men  and  women.  Whereas  interventions  did  not  have  any 
effect  on  male  students,  female  students  were  significantly  less  prone  to  donate  if  offered  cash  payments 
(their supply of blood dropped from 52 % to 30 %). 

In addition to mentioning experimental evidence on the effect of interventions on donor behaviour, here we 
include a study that tested the effect of two types of monetary intervention – a hypothetical cash payment of 
EUR 10 (treatment 1) and a hypothetical voucher to the value of EUR 10 (treatment 2) – on donor intention to 
donate.  Using a field experiment,  Lacetera and  Macis (2009)  varied these two  monetary incentives  for 467 
Italian  donors.  The  authors  reported  that  a  significant  number  of  survey  respondents  stopped  donating  if 
offered EUR 10 in cash in return for making a blood donation, but not if a voucher of the same nominal value 
was  offered  instead.  The  results  of  this  study  imply  that  donors  may  treat  vouchers  as  a  gift  exchanges 
rather than as a financial exchange. 

5.4.  Mixed interventions 

Some studies used a mix of interventions, including non-incentives, non-monetary incentives and/or monetary 
incentives, when testing and comparing their effectiveness in encouraging blood donations. One of the earliest 
studies that tested the effects of non-incentives and non-monetary incentives on donating blood (blood drive 
attendance in particular) was conducted in the United States The authors compared the effect of informing 
undergraduate students about the upcoming blood drive with a focus on altruism and the effect of rewards 
for  blood  donation  on  blood  drive  attendance.  Specifically,  rewards  were  coupons  redeemable  at  local 
merchants and the  possibility of  winning a raffle (tickets to a Broadway  play and a  college football game). 
Significantly  more  students  attended  the  blood  drive  if  offered  rewards  in  comparison  to  being  informed 
about altruistic reasons for blood donation (61 % v 29 %). 

In another study, Reich et al. (2006) used a field experiment with 6 919 first-time American donors to test the 
effect of the following strategies on return donation within 6 months: a non-monetary incentive (i.e. a T-shirt 
as  a  present)  and  two  non-incentives  (i.e.  a  story  about  a  liver  transplant  patient  who  required  blood 
transfusion aimed at donor empathy and altruism, and a complimentary message, such as ‘special people like 
you  are  crucial  to  our  blood  supply’,  aimed  at  donor  self-esteem).  Regardless  of  the  allocated  groups,  the 

(39) 

EUR 4.74, EUR 9.48 and EUR 14.22, respectively. 

26 

 
                                                        
authors  varied  the  method  of  contacting  donors  between  emails  and  phone  calls.  They  showed  that  the  T-
shirt incentive did not have a significant effect on return donation, and that appealing to donors’ empathy and 
altruism  was  significantly  more  effective  than  appealing  to  donor  self-esteem.  Furthermore,  contacting 
donors  by  email  was  significantly  less  effective  than  by  phone  call,  which  is  yet  further  evidence  on  the 
effectiveness of phone calls in comparison to other methods of communication to remind donors about the 
need for blood. 

Similarly, to measure the effect of treatments on the proportion of donors who registered to give blood within 
6 months  of  their  last  donation,  Myhal,  Godin  and  Dubuc  (2017)  randomised  7 399  donors  from  Quebec, 
Canada, to one of the following three treatments: (1) ‘action-planning treatment’ – at the end of the donation 
process, donors were invited to write the date of their next donation on a sticky note; (2) ‘reward treatment’ – 
donors  were  given  an  anti-theft  credit  card  sleeve  in  return  for  blood  donation;  and  (3)  ‘thank  you 
treatment’ –  donors  were  thanked  after  their  donation.  They  found  no  difference  between  the  three 
treatments in the proportions of donors who registered to give blood. However, they found that significantly 
more  women  registered  for  the  next  donation  in  the  ‘thank  you’  treatment  group.  It  is  worth  noting  that 
techniques  such  as  ‘action  planning’,  specifically  the  use  of  implementation  intentions (40)  and  explicit 
commitment ( 41) to bridge the intention–behaviour gap, have been shown to significantly increase the return 
of  newly  registered  donors  and  also  temporarily  deferred  novice  donors  (Godin  et  al.,  2013;  Wevers  et  al., 
2014). 

Using  a  research  design  that  combined  a  non-monetary  incentive  (a  cholesterol  test  in  return  for  blood 
donation) and a non-incentive (solicitation letters with and without an appeal for blood), Goette, Stutzer and 
Frey (2010) tested the effects of these strategies on attracting new donors and motivating previous donors. 
Results  showed  that  neither  cholesterol  tests  nor  solicitation  letters  significantly  increased  donations  from 
non-donors and previous donors during the study period. 

In  parallel,  using  a  large-scale  field  experiment  with  more  than  10 000  previous  blood  donors,  Goette  and 
Stutzer  (2019)  tested  the  effects  of  offering  non-incentives  (an  appeal  to  donate  blood),  non-monetary 
incentives (a cholesterol test) and monetary incentives (a lottery ticket) on the probability of donating blood. 
The authors reported that offering a lottery ticket increased the probability of donating blood during the study 
period by 5.6 percentage points compared with the baseline donation rate (46 %). Offering a cholesterol test 
did not have any effect on the probability of donating blood. 

Similar  to  Goette  and  Stutzer  (2019),  Iajya  et  al.  (2013)  tested  the  effects  of  all  three  types  of  strategies 
combined –  non-incentives,  non-monetary  incentives  and  monetary  incentives –  for  encouraging  blood 
donations using a large-scale field experiment with 18 500 individuals aged 18–65 years from San Miguel de 
Tucuman,  Argentina.  Individuals  received  either  a  ‘pure  control’  flyer  inviting  them  to  donate  or  one  of  the 
following  (combinations  of)  interventions:  (1)  an  ‘information  only’  flyer  that  included  information  on  the 
benefits of undirected donations as opposed to emergency-system donations, (2) an ‘information only’ flyer 
and a T-shirt indicating that  they donated  blood in  return for  blood donation; (3) an ‘information only’ flyer 
and an offer to mention their voluntary blood donation in the ‘Socials’ page of the local newspaper; or (4) an 
‘information only’ flyer and an offered vouchers for use at a local supermarket in three values (ARS 20, ARS 
60 or ARS 100 ( 42)) in return for their blood donation. Variables of interest were the number of usable units of 
blood  collected  and  donor  turnout.  The  results  of  this  study  showed  that  only  offering  incentives  of  higher 
value (vouchers worth ARS 60 and ARS 100) in return for blood donation significantly increased the likelihood 
that an individual made a usable donation compared with the control (‘information only’) condition. However, 
it should be taken into consideration that, as these are vouchers, the  positive effect  may be because these 
are  perceived  as  a  gift  exchange  rather  than  a  financial  exchange  (Lacetera  and  Macis,  2009).  The  donor 
turnout  was  0.43 %  and  0.83 %  (significant  in  both  cases)  in  the  ARS 60  and  ARS 100  treatments, 
respectively,  when  compared  with  the  control  condition,  confirming  that  monetary  incentives  in  the  form  of 
vouchers are effective in increasing blood donations and also usable donations in a middle-income economy. 
Thus, again, there was no evidence that financial incentives lead to donations of poorer-quality blood. 

(40) 

(41) 

(42) 

Implementation  intentions  refer  to  the  specific  plans  individuals  make  to  follow  through  on  their  intentions  to  donate  blood.  By 
creating a concrete plan for blood donation, individuals are more likely to fulfil their intentions and donate blood. 
Explicit commitment refers to the act of making a specific pledge to donate blood, such as signing a pledge card at a blood drive or 
making a verbal commitment to a healthcare provider. 
Approximately EUR 0.11, EUR 0.33 and EUR 0.5, respectively. 

27 

 
                                                        
5.5.  Other behavioural interventions 

Empirical  research  has  identified  several  factors  related  to  a  decreased  likelihood  of  repeat  donation, 
including donor age, gender, education and income (Piliavin, 1990). The study found that younger donors were 
more likely to be repeat donors than older donors, and that women  were more likely to donate blood more 
frequently  than  men.  Donors  with  higher  levels  of  education  and  income  were  also  more  likely  to  donate 
blood on a regular basis. The study also found that previous negative experiences with donating blood, such 
as  vasovagal  reactions,  pain  or  discomfort  during  donation,  were  associated  with  a  decreased  likelihood  of 
repeat donation. Other factors, such as inconvenience, lack of awareness about the need for blood, and fear 
of needles, were also identified as barriers to repeat donation. 

Applied muscle tension is a technique that involves the tensing and releasing of muscle groups to help reduce 
the  likelihood  of  vasovagal  reactions  during  blood  donation.  Vasovagal  reactions,  which  include  fainting, 
dizziness and nausea, are a  common occurrence among  blood  donors and  can discourage  repeat  donations 
(Thijsen and Masser, 2019). Vasovagal reactions were among the strongest factors that deterred donors from 
donating again (Ogata et al., 1980). 

Ditto  et  al.  (2003)  suggested  that  methods  of  preventing  vasovagal  reactions,  such  as  the  applied  muscle 
tension technique ( 43), might influence donor retention. The authors tested the effect of this technique using a 
field study with 605 donors  who were randomised to an  applied  muscle tension treatment  condition, a no-
treatment control condition or a placebo control condition. Although there was no effect of this technique on 
male donors, female donors reported significantly fewer donation-related symptoms. This suggests that the 
use of applied muscle tension could improve donor retention rates, particularly among female donors who are 
more  susceptible  to  vasovagal  reactions.  However,  a  meta-analysis  by  Fisher  et  al.  (2016)  reviewed 
interventions aiming to reduce vasovagal reactions in blood donors, including the use of the applied muscle 
tension technique, and found that although applied muscle tension did lead to a small reduction in the risk of 
vasovagal  reactions,  the  effect  was  not  statistically  significant.  Therefore,  it  can  be  concluded  that  applied 
muscle  tension  may  not  be  as  effective  in  preventing  vasovagal  reactions  as  previously  thought,  and  this 
information should be contemplated when considering interventions to improve donor retention. 

Other interventions include distraction techniques, such as watching videos or listening to music, which have 
been  found  to  be  effective  in  reducing  anxiety  and  pain  during  donation  (Akyol,  Kaban  and  Orsal,  2014; 
Popovsky, Audet and Andrzejewski, 2008). In addition, relaxation techniques such as deep breathing have also 
been  found  to  be  effective  in  reducing  vasovagal  reactions  and  increasing  blood  donation  (France  et  al., 
2008).  Overall,  these  behavioural  interventions  have  shown  promise  in  improving  blood  donation  behaviour 
among  individuals  who  experience  pain,  discomfort  and  fear  during  the  donation  process.  However,  further 
research  is  needed  to  determine  the  effectiveness  of  these  interventions  in  larger  and  more  diverse 
populations. 

(43) 

The applied muscle tension technique consists of repeated contraction of the major muscle groups of the arms and legs. 

28 

 
                                                        
6.  Ethical considerations in behavioural interventions to promote blood 

donation 

As  we  have  assessed  in  this  review,  as  concerns  over  public  health  and  well-being  continue  to  mount, 
behavioural interventions have become a popular approach for promoting blood donation. However, as blood 
donation decisions are highly personal and culturally influenced, the ethical considerations surrounding these 
interventions must not be overlooked. Behavioural interventions might be flagged as potentially manipulative 
and paternalistic and a potential infringement of individual autonomy – either by those implementing them or 
by those being affected by them. This section serves as a brief reminder of the need to reflect on the ethical 
implications  when  designing  and  implementing  behavioural  interventions  in  blood  donation  programmes. 
Although  we  will  touch  on  some  key  ethical  issues,  it  is  important  to  recognise  that  this  is  not  an  all-
encompassing discussion. Rather, it is intended to be a starting point for further dialogue and contemplation 
on the ethical concerns involved in this area. 

When considering the application of behavioural insights into blood donation, it is important to ensure that the 
interventions implemented increase both personal and social welfare. The aim of these interventions should 
be to assist individuals who wish to donate blood in translating their preferences into action. In fact, it should 
be noted that there exists a significant disparity between the intention to donate blood and actual donation 
rates.  Research  suggests  that  without  any  intervention  there  is  only  a  10 %  conversion  rate  in  non-donors, 
indicating  that  90 %  of  non-donors  do  not  act  on  their  expressed  preference  to  donate  blood  (Ferguson, 
Edwards  and  Masser,  2022).  A  similar  trend  is  observed  in  the  context  of  opt-in  organ  donation,  where 
approximately 70 % to 80 % express a desire to opt in but only about 30 % follow through. This implies that 
there  is  a  substantial  proportion  of  people  who  wish  to  donate  blood  (or  organs)  but  do  not,  potentially 
because  of  a  lack  of  information,  cognitive  resources  or  other  obstacles.  Behavioural  interventions  are 
designed to overcome these barriers and promote donation. 

In  promoting  blood  donation,  as  in  all  behavioural  interventions,  it  is  essential  to  address  ethical  concerns 
related  to  individual  welfare,  autonomy  and  dignity  and  the  legitimacy  of  external  influence  on  personal 
choices,  including  the  implications  of  a  potentially  manipulatory  intervention.  Although  manipulation  is  a 
criticism  commonly  levelled  at  behavioural  interventions,  it  is  crucial  to  note  that  an  intervention  aiming  to 
change behaviour does not inherently equate to manipulation (Sunstein, 2016). It is worth emphasising that 
an intervention can be considered manipulative only if it is implemented in a covert manner, through the use 
of  deception,  concealment  or  omission  of  relevant  information  during  the  interaction.  In  other  words,  if  the 
intervention is carried out in a transparent and open manner, and the people involved are fully informed about 
the  purpose  and  potential  consequences  of  the  intervention,  it  cannot  be  regarded  as  manipulative. 
Nevertheless,  this  does  not  prevent  such  interventions  being  considered  by  some  people  as  manipulative. 
Ferguson (2021a) has shown that when a message is clear and transparent, people may still perceive it as 
manipulative, depending on the content of the message. To make sure that behavioural interventions are not 
perceived  as  manipulative  by  those  affected,  acceptability  and  perceptions  of  manipulation  of  any  content 
should  ideally  be  assessed  and  considered.  This  is  particularly  important  when  it  comes  to  behavioural 
interventions  aiming  to  encourage  blood  donations –  which  are  based  on  health-related  and  therefore 
personal decisions – where individuals’ autonomy and consent must be fully respected. Although persuasion 
as  a  means  to  assist  people  in  acting  on  their  preferences  is  acceptable,  undue  pressure  on  individuals  to 
donate can compromise their decision-making process and may lead to regret or resentment. This is one of 
the  reasons  why  both  the  legislative  framework  in  the  EU  and  the  classical  nudging  approach  share  the 
principle that interventions must not include significant material incentives that may lead to negative health-
impacts for donors or others, preserving the freedom of choice. 

Therefore,  a  corollary  is  that  transparency  is  key  when  implementing  behavioural  interventions:  recent 
evidence suggests that transparent nudges can be just as effective, if not more so, than opaque nudges, and 
that transparent nudges are viewed more favourably than opaque alternatives (Bruns, 2021). In addition, all 
communication  materials  or  messaging  used  to  incentivise  donations  should  be  accurate  and  transparent, 
avoiding  the  use  of  false  or  exaggerated  claims.  Furthermore,  to  ensure  that  individuals  make  informed 
decisions  about  donation,  clear  and  comprehensive  information  should  be  provided  about  the  risks  and 
benefits involved, and also about any incentives, even if financially neutral, that may be offered. This enables 
individuals  to  make  informed  decisions  about  whether  to  donate,  based  on  a  realistic  understanding  of  the 
implications. 

Privacy concerns must also be addressed. Any data collected should be anonymised and used solely for the 
purpose of improving blood donation rates, and blood donors should be aware of this. This helps to build trust 

29 

in  the  blood  donation  processes  and  ensures  that  individuals  feel  comfortable  sharing  their  information, 
maintaining their dignity and autonomy in the use of their data. 

To  guide  policymakers  there  are  numerous  tools  that  can  be  utilised  to  ensure  a  thorough  application  of 
ethical principles to behavioural interventions. For example, the behaviours, analysis, strategies, interventions 
and  change  (BASIC)  toolkit  developed  by  OECD  (OECD,  2019)  is  a  comprehensive  framework  designed  to 
support  policymakers  in  conducting  behavioural  interventions  throughout  the  policy  cycle,  from  the  initial 
stages  of  policy  development  to  the  final  stages  of  evaluation.  Unlike  previous  frameworks,  which  have 
mainly focused on the latter stages of the policy cycle, such as experimentation and compliance, the BASIC 
toolkit places equal emphasis on the behavioural analysis of a policy problem. By doing so, the BASIC toolkit 
aims  to  close  the  gap  between  policy  analysis  and  behaviour  change,  providing  policymakers  with  a  set  of 
best practice tools, methods and ethical guidelines. Building on this document, OECD published Good practice 
principles  for  ethical  behavioural  science  in  public  policy  (OECD,  2022)  to  offer  a  consistent  set  of  ethical 
considerations  necessary  for  the  responsible  application  of  behavioural  science  to  public  policy.  The  report 
features  a  ‘three  Ps  approach’:  principles,  prompts  and  practices.  It  presents  users  with  overarching  ethical 
principles that reinforce the responsible use of behavioural insights in public policy, supported by prompting 
questions,  actionable  practices  and  real-life  case  studies.  Another  valid  tool  is  the  FORGOOD  framework 
(Lades  and  Delaney,  2022),  which  recommends  that  individuals  practising  nudging  consider  seven  essential 
ethical  dimensions,  namely  fairness,  openness,  respect,  goals,  opinions,  options  and  delegation.  This 
framework aims to encompass the fundamental aspects of the ethical debate surrounding the use of nudges 
in human behaviour, while also being adaptable for implementation across various public policy contexts. 

In conclusion, this section highlights the need to consider the ethical implications of behavioural interventions 
in  blood  donation  programmes.  Although  these  interventions  have  shown  promise  in  increasing  donation 
rates,  they  must  be  designed  and  implemented  with  care  to  avoid  potential  criticisms  of  manipulation, 
paternalism  and  infringement  of  individual  autonomy.  The  use  of  transparent  nudges  can  be  an  effective 
approach  in  promoting  blood  donation  while  preserving  individual  autonomy,  and  clear  and  accurate 
information  should  be  provided  to  individuals  to  ensure  informed  decision-making.  It  is  essential  to 
contemplate and engage in  further  dialogue about the ethical concerns involved in this area to ensure that 
these  interventions  increase  both  personal  and  social  welfare  while  respecting  individual  autonomy  and 
dignity. 

30 

 
7.  EU-27 blood donation overview 

With the aim of producing an overview of different kinds of blood donation schemes adopted in the EU-27, 
we collected the following sets of information for each Member State individually. 

Blood donation system. This section contains the information on the type of organisation of blood donation 
system, including the responsibilities of the national blood centres and Red Cross societies (when applicable), 
the  number  and  location  of  blood  establishments,  blood  banks,  blood  collection  unis  and  blood  donor 
associations and the number of fixed locations and mobile sessions. 

Blood donation model. This section outlines the blood donation model used by the Member State. According 
to the World Health Organization, a ‘voluntary non-remunerated blood donor gives blood, plasma or cellular 
components of his or her own free will and receives no payment, either in the form of cash or in kind, which 
could  be  considered  a  substitute  for  money.  This  would  include  time  off  work  other  than  that  reasonably 
needed for the donation and travel. Small tokens, refreshments and reimbursements of direct travel costs are 
compatible with  voluntary, non-remunerated  donation’  (WHO and International Federation of Red Cross and 
Red Crescent Societies, 2010). 

Donor  statistics.  This  section  contains  Member  State-specific  blood  donor  statistics  for  2021 ( 44).  We 
provide data on the number of donors, the number of donations of whole blood and blood components, donor 
gender and age distribution, distribution based on the frequency of donation, and similar. 

Types of incentives offered to blood donors. We summarise a variety of incentives used by the Member 
State to motivate donors to donate whole blood ( 45). 

Types  of  incentives  offered  to  plasma  donors.  We  summarise  non-incentives,  monetary  and  non-
monetary  incentives  with  some  material  component  used  by  the  Member  State  to  encourage  plasma 
donations (when applicable). 

Information system. This last section includes information on the technology used by the Member State to 
gather, process and store donor data,  what applications  and online systems are used to inform and remind 
donors about the upcoming blood drive, the usage of electronic donor questionnaires, and similar. This section 
should  help  us  understand  how  information  technology  contributes  to  better  blood  donor  management  and 
possibly to blood donor recruitment and retention. 

The following sections provide the above information for each Member State individually and a closing section 
summarises the main findings for all Member States. 

(44)  Data for 2020 are used for Germany and Slovakia. 
(45) 

To simplify data collection, we did not make a distinction between ‘incentives’, which are offered before donating to motivate action, 
and ‘rewards’, which are offered as surprises after donating (Chell et al., 2022). We used the term ‘incentive’ to encompass both. 

31 

                                                        
Austria 

BLOOD DONATION COUNTRY PROFILES 
2021 

Blood donation system 
Whole blood in Austria is mostly collected by blood services of the Austrian Red Cross through the Blood Donation 
Centre  for  Vienna,  Lower  Austria  and  Burgenland,  the  Blood  Centre  for  Upper  Austria,  the  Blood  Centre  for 
Carinthia, the Blood Centre for Vorarlberg and the Red Cross blood centres for Styria, Salzburg and Tyrol.   

Population 

8 951 520 

Blood donations 

Plasma donations 

352 000 

338 063 litres 

Donation model 
Whole blood donors donate voluntarily and without remuneration. There 
are no financial incentives or subsidies for the donations of whole blood. 

Types of incentives offered to blood donors 

•  Whole-blood donors sometimes receive small tokens or symbolic 

give-aways for marketing purposes. 

Types of incentives offered to plasma donors 

•  On average, plasma donors receive EUR 25 for their donation in 

private donation centres. 

Information system 

•  The Austrian Red Cross is working on a centralised register for 
blood donations that are collected at the blood establishments 
that are part of the Austrian Red Cross.  

•  The “Mein Blut” application was developed by Netcetera for the 

Austrian Red Cross in Upper Austria. 

Sources 
European Commission (2006), Report on the promotion by Member States of voluntary unpaid blood donations, Brussels. 
https://www.roteskreuz.at/home# 
https://www.netcetera.com/home/stories/news/20210824-ork-blood-donation-app.html 
https://volksanwaltschaft.gv.at/artikel/blood-donation-in-
austria#:~:text=In%20Austria%2C%20blood%20donation%20is,exclusion%20criterion%20for%20donating%20blood. 
https://europeanbloodalliance.eu/country/austria/ 

                                                                         32 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Belgium 

BLOOD DONATION COUNTRY PROFILES 
 2021 

Blood donation system 
The Belgian Red Cross has French and Flemish sections with their own blood institutes. The Flemish section has 
one blood establishment, 11 fixed donation centres and more than 800 mobile collection sites in Flanders and 
Brussels. The French section has 3 blood establishments, 19 fixed centres and more than 850 mobile collection 
sites in the Walloon Region and Brussels. 

Population 

11 521 238 

Blood donors 

289 918 

Donations 

638 818 

Donation model 
Blood donors in Belgium donate voluntarily and without remuneration. 

Donor statistics 

Types of incentives offered to blood donors 
•  Refreshments. 
•  Up to 1 day off work depending on the employer. 

Plasma donations 
Belgium has set the goal to increase plasma collection by 5 % yearly. 
To achieve this goal, the following procedures are used:  
•  opening new centres, 
•  calling existing donors more often, 
•  educating the public about plasma and plasma donations. 

Sources 
Graf, C., Merz, E.-M., Suanet, B. and Wiepking, P. (2023), ‘Social norms offer explanation for inconsistent effects of incentives on prosocial behavior’, Journal of Economic 
Behaviour & Organization, Vol. 221, June, pp. 429–441. 
www.transfusion.be 
www.rodekruis.be 
https://europeanbloodalliance.eu/country/belgium/ 

                                                                         33 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Bulgaria 

BLOOD DONATION COUNTRY PROFILES 
 2021 

Blood donation system 
The  Bulgarian  blood  system  consists  of  the  following  institutions:  National  Centre  of  Haematology  and 
Transfusiology, which is the main centre for blood collection; regional centres of haematology and transfusiology; 
the Centre of Transfusion Haematology at the Military Medical Academy, departments of transfusion haematology 
and  hospital  transfusion  facilities.  The  Bulgarian  Organization  of  Voluntary  Blood  Donation  is  a  non-profit 
association with the main goal of encouraging and promoting blood donations. 

Population  

6 838 937 

Donations  

159 782 

Blood donors in eligible population  

3.5 % 

Donation model 
In accordance with the Bulgarian Blood, Blood Donation, and Blood Transfusion 
Act,  donations  of  blood  and  blood  components  are  voluntary  and  without 
remuneration.  The  only  exceptions  are  monetary  remunerations  for  blood 
donations  in  emergency  cases,  for  production  of  vaccines,  serums  and 
immunoglobulins, and for research and diagnostic purposes. 

Types of incentives offered to blood donors 
•  Restorative and refreshing food and drink in an individual pack. 
•  Compensation for the direct costs incurred to donate blood (e.g. 

transportation cost), which should be compatible with the principle of 
voluntary donation of blood. 

•  Time off work (2 days, one of them on the day of donation). 
•  Small tokens (e.g. badges, pens, towels or T-shirts) that should be 
compatible with the principle of voluntary donation of blood. 

Information system 
•  Blood donation mobile application: “Дари Кръв” (Donate Blood). 

Sources 
https://ncth.bg/statistika/otcheti-7/ 
https://www.bda.bg/images/stories/documents/legal_acts/20210208_ZKKK_english.pdf 
https://accedia.com/blood-donation-mobile-application/ 

                                                                         34 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Croatia 

BLOOD DONATION COUNTRY PROFILES 
 2021 

Blood donation system 
The blood system in Croatia consists of 34 transfusion departments: 7 blood establishments and 27 hospital blood banks. The Croatian 
Institute of Transfusion Medicine (CITM) is the only independent blood establishment and reference centre for transfusion medicine of 
the Ministry of Health, and the remaining six blood establishments are part of hospitals. More than 50 % of whole-blood donations and 
about 65 % of apheresis donations in Croatia are collected by the CITM. Immunohaematology testing is performed in all seven blood 
establishments, and infectious disease testing (serology) is performed in five of them (the remaining two centres send samples to the 
CITM). NAT (ID) testing is centralised in Zagreb (CITM) for the whole country. 

Population 

3 888 529 

Blood donors 

94 168 

Donations 

190 935 

Donation model 
All donations are voluntary and non-remunerated. 

Donor statistics 

Types of incentives offered to blood donors 
• 
Refreshments and small gifts are provided. 
•  Donors can take 1–2 days of paid leave (maximum 10 days per year). 
•  Men who give blood at least 35 times and women who give blood at least 25 times 

are rewarded with supplementary health insurance. 

•  Men who give blood at least 30 times and women who give blood at least 20 times 
and who live in the capital (Zagreb) have a right to use public transportation for 
free. 

Information system 
• 

The national IT system (e-Delphyn) connects all transfusion centres in the country.  

Sources 
https://europeanbloodalliance.eu/country/croatia/  
https://hztm.hr/ 

                                                                         35 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cyprus 

BLOOD DONATION COUNTRY PROFILES 
 2021 

Blood donation system 
In 2016 all small blood collection and testing sites were merged into a single blood establishment. 
Cyprus has one of the highest rates of blood donors in the world – around 9% of the country’s population are 
blood donors. 

Population 

1 215 584 

Blood donors 

78 475 

Donations 

300 per day 

Donation model 
Blood donors in the Cyprus donate voluntarily and without remuneration. 

Types of incentives offered to blood donors 

•  Biscuits and refreshments. 
•  Time off work depending on the employer. 
•  Medals and diplomas of recognition on Blood Donor Day (14 

June). 

Sources 
Graf, C., Merz, E.-M., Suanet, B. and Wiepking, P. (2023), ‘Social norms offer explanation for inconsistent effects of incentives on 
prosocial behavior’, Journal of Economic Behaviour & Organization, June, Vol. 221, pp. 429–441. 
https://in-cyprus.philenews.com/news/local/cyprus-has-the-highest-rate-of-blood-donors-in-the-world-health-ministry/ 
https://worldpopulationreview.com/countries/cyprus-population 
https://www.edqm.eu/en/d/247845?p_l_back_url=%2Fen%2Fsearch-edqm%3Fq%3Dcyprus%2Bblood%2Bdonation 

                                                                         36 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Czechia 

BLOOD DONATION COUNTRY PROFILES 
 2021 

Blood donation system 
The Blood donation system in Czechia consists of public ‘hospital-based’ blood establishments (68 fixed blood collecting centres and 
several mobile teams) located within hospitals (approximately one third of them collect plasma by plasmapheresis), around 150 hospital 
blood banks and around 50 private plasma donation centres, which collect exclusively plasma for fractionation and cover around two 
thirds of Czechia’s plasma production. 

Population 

10 712 000 

Donors in public sector: 250 000 

Whole-blood donations: 427 000 

Donors in private plasma sector: 100 000 

Plasma donations: 993 700 

Donation model 
Whole-blood and plasma donations in the public sector are voluntary and  
non-remunerated. Plasma donations in private plasma donation centres  
are remunerated. The law allows for financial compensation for donation  
(current upper limit is EUR 32) for inconvenience and time lost when donating. 

202 750 collected in 
public blood 
establishments 

790 950 collected in 
private plasma 
donation centres 

Refreshments are provided. 

Types of incentives offered to blood donors 
• 
•  Donors can receive benefits from health insurance companies such as free vitamins.  
•  Medals of merit are awarded by the Red Cross to return donors (several grades) during 

ceremonies supported by the authorities. 

•  Donors can take time off work – employers have to allow the time off necessary for 
making a blood donation and travel. However, there are still some employers who 
refuse, resulting in donors donating in their free time. There are also employers who 
organise blood drives at their companies as a team-building activity. 
Since blood donation falls into the category of ‘projects of public interest’, it is possible 
to apply for tax deductions to the amount of CZK 450 (EUR 18) per donation. This is 
only possible if compensation for donation was not given. It is assumed that around 50 
% of donors apply for tax relief. 

• 

Software for creating appointments is used in the majority of public and private centres. 

Information system 
• 
•  Different types of software for data management with different levels of complexity are available and used. 
•  An electronic donor questionnaire is available at a few centres. 

Donor statistics 
•  29 300 first-time 
donors in the 
public sector. 
•  51 900 first-time 
donors in private-
sector plasma 
centres. 

Sources 
Graf, C., Merz, E.-M., Suanet, B. and Wiepking, P. (2023), ‘Social norms offer explanation for inconsistent effects of incentives on prosocial behavior’, Journal of Economic 
Behaviour & Organization, Vol. 221, June, pp. 429–441.  
Zimová, R., and Turek, P. (2006). ‘Blood transfusion service in the Czech Republic – Organization, regulation and guidelines, quality and safety, perspectives and 
challenges’, Transfusion Medicine and Hemotherapy, Vol. 33, pp. 407–414. 
https://www.uhkt.cz/blood-donors/whole-blood-donation 

                                                                         37 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Denmark 

BLOOD DONATION COUNTRY PROFILES 
 2021 

Blood donation system 
Denmark consists of five regions that are each legally responsible for the public health of its citizens. Blood establishments 
are integrated into the public hospital system and blood collection is, in accordance with legislation, allowed only for these 
public blood establishments. Thus, five blood centres exist, with blood banks and blood depots in various hospitals. All blood 
in Denmark is provided by these blood centres and they collaborate across the regional borders. The competent authority is 
the Danish Patient Safety Authority. 
All  blood  donors  are  organised  in  a  central  organisation,  'The  Danish  Blood  Donor  Organisation',  which  is  operated  by 
volunteers and is responsible for recruitment and recognition of donors. It has 51 local units across the country. A fixed 
payment per donation by the blood centres provides the economical basis of these local units to secure a sufficient pool of 
donors. Mobile blood banks serve rural areas. Blood centres inform donors through text messages or the media to attend 
their local blood bank in cases of shortages of blood. 

Population 

5 873 420 

Blood donors 

183 409 

Donations 

291 934 

Donation model 
All blood donations are voluntary, unpaid and uncompensated, as 
required by the law. 

Donor statistics 
•  121 019 donors gave blood in 2021 (66 % of the registered 

donors), of whom 22 264 also gave 95 816 plasma 
donations. 

•  14 362 were first-time donors. 
•  The majority of blood donors are female. 
•  More than third of the donors are aged 20 to 30 years. 

Types of incentives offered to blood donors 
•  Refreshments (e.g. soft drink or chocolate bar). 
•  Symbolic gifts for donor anniversaries given by the Danish 
Blood Donor Organisation (e.g. pin, umbrella, wood art or 
gratitude letter from the royal patron). 

•  Public insurance covering expenditure arising from personal 

injuries to a donor before, during or after donation. 

Information system 
•  Each region has its own blood establishment 
computer system (ProSang or Blodflödet). 
•  The Danish Society for Clinical Immunology 

collects clinical data on donors and recipients. 
•  An annual report on blood products is published 

by the Danish Patient Safety Authority. 

Sources 
Rapport over blodproduktområdet 2021 (https://stps.dk/udgivelser-1/2022/okt/rapport-over-blodproduktomraadet-2021). 

                                                                         38 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Estonia 

BLOOD DONATION COUNTRY PROFILES 
2021 

Blood donation system 
The blood donation system in Estonia comprises two big blood collection and processing establishments in Tallinn and Tartu and two 
smaller establishments in Kohtla-Järve and Pärnu. North Estonia Medical Centre’s Blood Centre in Tallinn is the biggest blood collection 
and processing facility in Estonia. More than half of all donations are made there. 

Population 

1 331 796 

Whole-blood 
donors: 28 211 
Apheresis 
donors: 684 

Whole-blood 
donations: 48 348 
Apheresis 
donations: 3 001 

Donation model 
Blood donations in Estonia are voluntary and non-remunerated.  
Donor statistics 
•  2.2 % of the population donated blood. 
•  13 % of all donations were from first-time donors which is 0.28 % of the 

population. 

•  37 % of donations are collected by mobile groups operated by blood 

establishments. 

•  50.12 % of donors are male. 
Information system 
Estonia has its own information system, with donor registry, donor management, e-donor 
application, blood components quarantine and release functions. This information system 
is not central and is managed by each blood establishment separately. 

Types of incentives offered to blood donors 
• 

The mentality 'donate blood while you are in good health and use it when you need 
it or someone close needs the blood you donated’ is prompted. 

Slogans such as ‘save a life’ and ‘donor is a lifesaver' on websites and Facebook. 

•  Donors can take paid time off work. 
• 
•  Donor feedback on how to improve the donation experience is used. 
•  Courtesy messages are sent on donors birthdays, at Christmas and similar. 
•  After donating, as a sign of gratitude, the donor can pick a suitable object marked 

with the blood establishment’s logo, such as a towel, a coffee mug, a blanket, socks, 
a water bottle or shopping bags. 

•  Donors are given a badge to attach to clothing that certifies 25, 50, 75 or 100 blood 

• 

• 

donations. 
In cooperation with the Red Cross, donors with 100 donations are nominated to 
receive the Order of the Estonian Red Cross. 
Free drinks and snacks are provided in the waiting area to strengthen donors and 
reduce the incidence of adverse reactions. 

Additional incentives offered to 
apheresis donors (one in two blood centres 
with apheresis equipment offers additional 
incentives)  
•  Apheresis donors are referred to as elite 

or VIP blood donors. 

•  Apheresis donors can pick two items, or 
one more valuable item, as a sign of 
gratitude. 
Taxi costs are covered to and from the 
blood establishment. 

• 

•  A more personalised approach is taken: 
donors are called to donate and are 
offered snacks and reading materials 
during the procedure. 

•  An extended health analysis is provided 

to apheresis donors. 

Sources 
European Commission (2006), Report on the promotion by Member States of voluntary unpaid blood donations, Brussels. 
https://statistika.tai.ee/pxweb/en/Andmebaas/Andmebaas__04THressursid__04Verekomponendid/?tablelist=true 
https://verekeskus.ee/en/about-us/blood-transfusion-service-in-estonia/ 

                                                                         39 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Finland 

BLOOD DONATION COUNTRY PROFILES 
 2021 

Blood donation system 
The Finnish Red Cross Blood Service is the only blood establishment in Finland. Its main activities include organising 
blood collections, testing donated blood, manufacturing blood products and distributing them to hospitals all over 
Finland. It also performs scientific research, for example on blood donors’ health and well-being, and operates as 
a biobank, utilising blood donor samples with informed consent. Blood was donated at 10 fixed locations and at 
over 1 000 mobile sessions. 

Population 

5 550 000 

Blood donors 

113 006 

Donations 

185 326 

Donation model 
100 % voluntary and non-remunerated blood donations. 
Currently, there are no plasma donations in Finland. 

Types of incentives offered to blood donors 
•  Refreshments (e.g. coffee, tea, snacks). 
•  Small gifts (e.g. pens and mugs). 
•  Recognition for a high number of donations (e.g. 100, 150, 

200). 

•  Reimbursement of travel expenses (only when the donor 
has been specifically called for an urgent donation). 

Information system 
•  Online appointments system.  
•  Electronic questionnaire for donors. 
•  An information system that includes donor registry and 

management, and blood product management. 

Sources 
https://europeanbloodalliance.eu/country/finland/ 
https://vuosikertomus.veripalvelu.fi/en/statistics.html 
https://www.statista.com/statistics/521116/total-population-of-finland/ 

Donor statistics  
•  Nearly 16 000 new donors were recruited 

in 2021. 

•  Of donors registered to donate, 5.3 % 

could not donate. 

•  The most common obstacle to blood 

donation was low haemoglobin levels (1.8 
% of those registered for donation). 
•  5 % of donors respond to their donation 

invitation within 7 days. 

                                                                         40 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
France 

BLOOD DONATION COUNTRY PROFILES 
2021 

Blood donation system 
There are 2 blood establishments in France: the French  blood  establishment  (establishment  for  transfusion in 
civilian life) and the army blood transfusion centre. The French blood establishment (EFS) is a public organization 
responsible for blood collection, testing, preparation and distribution to around 1 900 healthcare facilities. The 
EFS has one national headquarters and 13 regional establishments  (10 in mainland France,  1 in the Martinique, 
1 in Guadeloupe-Guyana and 1 in Réunion Island). 

Population 

66 410 000 

Blood donors 

1 578 827 

Donations 

2 840 072 

Donation model 
French blood donations are voluntary and non-remunerated.  

Whole-blood: 
Plasma apheresis: 
Platelets apheresis 
Apheresis granulocytes:  

2 440 768  
302 097 
97 146 
61  

 Donor statistics 

•  57 % of the French population 
thinks that better information 
on blood requirements would 
encourage them to donate 
blood. 

•  87.7 % of all donations are 

collected from repeat donors. 

Age 

(years) 

18–19 

20–24 

25–29 

30–34 

35–39 

40–44 

45–49 

50–54 

55–59 

60–64 

65–69 

70 

% of 

donors 

4.7 % 

14.7 % 

10.9 % 

9.5 % 

9.2 % 

9.4 % 

10.4 % 

9.7 % 

8.8 % 

7.1 % 

4.6 % 

0.9 % 

Sources 
European Commission (2006), Report on the promotion by Member States of voluntary 
unpaid blood donations, Brussels.  
Fonte, D., Blondé, J. and Girandola, F. (2017), ‘How to encourage non-donors to be more 
willing to donate blood? Testing of binding communication based interventions’, 
Transfus Med, June, Vol. 27, No 3, pp. 207–212, doi:10.1111/tme.12376, epub 10 
November 2016, PMID: 27859798. 
https://dondesang.efs.sante.fr/ 
https://europeanbloodalliance.eu/country/france 
https://www.statista.com/statistics/1104384/incentives-for-donation-of-blood-france/ 
https://www.statista.com/statistics/459939/population-france/ 

Types  of  incentives  offered  to  blood 
donors 

•  Compensation for travel expenses. 
•  Small gifts (e.g., pens and mugs). 
•  Paid time off work. 
  Information system 
•  Data collection (INLOG and Medinfo). 
•  The creation of appointments to 

donate blood (System 1 and System 2).  

•  Electronic pre-donation questionnaire 

not yet used. 

                                                                         41 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
any 

Germany 

BLOOD DONATION COUNTRY PROFILES 
 2020 

Blood donation system 
The blood donation system in Germany is a three-tier system. The majority of German blood collection is carried 
out by the German Red Cross (GRC) blood services. The GRC collects around 70 % of all blood donations in Germany 
and all of those donations are voluntary and non-remunerated. It has seven blood transfusion services, including 
28 donation centres and institutes. Furthermore, there are state agencies, which collect another 20 % of all blood 
donations and are mostly located close to university hospitals. Lastly, there are private donation sites, which are 
located in East Germany and collect the remaining 10 % of all blood donations in Germany. 

Population 

83 408 554 

Donations 

6 388 992 

Whole-blood: 
Plasma: 
Red cells: 
Platelets:  
Granulocytes:  
Multi component donations: 
Autologous blood donations:            

3 671 838  
2 551 092 
783 
110 506 
346 
53 459 
968 

Donation model 
Each blood donation service can decide about offering monetary 
remuneration for donation. 

Donor statistics 
•  2-3 % of the German population donates blood. 
•  44  whole-blood  donations  and  33  apheresis  donations  per  1  000 

inhabitants were made in 2020. 

Types of incentives offered to blood donors 
•  Monetary remuneration to cover, for example, travel costs (not all 
blood services provide blood donors with monetary remuneration). 

Sources 
Becker, D. M., Klüter, H., Niessen-Ruenzi, A. and Weber, M. (2019), ‘The impact of direct cash payments on whole blood supply’, German Economic Review, Vol. 20, No 4, 
pp. e973–e1001, doi:10.1111/geer.12204. 
Greffin, K. (2021), ‘“Blood for blood”? Personal motives and deterrents for blood donation in the German population’, International Journal of Environmental Research 
and Public Health, April, Vol. 18, No 8, 4238, doi:10.3390/ijerph18084238, PMID: 33923586, PMCID: PMC8072955. 
Ritter, S., Willand, L., Reinhardt, B., Offergeld, R. and Hamouda, O. (2008), ‘Blutspenderpopulationen in Deutschland: Demographie und Spendeaktivität : Ergänzung zum 
Bericht des Robert Koch-Instituts zu den Meldungen nach section sign 22 Transfusionsgesetz [Demography and donation frequencies of blood and plasma donor 
populations in Germany]; Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz, August, Vol. 51, No 8, pp. 915–925, doi:10.1007/s00103-008-0613-7, 
PMID: 18787870. 
https://europeanbloodalliance.eu/country/germany/ 
https://www.macrotrends.net/countries/DEU/germany/population-growth-rate 

                                                                         42 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Greece 

BLOOD DONATION COUNTRY PROFILES 
 2021 

Blood donation system 
The blood system in Greece is decentralised and comprises 97 blood banks. Each blood bank is an integrated 
part of a public hospital and it is responsible for recruiting blood donors and collecting, testing and processing 
blood. 

Population 

10 370 747 

Blood donations 

568 000 

Blood donor statistics 
•  5.6 % of the eligible population donates blood. 

Donation model 
All donations are voluntary and non-remunerated. 

Types of incentives offered to blood donors 
•  Medals to individuals who have reached certain donation milestones 

awarded during annual donor awards ceremonies. 

•  Public servants granted paid leave from work when making a blood 

donation. 

•  Small souvenirs. 
•  Soft drinks. 
•  Compensation for travel costs. 

Sources 
Fragoulakis, V., Stamoulis, K., Grouzi, E and Maniadakis, N. (2014), ‘The cost of blood collection in Greece: An economic analysis’, Clinical Therapeutics, 
Vol. 36., No 7, pp. 1028–1036.E5, doi:10.1016/j.clinthera.2014.05.003. 
Kalargirou, A. A., Beloukas, A. I., Kosma, A. G., Nanou, C. I., Saridi, M. I. and Kriebardis, A. G. (2013), ‘Attitudes and behaviours of Greeks concerning blood 
donation: recruitment and retention campaigns should be focused on need rather than altruism’, Blood Transfusion, July, Vol. 12, No 3, pp. 320–329, 
doi:10.2450/2014.0203-13, epub 19 March 2013, PMID: 24887229, PMCID: PMC4111812. 
European Commission (2006), Report on the promotion by Member States of voluntary unpaid blood donations, Brussels. 
https://europeanbloodalliance.eu/country/greece/ 

                                                                         43 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hungary 

BLOOD DONATION COUNTRY PROFILES 
 2021 

Blood donation system 
The blood system in Hungary comprises 5 regional blood centres and 23 local blood banks. The Hungarian Red 
Cross is involved in blood donor recruitment. 

Population 

9 800 000 

Donations 

397 000 

Donation model 
Whole-blood donations are voluntary and non-remunerated. 

Types of incentives offered to whole-blood donors 
•  Calorie and fluid replenishment refreshment.  
•  Reimbursement of justified and certified travel expenses 

according to flat rates. 

Types of incentives offered to plasma donors 

•  Monetary remuneration (around HUF 8 000 per donation) 

Sources 
European Commission (2006), Report on the promotion by Member States of voluntary unpaid blood donations, Brussels. 
https://europeanbloodalliance.eu/country/hungary/ 
https://www.karger.com/Article/Pdf/95119 
https://www.frontiersin.org/articles/10.3389/fpsyg.2021.653848/full 
https://worldpopulationreview.com/countries/hungary-population 

                                                                         44 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ireland 

BLOOD DONATION COUNTRY PROFILES 
 2021 

Blood donation system 
The Irish Blood Transfusion Service (IBTS) has its headquarters in the National Blood Centre in Dublin. In addition, there are five regional 
centres, in Cork, Ardee, Limerick, Tuam and Carlow. The IBTS operates a two-pronged donor blood donation approach for whole blood:  
fixed clinics (three) and mobile clinics (six). The mobile clinics operate around the country 12 months per year, visiting different venues 
including schools, hotels, and sports and leisure facilities. Since the start of the pandemic, the IBTS has operated an appointment-only 
donation process rather than the traditional ‘walk-in’ clinic model previously used. This appointment-only model was introduced to ensure 
that the IBTS complied with public health pandemic guidelines and in particular guidelines on ‘social distancing’. This appointment system 
has proven to be very popular with donors. Also during the pandemic, the IBTS took a strategic decision to concentrate on asking regular 
donors to donate, to get these donors through the clinics quickly and efficiently. All marketing aimed at trying to recruit new and first-
time donors was stopped, and is due to be resumed in the near future. 

Population 

4 986 526 

Blood donors 

72 791 

Donations 

127 614 

Donation model 
All donations are voluntary and non remunerated. 

Donor statistics 
•  Approximately 3 % of the eligible Irish population donate blood. 
•  55 % of blood donors are male. 
• 

The most common blood group in Ireland is O positive (47 % of the population). 

Types of incentives offered to blood donors 
• 
•  Donor merchandise (e.g. pens, pencils, Christmas decorations, shopping trolley coins, and 

Refreshments. 

sweets). 

•  Awards (a silver award for 10 donations, gold for 20 donations, gold drop-shaped lapel pin 

representing blood for 50 donations and, for 100 donations, a presentation at an awards dinner 
ceremony and a porcelain pelican). 

Information system 
• 
• 
•  New online appointment system to be available using the MAK-SYSTEMS software by the end of 

Software solution supplied by MAK-SYSTEMS (Cambridge, MA, USA) (eProgesa 5.0.3). 
eBoss software package for data collection and analysis. 

the year.  

Sources 
Harrington, M., Sweeney, M. R., Bailie, K., Morris, K., Kennedy, A., Boilson, A., O'Riordan, J. and Staines, A. (3007), ‘What would encourage blood donation in Ireland?’, Vox 
Sanguinis, May, Vol. 92, No 4, pp. 361–367, doi:10.1111/j.1423-0410.2007.00893.x, PMID: 17456160. 
McMahon, R. and Byrne, M. (2008), ‘Predicting donation among an Irish sample of donors and nondonors: Extending the theory of planned behavior’, Transfusion, 
February, Vol. 48, No 2, pp. 321–331, doi:10.1111/j.1537-2995.2007.01526.x, epub 19 November 2007, PMID: 18028275. 
https://www.independent.ie/regionals/droghedaindependent/news/blood-donor-awards-are-handed-out-36766760.html 
https://www.giveblood.ie/learn-about-blood/did_you_know/ 
https://www.macrotrends.net/countries/IRL/ireland/population-growth-rate 

                                                                         45 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Italy 

BLOOD DONATION COUNTRY PROFILES 
2021 

Blood donation system 
The blood donation system in Italy is part of the National Health Service. The Italian National Blood Centre (CNS), which was established 
in  2007,  is  the  technical  body  of  the  Italian  Ministry  of  Health  for  all  transfusion  activities.  The  CNS  coordinates  and  monitors  the 
transfusion system from a technical scientific point of view to ensure that specific goals are reached, including regional and national 
self-sufficiency in blood components and plasma-derived medicinal products (PDMP) and the highest level of safety in all processes 
related  to  blood  and  blood  products  donation  and  transfusion,  in  compliance  with  EU  and  national  legislation.  In  addition,  the  CNS 
promotes multidisciplinary activities aimed at avoiding unnecessary transfusions (patient blood management) and manages the National 
Registry of Thalassemia and other haemoglobinopathies. The CNS also actively participates in a number of international projects.  
There are 21 regional blood centres that coordinate the related networks of blood establishments and blood collection units. There are 
four main blood donor associations (AVIS, FIDAS, FRATRES, CRI) that are institutionally involved in both blood donor management and 
blood collection.  

Population 

59 236 213 

Whole-blood donors: 
1 653 268 
 Apheresis donors: 
106 781 

Whole-blood donations: 
3 021 143 

Apheresis donations: 
426 738 

Donation model 
The  blood  donation  system  in  Italy  is  built  on  the  voluntary  non-remunerative  model, 
relying on altruism and prosociality as the fundamental determinants of the willingness 
to donate. 

Types of incentives offered to blood donors 

Refreshments. 
Paid time off work. 
Symbolic awards. 

• 
• 
• 
•  Associative medals (medals with an increasing symbolic value, e.g. green medal 

(basic prize) and diamond medal (highest prize)). 

Types of incentives offered to plasma donors 

Refreshments. 
Paid time off work. 

• 
• 
•  Medals of merit or recognition tokens. 
• 
• 

Small tokens or symbolic gifts. 
Educating public about plasma and plasma donations. 

Information system 

• 

Sistema Informativo dei Servizi 
TRAsfusionali (SISTRA) – national 
IT system for blood 
establishments.  
Each region has its own blood 
establishment computer system.  
•  Certain local blood establishments 
have online appointment systems 
and/or a blood mobile application. 

• 

Sources 
Bilancini, E., Boncinelli, L., Di Paolo, R., Menicagli, D., Ricciardi, E. and Serti, F. (2021), ‘ Symbolic incentives can affect the frequency of blood and plasma donations: 
Evidence from 12 years of donors’ behavior and donation award’(https://psyarxiv.com/mgvtd/). 
https://europeanbloodalliance.eu/country/italy/; https://www.centronazionalesangue.it/italian-national-blood-centre-cns/ 
https://www.donailsangue.salute.gov.it/donaresangue/homeCns.jsp 
https://www.centronazionalesangue.it/wp-content/uploads/2022/11/22-25-web.pdf 

                                                                         46 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Latvia 

BLOOD DONATION COUNTRY PROFILES 
2021 

Blood donation system 
The Latvian blood donor service consists of 5 blood establishments and 51 hospital blood banks. The cooperation between all these 
institutions is ensured by legislation and based on agreements. The State Blood Donor Centre is the national blood establishment, located 
in Riga, with two branches in Rezekne and Liepaja. Being the main institution within the blood donor service of Latvia, the State Blood 
Donor Centre administrates and coordinates the work of the blood donor service and provides training and specialization for blood service 
and clinical personnel. The main task of the Latvian blood donor service is to ensure the constant supply of safe blood components and 
blood products to healthcare institutions. The blood donor service of Latvia has a relatively stable population of donors, around which a 
well-functioning everyday blood component  supply chain has been developed, and the safety of blood products is ensured. Blood service 
is financed by the government. Overall, Latvia is self-sufficient in blood components for transfusion. 

Population 

1 866 942 

Blood donors 

33 323 

Donations 

56 200 

Donor statistics 
•  54.4 % of all blood donors are women. 
• 
The average donor is 37 years old. 
•  42.8 % of all blood donors are regular donors. 
•  6 691 are first-time donors (56.4 % women). 
•  480 are apheresis donors (37.7 % women). 
Types of incentives offered to blood and plasma donors 
•  A lunch allowance is provided (worth EUR 1.42). 
•  Donors can take a day off work. 
•  Donor can choose to be compensated for travel expenses associated with blood 

donation to the amount of EUR 4.27 (via bank account). 

•  Donors can receive a coffee voucher (this incentive is part of a current campaign 

organized in cooperation with a specific company). 

•  Motivating gifts are given for donating blood for the first time, after reaching a 

• 

• 

certain number of donations and on birthdays and holidays. 
Special care and effort is invested to make the blood donation experience as 
enjoyable as possible for each donor. 
Plasma donors are compensated EUR 17.07 (via bank account). Plasma obtained by 
apheresis is directly used for the production of plasma preparations (not 
commercial matters) for Latvian patients and, like blood components, is distributed 
to medical institutions free of charge. 

Information system 
• 

The IS ProSang donor database was 
implemented in 2006. 

•  A donor portal will be created in the 
upcoming  year.  It  will  contain  a 
feature  that  informs  donors  once 
their  blood  reaches  the  recipient. 
important 
Donors  will 
information  on  their  health  status 
and  donation  times  and  reminders 
about their next visits. 

receive 

Sources 
European Commission (2006), Report on the promotion by Member States of voluntary unpaid blood donations, Brussels. 
https://europeanbloodalliance.eu/country/latvia/ 
https://eng.lsm.lv/article/society/health/donors-will-be-able-to-find-out-where-their-blood-goes-on-new-website.a402363/ 
https://www.macrotrends.net/countries/LVA/latvia/population 

                                                                         47 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Lithuania 

BLOOD DONATION COUNTRY PROFILES 
 2021 

Blood donation system 
The  Lithuanian  blood  donation  system  consists  of  three  blood  establishments,  which  are  non-profit  public 
institutions:  National  Blood  Centre  and  two  hospital–based  blood  establishments.  The  National  Blood  Centre 
collects approximately 65 % of all donations in Lithuania. 

Population 

2 800 000 

Blood and blood 
components 
donors: 

54 120 

Donations 

101 568 

Whole-blood: 
Red cells: 
Plasma: 
Platelets: 
Plasma and platelets:  

95 635  
2 600 
555 
2 627 
151  

Donation model 
All donations in Lithuania are voluntary and non-remunerated. 

Donor statistics 

Types of incentives offered to blood donors 
•  Voluntary donors receive pins, pencils, tea-cups, towels, T-shirts, 
mugs, postcards and/or backpacks and paid time off work. 

Information system 
•  Two blood establishments use eProgesa; the remaining blood 

establishment uses a bespoke, in-house IT system. 

Sources. 
Graf, C., Merz, E.-M., Suanet, B. and Wiepking, P. (2023), ‘Social norms offer explanation for inconsistent effects of incentives on prosocial behavior’, Journal of Economic 
Behaviour & Organization, June, Vol. 221, pp. 429–441. 
European Commission (2006), Report on the promotion by Member States of voluntary unpaid blood donations, Brussels. 
https://europeanbloodalliance.eu/country/lithuania/ 

                                                                         48 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Luxembourg 

BLOOD DONATION COUNTRY PROFILES 
2021 

Blood donation system 
The Luxembourg Red Cross operates as a single blood centre to meet the demand for blood components and 
plasma  derivatives.  It  has  a  national  responsibility  to  supply  all  blood  and  plasma  products  requested  by  the 
hospitals.  

Population 

634 730 

13 719 donors 

Whole-blood 
donors: 12 698 

Apheresis 
donors: 1 021 

Homologous whole-blood donations: 18 946 
Autologous whole-blood donations: 1 
Plasma donations by apheresis: 2 449 
Platelet plus plasma donations by apheresis: 969 

Donation model 
All donations are voluntary and not remunerated.  

Donor statistics 
•  1 388 are first-time whole-blood donors. 
•  46.9 % of all donors are women. 

Types of incentives offered to blood and plasma donors 
•  Refreshments. 
•  Medals (awarded to individuals who have reached certain numbers of 

donations). 

•  Paid time off work (depends on the employer). 

Information system 
•  eProgesa from MAK-SYSTEMS. 
•  eDMS from MAK-SYSTEMS for the laboratory, connected to eProgesa. 

Sources 
European Commission (2006), Report on the promotion by Member States of voluntary unpaid blood donations, Brussels. 
https://europeanbloodalliance.eu/country/luxembourg/ 
https://www.croix-rouge.lu/en/ 

                                                                         49 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
Malta 

BLOOD DONATION COUNTRY PROFILES 
2021 

Blood donation system 
The blood donation system in Malta comprises one government-funded blood establishment and three hospital-
based blood banks. 

Population 

442 784 

Donations 

18 000 

Donation model 
All donations are voluntary and non-remunerated.  

Types of incentives offered to blood donors 

•  Refreshments are provided. 
•  Employers are encouraged to allow workers the required time off 

work to donate. 

Information system 

•  Mobile application: Blood Donors MT. 

Sources 
European Commission (2006), Report on the promotion by Member States of voluntary unpaid blood donations, Brussels. 
https://europeanbloodalliance.eu/country/malta/ 
https://deputyprimeminister.gov.mt/en/nbts/Pages/home.aspx 
https://worldpopulationreview.com/countries/malta-population 

                                                                         50 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Netherlands 

BLOOD DONATION COUNTRY PROFILES 
 2021 

Blood donation system 
Blood collection in the Netherlands is organised by a non-profit organization, Sanquin. Sanquin is the only blood organisation in the world 
to offer the combination of in-house medical, pharmaceutical and scientific knowledge and expertise. Donations are usually made at 
mobile and fixed locations. In Q4 2022, a new online system for inviting donors to donate blood and making appointments was introduced. 

Population 

17 475 415 

Blood donors 

384 352 

Donations 

743 884 

407 203 whole-
blood donations 

336 681 plasma 
donations 

Donation model 
Blood donations in the Netherlands are made voluntarily and are non-remunerated. 

Types of incentives offered to blood donors 
• 
Refreshments. 
•  Covered expenses. 
• 
•  Donor recognition tokens.  
•  Opportunity to relax in the donor café. 

Insurance. 

Recruitment strategies 
• 

Sanquin at Work campaign (cooperating with companies to foster employees to 
donate blood or plasma during working hours). 
There is a Let You Hear campaign (thanking donors for their donation and 
encouraging them to talk about their donation experience). 

• 

•  During December, Sanquin initiated a campaign to donate EUR 1 to Het Vergeten 

• 

Kind foundation for each blood donation made by their donors. 
There is a League of Legends campaign (launched in 2018 for gaming community; 
for making their first donation, donors could earn a ‘skin’, which is a particular 
virtual game character appearance from Riot Games (Los Angeles, CA, USA). This 
campaign resulted with 2 500 first-time donors). 

•  Donor Recruit Donor strategy. 

Types  of  incentives  offered  to  plasma 
donors 

•  Saving system for a limited group 
of plasma apheresis donors (pilot 
study), plasma apheresis donors 
receive virtual donor drops, which 
they can redeem for small gifts 
related to health or leisure 
experiences such as book/cinema 
vouchers, health checks, yoga 
lessons and power banks. The 
number of drops saved determines 
the gift received. 

Sources 
Timmer, T. C., de Groot, R., Habets, K., Merz, E.-M., Prinsze, F. J., Atsma, F., de Kort, W. L. A. M. and van den Hurk, K. (2018), ‘Donor InSight: Characteristics and 
representativeness of a Dutch cohort study on blood and plasma donors’, Vox Sanguinis, February, Vol. 114, No 2, pp. 117–128, doi:10.1111/vox.12731, epub 27 
December 2018, PMID: 30590867, PMCID: PMC7379571. 
https://www.sanquin.nl/en 
https://www.sanquin.nl/binaries/content/assets/sanquinnl/over-sanquin/pers--actueel/jaarverslagen/stichting-sanquin-bloedvoorziening_jaarverslag-2021.pdf  
https://www.statista.com/statistics/519720/total-population-of-the-netherlands/ 

                                                                         51 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Poland 

BLOOD DONATION COUNTRY PROFILES 
2021 

Blood donation system 
The blood donation system in Poland comprises 21 regional blood transfusion centres, 1 military blood transfusion centre, 
and 1 blood transfusion centre of the Ministry of Internal Affairs. The Ministry of Health supervises the entire public blood 
service  in  Poland.  There  are  two  organisations  that  are  responsible  for  the  national  blood  service  and  its  activities:  the 
National  Blood  Center  (NBC)  and  the  Institute  of  Hematology  and  Transfusion  Medicine  (IHTM).  The  IHTM  assures  the 
development of scientific research and works in the field of haematology, transfusion medicine and related disciplines, and 
the NBC focuses on the monitoring and control needs for blood supply, its components and blood products, and supervision 
of issues related to blood transfusion. Therefore, close cooperation between the NBC and the IHTM is necessary to ensure 
effective provision of all blood services activities. 

Population 

38 538 447 

Blood donors 

615 927 

Donations 

1 352 885 

Types of incentives offered to blood donors 
•  Refreshments are provided. 
•  Voluntary  donors  receive  pins,  pencils,  tea-cups,  towels,  T-shirts,  mugs, 

postcards and/or backpacks. 

•  Blood donors who gave at least 5 (female donors) or 6 litres (male donors) of 
blood  are  awarded  the  title  ‘honoured  voluntary  blood  donor’  and  given  a 
badge. 

•  Donors can take paid time off work (starting from 14 March, 2020, honoured 
voluntary  blood  donors  who  donate  blood  or  blood components  during  the 
epidemic  emergency  are  eligible  for  2  days  off  from  work  –  the  day  of 
donation and the next day). 

•  Donors  who  donated  blood  or  blood  components  at  least  three  times  are 
eligible  for  an  additional  certificate  entitling  them  to  a  33  %  discount  on 
domestic  transport  by  collective  and  accelerated  modes  of  transport  (not 
applicable to public transport – discounts for donors in public transport are 
determined individually in each city) and the possibility of using services out 
of the queue in pharmacies. 

•  Donors are eligible for a tax deduction. 

Donation model 
The majority of blood donations collected 
in Poland are voluntary and non-
remunerated; the rest are remunerated. 

Information system 
Each blood donation centre has its 
individual information system. It is 
planned to develop one common system 
for all blood donation centres. 

Sources 
Antoniewicz-Papis, J. and Łętowska, M. (2006), 'The Polish Blood Transfusion Service – Quality, guidelines, laws, selected topics of Interest and future challenges', 
Transfusion Medicine and Hemotherapy, Vol. 33, No 5, pp. 401-406, doi: 10.1159/000095006. 
European Commission (2006), Report on the promotion by Member States of voluntary unpaid blood donations, Brussels. 
Rosiek, A., Tomaszewska, A., Lachert, E., Antoniewicz-Papis, J. and  Łętowska, M. (2019), 'Blood transfusion service in Poland in 2018’, Journal of Transfusion Medicine, Vol. 
13, No 4, pp. 212–227, doi: 10.5603/JTM.2019.0008. 
Health policy programe entitled Ensuring self-sufficiency of Poland in blood and its components for the years 2021–2026. 
https://www.gov.pl/web/nck/ 

                                                                         52 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Portugal 

BLOOD DONATION COUNTRY PROFILES 
 2021 

Blood donation system 
The  Portuguese  Institute  of  Blood  and  Transplantation  (IPST)  ensures  the  collection,  processing,  storage  and 
distribution of blood and its components. It collects around 60 % of all blood donations in Portugal. The remaining 
40% of blood donations in Portugal are collected by hospital blood establishments. 

Population 

10 344 802 

Blood donors 

235 178 

Donations 

310 727 

Donation model 
100% voluntary non-remunerated blood donation. 

 Donor statistics 

Age (years) 

18–24 

25–44 

45–65 

65 

% of 
donors 

16.45 % 

44.38 % 

38.75 % 

0.42 % 

Types of incentives offered to blood donors 

•  Exemption from paying fees for access to national healthcare (tax 

cut). 

Information system 

•  ASIS: in-house software developed by IPST. 
•  SIBAS: commercial software developed by Glint. 
• 

Imaginasoft: commercial software developed by ImaginaSoft.  

Sources 
Graf, C., Merz, E.-M., Suanet, B. and Wiepking, P. (2023), ‘Social norms offer explanation for inconsistent effects of incentives on 
prosocial behavior’, Journal of Economic Behaviour & Organization, June, Vol. 221, pp. 429–441. 
Henriques, T. and Quintal, C. (2018), ‘Young and healthy but reluctant to donate blood: An empirical study on attitudes and motivations 
of university students’, Notas Económicas, December, Vol. 47, pp. 59–73, doi:10.14195/2183-203X_47_4. 
https://europeanbloodalliance.eu/country/portugal/ 

                                                                         53 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
Romania 

BLOOD DONATION COUNTRY PROFILES 
 2021 

Blood donation system 
The blood donation system in Romania is organised as a nationally coordinated system, under the Ministry of Health, which acts as the 
national competent authority. A total of 41 public, civil blood establishments carry out the whole chain of activities, from blood collection 
to distribution and issuing of blood components to hospitals. The National Institute of Blood Transfusion is coordinating the activity of 
these 41 blood establishments. In addition, a public military blood establishment, under the Ministry of Defence is in place in Bucharest. 
Blood components produced by the 42 blood establishments are distributed to around 330 hospitals in the country. Each hospital has 
its own hospital blood bank.  

Population 

19 127 774 

Blood donors 

313 843 

Donations 

387 391 

Donation model 
Blood donation is voluntary and non-remunerated. Romania is not providing plasma 
for fractionation. 

Donor statistics 

Food vouchers (EUR 13). 

Types of incentives offered to blood donors 
• 
•  1 day off work (the donation day). 
• 

Reimbursement for travel expenses (for donors who need to travel to the 
donation site). 

•  50 % discount for public transportation for 1 month (for donors living in the 

same town as the blood establishment venue). 

•  Occasionally, for specific events, free access to cultural or educational events, 

concerts, etc. 

• 

Information system 
•  All 41 civil blood establishments are using the 
same software for blood donors and donation 
activities (national blood donors database). 
Some blood establishments are using a 
software that covers the entire chain of 
specific activities. 
• 
The donor questionnaire is filled out on site. 
•  Appointments are by phone and/or one of two 

mobile applications – Donorium and 
BlooDoChallenge – depending on the blood 
establishment decisions made locally. 

Sources 
Graf, C., Merz, E.-M., Suanet, B. and Wiepking, P. (2023), ‘Social norms offer explanation for inconsistent effects of incentives on prosocial behavior’, Journal of Economic 
Behaviour & Organization, June, Vol. 221, pp. 429–441. 
https://www.macrotrends.net/countries/ROU/romania/population 

                                                                         54 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Slovakia 

BLOOD DONATION COUNTRY PROFILES 
2020 

Blood donation system 
Slovak blood donation system comprises two types of blood establishments:   
1.  The National Transfusion Service of the Slovak Republic (NTS SR) is an organisation within the competence of the Ministry of Health 
of the Slovak Republic, which carries out around two thirds to three quarters of all blood and blood components collections (around 
160 000 yearly) in Slovakia. The NTS SR comprises 3 processing and testing centres (each of them performing whole-blood and 
blood components processing, pathogen inactivation of plasma and platelets and testing – immunohaematology, virus serology, and 
HIV-HBV-HCV NAT) and 12 collection centres (each performing the collection of whole blood, plasma, platelets, red cells and certain 
granulocytes). 

2.  The rest of blood and blood components collections (around 60 000 yearly) are performed by 31 hospital-based departments of 
haematology and transfusion, which are usually part of private regional hospitals, and which provide blood for their own use in 
hospitals. Each of them performs collection of whole blood (some of them collect plasma and platelets as well), basic processing of 
whole blood and blood components, and testing (immunohaematology and virus serology, but not NAT testing). 

Population 

5 447 247 

Blood donors 

119 269 

Donations 

206 467 

Donation model 
Voluntary  and  non-remunerated  donation  of  whole  blood  and  blood  components 
(plasma and platelets) is mandatory and regulated by law. The Council of Europe’s 
definition of voluntary non-remunerated donation is respected and implemented by 
the Medicines Act.  

Whole-blood donations: 199 961 
Combined platelets and plasma donations: 435 
Plasma donations: 40 
Platelets donations: 6 014 
Red cells donations: 8 
Granulocytes donations: 9  

Donor statistics 

Information system 
• 

IS Rubín, which includes a centralised 
register of blood donors, is managed by 
the ICZ. 

•  A mobile application offers information 
about donor’s previous donation, the 
predicted time of next donation, and 
similar information. 

•  A website and an online appointment 

Sandwich and meal voucher worth EUR 1.5 are provided. 

Types of incentives offered to blood donors 
• 
•  Blood donors are honoured by the Red Cross of the Slovak Republic according 
to the number of blood donations; they are given plaques of Dr. Ján Jánský and 
the medal of Prof. Kňazovický. 
Some employers offer 1 day off for blood donation. 

• 
Sources 
https://english.radio.cz/slovak-plasma-donors-crossing-border-austria-8603209 
https://data.worldbank.org/indicator/SP.POP.TOTL?locations=SK 
https://www.iczgroup.com/en/pa-reference/completion-information-system-national-blood-transfusion-service-slovak-republic/ 

                                                                         55 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Slovenia 

BLOOD DONATION COUNTRY PROFILES 
 2021 

Blood donation system 
The  blood  donation  system  in  Slovenia  consists  of  the  Blood  Transfusion  Centre  of  Slovenia  in  Ljubljana  and 
associated blood transfusion units in Izola, Jesenice, Nova Gorica, Novo Mesto, Slovenj Gradec and Trbovlje; the 
Transfusion Medicine Centre at Maribor University Medical Centre and associated blood transfusion units in Murska 
Sobota and Ptuj; the Transfusion Centre at the Celje General Hospital; and the hospital blood bank at the General 
Hospital  Brežice.  The  Blood  Transfusion  Centre of  Slovenia  works  in  close  cooperation  with  the  Slovenian  Red 
Cross. Through its network of 56 local Red Cross branches, the Slovenian Red Cross provides information about 
blood  donations,  educates  and  recruits  blood  donors  through  blood  drives.  The  Slovenian  Red Cross  organises 
around 1 150 blood sessions annually, of which over 370 are mobile blood drives. 

Population 

2 101 000 

Blood donors 

Donations in 2020 

62 000 

75 638 

Donation model 
100% voluntary non-remunerated blood donation. 

Donor statistics 

Types of incentives offered to blood donors 

•  Pre- and post-donation refreshments are provided. 
•  Donors can take a paid day off work. 
•  On  National  Blood  Donation  Day,  President  of  the  Republic  of  Slovenia  Borut  Pahor  thanked  blood 
donors, saying the following: ‘Blood donors are our role models and inspiration. On the occasion of your 
day, I wish to inform you that we are aware of your noble mission, admire you, and thank you.’ 

Sources 
European Commission (2006), Report on the promotion by 
Member States of voluntary unpaid blood donations, Brussels. 

https://europeanbloodalliance.eu/country/slovenia/ 
http://www.ztm.si/en/blood-donation/blood-donation-in-numbers/ 
http://www.ztm.si/en/blood-donation/blood-donation-service/ 
https://knoema.com/atlas/Slovenia/Population 

                                                                         56 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Spain 

BLOOD DONATION - COUNTRY PROFILES 
 YEAR 2021 

Blood donation system 
The  blood  donation  system  in  Spain  consists  of  20  blood  establishments.  The  blood  establishments  are  fully 
incorporated into a unique and common public national health system. They are also responsible for designing 
programmes to promote donations. 

Population 

47 160 415 

Blood donors 

1 133 131 

Whole-blood donations: 
1 622 610 

Apheresis donations: 
97 792 

Donation model 
100% voluntary non-remunerated blood donation. 

Donor statistics 

• 36.48 donations per 1 000 inhabitants.

Type of donor 
New donor 
Regular donor 
Family/replacement donor 

% of all 
donors 
14.9 % 
70.6 % 
14.5 % 

Sources 
https://europeanbloodalliance.eu/country/spain/ 
https://www.sanidad.gob.es/profesionales/saludPublica/medicinaTransfusional/indicadores/indicadores.htm 

                                                                         57 
 
Sweden 

BLOOD DONATION COUNTRY PROFILES 
2021 

Blood donation system 
The blood services are the responsibility of the individual health care regions in Sweden; there are 21 of them. 
They are independent, but collaborate when needed.  
The non-profit nationwide organisation the Swedish Blood Alliance (SweBA) has a communications department 
called GeBlod that is responsible for donor recruitment through campaigns in magazines, newspapers and social 
media and organised blood drives in cooperation with some companies.  

Population 

9 800 000 

Blood donors 

198 709 

Donations 

387 757 

Donation model 
100% voluntary non-remunerated blood donation. 

 Donor statistics 

Age (years) 

Female 
donors 

Male 
donors 

18–24 

25–44 

45–64 

65 

4 % 

15 % 

22 % 

3 % 

3 % 

20 % 

29 % 

5 % 

• 30 136 first-time donors.
• 24 383 plasma donations.

Types of incentives offered to blood donors 

•
•

Paid day off work.
Text  message  to  inform  a  donor  once  their  blood  has  reached  a
recipient.

Information system 

• Comprehensive database – Scandat – that includes 50 years of

donor tracking data.

• 
Sources 
Edgren, G., Rostgaard, K., Vasan, S. K., Wikman, A., Norda, A., Pedersen, O. B., Erikstrup, C., Nielsen, K. R., Titlestad, K., Ullum, H., Melbye, M., Nyrén, O. and Hjgalgrim, H. 
(2015), ‘The new Scandinavian Donations and Transfusions database (SCANDAT2): a blood safety resource with added versatility’, Transfusion, July, Vol. 55, No 7, pp. 
1600–1606, doi:10.1111/trf.12986, epub 9 January 2015, PMID: 25573303. 
https://europeanbloodalliance.eu/country/sweden/  
https://geblod.nu/ 

                                                                         58 
 
 
7.28. Summary of the EU-27 blood donation landscape findings 

Blood donation system. By reporting Member State-specific information about blood donation systems, we 
show how the collection of blood is organised in the EU-27 today. As might be expected, there is considerable 
organisational variation across Member States. In 13 Member States, a national health service is responsible 
for collection of blood and  blood components. In one  Member State blood  collection is organised  by a non-
profit  organisation.  In  the  remaining  13  Member  States,  hospital  or  community  blood  banks  have  this 
responsibility solely or share it with the Red Cross. 

Blood donation model. The compiled data on blood donation models used by Member States show that only 
Bulgaria  (in  specific  cases ( 46)),  Germany ( 47)  and  Latvia  provide  financial  remuneration  for  whole-blood 
donations, whereas all other Member States declare to practice a voluntary, non-remunerated blood donation 
model ( 48). In addition, Austria, Czechia, Germany, Hungary and Latvia offer financial remuneration for plasma 
donations. See Table 2 – Summary of non-monetary and monetary blood donation incentives used in the EU 
Member States. 

Donor statistics. A general overview of the number of blood donors, the number of whole-blood donations 
and the ratio of donors in the general population in 2021 for the EU Member States is given inTable 3. The 
average  rate  of  blood  donors  in  the  general  population  for  22  Member  States ( 49)  is  2.41 %,  with  Ireland 
having the lowest rate (1.43 %) and Cyprus the highest (6.46 %). Notably, in almost all of these 22 countries 
this rate is lower than 3 %. Unfortunately, we were not able to collect data for the ratio of blood donors in the 
eligible population (i.e. the number of donors among people who can actually donate blood). Table 4 – Plasma 
donor  statistics  for  2021  (subset  of  Member  States)summarises  the  number  of  plasma  donors  and  the 
number of plasma donations in 2021 for several Member States.  

Types of incentives offered to blood donors. We summarise a variety of incentives for encouraging blood 
donations  in  EU  Member  States  in  Table 5.  We  divide  all  incentives  into  non-monetary  and  monetary 
incentives, differentiating based on the presence or absence of a monetary value attached to incentives (Chell 
et al., 2018). Furthermore, we follow Chell et al.’s (2022) typology for incentives used by Member States (see 
Table 6 for more detail). According to this typology, all strategies to recognise, reward and incentivise blood 
donations  can  be  described  as  congruent  or  incongruent,  private  or  public,  and  self-regarding  or  other-
regarding.  For  example,  congruent  strategies  are  strategies  that  directly  facilitate  blood  donation. 
Furthermore, depending on how visible the acknowledgement of donation is, strategies can be  classified as 
public or private. Lastly, depending on blood  donor or  blood  recipient  being the  main beneficiary, strategies 
provided  could  be  categorised  as  self-regarding  or  other-regarding.  The  most  used  strategies  to  recognise, 
reward and incentivise blood donors among EU Member States are a paid day or time off work (used by 63 % 
of Member States), refreshments (used by 56 % of Member States) and small tokens or symbolic gifts (used 
by  52 %  of  Member  States).  There  are  some  Member  States  that  use  interesting  strategies  that  could  be 
replicated  in  other  Member  States;  for  example,  the  Netherlands  uses  a  variety  of  campaigns ( 50),  Croatia 
rewards donors with supplementary health insurance and public transportation tickets for donors that reach a 
certain  number  of  donations,  and  the  Slovenian  president  acknowledges  donors’  contribution  on  a  National 
Blood Donation Day. 
Types  of  incentives  offered  to plasma  donors.  The  main  focus  of  this  literature  review  is  whole-blood 
donors, but we also collected, where possible, data about plasma donors and plasma donations (seeTable 6 
for  strategies  applied  to  recognise,  reward  and  incentivise  plasma  donors).  It  is  worth  noting  that  some 
Member States use innovative strategies to recruit and retain plasma donors. For example, Estonian plasma 
donors get a refund for taxi costs to and from the blood establishment. In addition, Estonian plasma donors 

(46)  Donations  of  blood  and  blood  components  in  Bulgaria  are  voluntary  and  not  remunerated.  The  only  exceptions  are  monetary 
remunerations  for  blood  donations  in  emergency  cases,  for  the  production  of  vaccines,  serums  and  immunoglobulins,  and  for 
research and diagnostic purposes. 
Around 10 % of German blood donations are remunerated. 
Some  Member  States  provide  whole-blood  donors  with  a  day  off  work  (‘reasonably  needed  for  the  donation  and  travel’),  tax 
deductions, subsidised public transportation and similar (see Table 3 for the list of countries that use these types of incentives) as 
part of their voluntary, non-remunerated donation model. 

(47) 
(48) 

(49)  Belgium,  Bulgaria,  Czechia,  Denmark,  Estonia,  Ireland,  Spain,  France,  Croatia,  Italy,  Cyprus,  Latvia,  Lithuania,  Luxembourg,  the 

(50) 

Netherlands, Poland, Portugal, Romania, Slovenia, Slovakia, Finland and Sweden. 
Those campaigns were the Sanquin at Work campaign, in which they cooperated with companies to encourage employees to donate 
blood or plasma during working hours; the Let You Hear campaign, in which they thanked donors for their donation and encouraged 
them to talk about their donation experience; and the League of Legends campaign, which was launched in 2018 for the gaming 
community and resulted in 2 500 new donors. 

59 

                                                        
are  eligible  for  extended  health  analysis.  Furthermore,  as  a  part  of  a  pilot  study,  a  savings  system  was 
introduced  to  a  limited  number  of  Dutch  plasma  donors:  when  they  donate,  they  are  given  a  virtual  donor 
drop  as  a  gesture  of  gratitude,  which  can  be  exchanged  for  a  small  reward  related  to  a  health  or  leisure 
experience. The gifts available include items such as book or cinema vouchers, health checks, yoga lessons or 
power banks, with the specific reward depending on the number of virtual drops accrued. 

Information system. Table 7 summarises types of the information technology that Member States use. 

60 

 
 
Table 2 – Summary of non-monetary and monetary blood donation incentives used in the EU Member States 

Incentives offered to blood donors 

Non-monetary incentives with some material 
component 

Monetary incentives 

Refreshments 

Medals of 
merit or 
recognition 
tokens 

Small 
tokens or 
symbolic 
gifts 

Paid 
time 
off 
work 

Subsidised public 
transportation 

Food 
vouchers 

Tax 
relief 

Heath 
insurance 
benefits 

Compensation 
for donor’s 
direct costs 

Cash 
payment 



(1) 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



(5) 

 

 

 

 



(7) 

 

 

 



(9) 

 



(9) 

 

 

 

 

 

 

 

 

 



(2) 



(4) 



(3) 

 

 

 

 



(6) 

 

 

 



(8) 

 

 

 

 

 

Member 
State 

Austria 

Belgium 

Bulgaria 

Croatia 

Czechia 

Denmark 

Estonia 

Finland 

France 

Germany 

Greece 

Hungary 

Ireland 

Italy 

Latvia 

Lithuania 

Luxembourg 

Malta 

Netherlands 

Poland 

Portugal 

Cyprus 

Romania 

Slovakia 

Slovenia 

Spain 

Sweden 

(1) 
(2) 

(3) 
(4) 
(5) 
(6) 

(7) 
(8) 
(9) 
Note: 

 Up to 1 day off work, depending on the employer. 
 Donations of blood and blood components in Bulgaria are voluntary and not remunerated. The only exceptions are monetary remunerations for 
blood donations in emergency cases, for the production of vaccines, serums and immunoglobulins, and for research and diagnostic purposes. 
 Only in cases where the donor has been specifically called for an urgent donation. 
 Not all blood services provide donors with monetary remuneration. 
 Public servants are granted paid leave when making a blood donation. 
 Blood donors in Latvia donate voluntarily. However, in accordance with Latvian legislation, donors have the option to have their travel expenses 
associated with blood donation covered up to EUR 4.27 (paid to a bank account). 
 Employers are encouraged to allow workers the required time off work to donate. 
Exemption from paying fees for access to national healthcare (tax cut). 
Granting paid leave for a donation depends on the employer. 
This  table  summarises  the  main  findings  of  the  EU-27  blood  donation  overview  related  to  different  types  of  non-monetary  and  monetary 
incentives used to motivate donors to donate blood. 

61 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Table 3 – EU Member States’ blood donor statistics for 2021 

Member State 

Population 

Median age 
(years) of 
population (1) 

Number of 
blood donors 

Austria 

Belgium 

Bulgaria 

Croatia 

Czechia 

Denmark 

Estonia 

Finland 

France 

Germany 

Greece 

Hungary 

Ireland 

Italy 

Latvia 

Lithuania 

Luxembourg 

Malta 

Netherlands 

Poland 

Portugal 

Cyprus 

Romania 

Slovakia 

Slovenia 

Spain 

Sweden 

8 951 520 

11 521 238 

6 838 937 

3 888 529 

10 712 000 

5 873 420 

1 331 796 

5 550 000 

66 410 000 

83 408 554 

10 370 747 

9 800 000 

4 986 526 

59 236 213 

1 866 942 

2 800 000 

634 730 

442 784 

17 475 415 

38 538 447 

10 344 802 

1 215 584 

19 127 774 

5 447 247 

2 101 000 

47 160 415 

9 800 000 

43.6 

41.8 

45.0 

44.4 

43.3 

42.2 

42.5 

43.3 

42.1 

45.9 

45.5 

43.6 

38.5 

47.6 

43.9 

44.1 

39.6 

40.1 

42.7 

41.6 

45.8 

38.0 

43.0 

41.4 

44.0 

44.7 

40.6 

289 918 

159 782 

94 168 

250 000 

183 409 

28 211 

113 006 

1 578 827 

72 791 

1 653 268 

33 323 

54 120 (4) 

12 698 

384 352 

615 927 

235 178 

78 475 

313 843 

119 269 

62 000 

1 133 131 

198 709 

Ratio of 
blood 
donors in 
the general 
population 

2.52 % 

2.34 % (2) 

2.42 % 

2.33 % 

3.12 % 

2.12 % 

2.04 % 

2.38 % 

(3) 

1.46 % 

2.79 % 

1.78 % 

1.93 % 

2.00 % 

2.20 % 

1.60 % 

2.27 % 

Number of 
whole-blood 
donations 

352 000 

638 818 

190 935 

427 000 

291 934 

48 348 

185 326 

2 840 072 

3 671 838 

568 000 

397 000 

127 614 

3 021 143 

56 200 

95 635 

18 946 

18 000 

407 203 

1 352 885 

310 727 

6.46 % 

300 per day (5) 

1.64 % 

2.19 % 

2.95 % 

2.40 % 

2.03 % 

387 391 

206 467 

75 638 (6) 

1 720 402 

387 757 

(1) 
(2) 
(3) 
(4) 
(5) 
(6) 
Note: 

Data were obtained from Eurostat. 
3.5 % of the eligible Bulgarian population donates blood. 
2–3 % of the German population donates blood. 
Whole-blood and blood component donors. 
69 374 units in 2022. 
Data for 2020. 
This  table  shows  the ratio  of  donors  in the  general  population in  EU Member  States  and  the number of  donations  in  2021. 
Because the ‘general population’ consists of the population that is eligible to donate and the population that it is not eligible to 
donate (for example, those aged < 18 years, those aged > 65 years or > 70 years depending on the policies of the particular 
Member  State,  those  with  medical  conditions  that  prevent  them  from  donating,  and  similar),  we  included  additional 
information on the median age of the population in each Member State. Data for 2020 are used for Germany and Slovakia. 

62 

 
 
 
 
 
 
 
 
 
 
 
 
 
Table 4 – Plasma donor statistics for 2021 (subset of Member States) 

Member State 

Number of plasma donors 

Number of plasma 
donations 

100 000 in private sector + additional 
donors in public sector 
684 

106 781 

480 (apheresis donors)  

1 021 (apheresis donors) 

Austria 

Czechia 

Estonia 

France 

Italy 

Germany 

Latvia 

Lithuania 

Luxembourg 

Netherlands 

Slovakia 

Sweden 

338 063 

993 700 

3 001  

302 097 

426 738 

2 551 092 

555 

3 418 

336 681 

40 

24 383 

Note: 

This table shows the number of plasma donors and plasma donations in EU Member States in 2021 that were successfully 
collected. 

63 

 
 
 
 
 
 
 
 
 
 
 
Table 5 – Categorising the incentives offered to blood donors in EU Member States using the typology proposed by Chell 
et al. (2022) 

Incentive offered to blood donors in EU 
Member States 

Percentage of 
Member States 
using this 
incentive 

Incongruent 
or congruent 

Private or 
public 

Refreshments 

56 % 

Incongruent 

Medals of merit or recognition tokens 

37 % 

Incongruent 

Small tokens or symbolic gifts 

52 % 

Incongruent 

Paid time off work 

63 % 

Incongruent 

Donors  

7 % 

Incongruent 

Subsidised public transportation 

11 % 

Incongruent 

Food vouchers 

11 % 

Incongruent 

Tax relief 

11 % 

Incongruent 

Heath insurance benefits 

11 % 

Incongruent 

Compensation for donor’s direct costs 

33 % 

Congruent 

Cash payment 

4 % 

Incongruent 

Self-regarding 
or other-
regarding 

Self-regarding 

Self-regarding 

Self-regarding 

Self-regarding 

Self-regarding 

Self-regarding 

Self-regarding 

Self-regarding 

Self-regarding 

Private token for 
generosity 

Public display of 
generosity 

Public display of 
generosity 

Private token for 
generosity 

Private token for 
generosity 

Private token for 
generosity 

Private token for 
generosity 

Private token for 
generosity 

Private token for 
generosity 

Private token for 
generosity 

Barrier 
removal 

Private token for 
generosity 

Self-regarding 

Note: 

This  table  uses  the  typology  proposed  by  Chell  et  al.(2022)  to  categorise  incentives  offered  to  blood  donors  in  EU  Member 
States. In addition, column 2 shows how common the usage is of each incentive within the EU Member States. 

64 

 
 
Table 6 – Summary of non-incentives and non-monetary and monetary incentives used to encourage plasma donations in 
a selection of EU Member States 

Member 
State 

Non-incentives 

Non-monetary incentives with some material component 

Monetary incentives 

Educating 
public  about 
plasma  and 
plasma 
donations 

Opening 
new 
plasma 
centres 

Refreshments 

Medals of 
merit or 
recognition 
tokens 

Small 
tokens or 
symbolic 
gifts 

Paid 
time 
off 
work 

Saving 
system 

Food 
vouchers 

Cash 
payment 

 

 

 

 

Austria 

Belgium 

 

 

Czechia 

Germany 

Hungary 

Italy 

Latvia 

Luxembourg 

Netherlands 

 

 

 

 

 

 

 

 

 

 

 

 



(1) 



(2) 

(1) 

(2) 

Note: 

In accordance with Latvian legislation, apheresis procedures are organised only by the state institution (national blood donor 
centre). Plasma obtained by apheresis is used directly to produce plasma preparations (not commercial matters) for Latvian 
patients  and,  like  blood  components,  is  distributed  to  medical  institutions  free  of  charge.  Plasmapheresis  donations  are 
compensated (EUR 17.07 paid into a bank account). 
As  part  of  a  pilot  study  due  to  run  until  July  2023,  a  savings  system  for  a  limited  group  of  plasma  apheresis  donors  was 
introduced. 
This  table  summarises  the  main  findings  of the  EU-27  blood  donation overview  related  to  different types of  non-incentives 
and non-monetary and monetary incentives used to motivate plasma donors to donate. 

65 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Table 7 – Information technology used by EU Member States for blood donor management, donor recruitment and 
retention 

Member State 

Information technology 

Austria 

—  The Austrian Red Cross is working on a centralised register for blood donations that are collected 

Bulgaria 

Croatia 

Czechia 

Denmark 

Estonia 

Finland 

France 

Ireland 

at the blood establishments that are part of the Austrian Red Cross 

—  The Mein Blut application, developed by Netcetera for the Austrian Red Cross in Upper Austria 
—  The blood donation mobile application Дари Кръв (Donate Blood) 

—  National IT system (e-Delphyn) connecting all transfusion centres in the country 

—  Software for creating appointments used in majority of public and private centres 
—  Different software for data management with different levels of complexity are available and in 

use 

—  An electronic donor questionnaire is available at a few centres 
—  Each region has its own blood establishment computer system (ProSang or Blodflödet) 

—  Estonia  has  its  own  information  system  with  donor  registry,  donor  management,  e-donor 
application, and blood components quarantine and release functions. This information system is 
not central and is managed by each blood establishment separately 

—  Online appointments system 
—  Electronic questionnaire for donors 
— 

Information  system  that  includes  donor  registry  and  management,  and  blood  products 
management 

—  Data collection (INLOG and Medinfo) 
—  The creation of appointments to donate blood  
—  Software solution supplied by MAK-SYSTEM software eProgesa 5.0.3 
—  eBoss software package for data collection and analysis 
—  New online appointment system to be available using the MAK-SYSTEM software by the end of 

the year 

Italy 

—  SISTRA  (Sistema  Informativo  dei  Servizi  TRAsfusionali) –  national  IT  system  for  blood 

establishments 

—  Each region has its own blood establishment computer system 
—  Certain  local  blood  establishments  have  online  appointment  systems  and/or  blood  mobile 

applications 

Latvia 

—  The IS ProSang donor database was implemented in 2006 
—  A donor portal will be created in the coming year. It will contain a feature that informs donors 
once  their  blood  reaches  a  recipient.  Donors  will  be  receiving  important  information  on  their 
health status and donation times, and reminders about their next visits 

Lithuania 

—  Two blood establishments use eProgesa, the remaining blood establishment uses a bespoke, in-

Luxembourg 

Malta 

Poland 

Portugal 

Romania 

Slovakia 

house IT system 

—  eProgesa from MAK-SYSTEM 
—  eDMS from MAK-SYSTEM for the laboratory, connected to eProgesa 
—  The mobile application Blood Donors MT 

—  Each  blood  donation  centre  has  its  individual  information  system.  It  is  planned  to  develop  one 

common system for all blood donation centres 

—  ASIS: in-house software developed by IPST 
—  SIBAS: commercial software developed by Glint 
— 
—  All  41  civil  blood  establishments  are  using  the  same  software  for  blood  donors  and  donation 

Imaginasoft: commercial software developed by ImaginaSoft 

activities (national blood donors database) 

—  Some blood establishments are using a software that covers the entire chain of specific activities 
—  Appointments  are  made  by  phone  and/or  one  of  two  mobile  applications –  Donorium  and 

BlooDoChallenge – depending on the blood establishment decisions made locally 
IS Rubín, which includes centralised register of blood donors, is managed by ICZ 

— 
—  A mobile application that offers information about a donor’s previous donation, predicted time of 

the next donation and similar 

Sweden 

—  A website and an online appointment system are being developed 
—  A comprehensive database – SCANDAT – that includes 50 years of donor tracking data 

Note: 

This table summarises the information technology that different Member States use to gather, process and store donor data; 
what  applications  and  online  systems  are  used  to  inform  and  remind  donors  about  upcoming  blood  drives;  the  usage  of 
electronic donor questionnaires; and similar. We excluded Member States for which we could not collect these data. 

66 

 
8.  Conclusions 

The main aim of this narrative literature review was to summarise the most recent research in the field of 
blood  donation,  offering  new  perspectives  on  factors  that  are  strongly  associated  with  blood  donor 
motivations, intentions and behaviour. Recognising that interventions can have different effects on different 
categories  of  donors  (e.g.  new  donors,  experienced  donors  and  inactive  donors),  understanding  donor 
motivations  is  essential  for  developing  effective  and  targeted  interventions  for  these  groups.  Identifying 
general  principles  that  are  effective  provides  a  strong  starting  point  when  facing  the  challenges  of  blood 
services, such as  (1) the need for  recruiting  donors  with  specific blood phenotypes (e.g. Ro Kell) to enhance 
donor–recipient matching for more effective treatment outcomes and  (2)  replacing the loss of older  donors 
with  younger  donors.  That  is,  how  can  these  general  principles  be  tailored  and  adapted  to  meet  these 
challenges, or are completely alternative approaches needed? 

We identified 78 studies to include in this literature review that followed either social science or behavioural 
science  research  agendas,  with  some  exceptions  being  literature  reviews,  theoretical  studies,  studies  about 
blood  donation  trends  and  observations,  and  guidelines.  We  summarised  studies  that  followed  a  social 
science  research  agenda  that  evaluated  the  effects  of  different  interventions  on  blood  donor  intentions. 
Furthermore,  when  reviewing  studies  that  followed  a  behavioural  science  research  agenda,  we  categorised 
them into the following groups based on the type of strategies on promoting blood donation that were tested: 
(1)  monetary  incentives  (i.e.  cash  payments,  vouchers,  gift  cards  and  similar),  (2)  non-monetary  incentives 
with  some  material  component  (i.e.  paid  days  off  work,  health  checks  and  similar),  (3)  social/community 
recognition  non-incentives  (i.e.  text  messages,  public  pledges  to  donate  blood  and  similar),  (4)  mixed 
interventions and (5) other behavioural interventions. 

In terms of behavioural interventions, Table 8 provides a brief summary of the main findings, with supporting 
notes. 

67 

 
 
Table 8 – Summary of the main findings from studies utilising behavioural interventions and following a behavioural 
science research agenda 

Intervention 

Effectiveness 
on behaviour 

Additional notes 

Solicitation letters 

Phone calls 

Email – warm-glow messages 

Donor registry 

Combining  different 
reminders 

types  of 

Active 
mechanisms 

decision 

elicitation 

Pledge – public v private 

 

 

 

 

 

 

Χ 

Information when blood is used 

Mixed (/Χ) 

For  return  donors,  especially  those  who  have  not  booked 
another donation appointment 

When appeals are made for shortages, but not when blood 
is not in short supply 

Phone  calls  and  text  messages;  phone  calls  and  email 
messages 

When the donor is not informed about donation 

Increases pledges, especially in public, but not behaviour 

Can be effective as a text. Emails may not be effective and 
need  to  be  careful  not  to  crowd  out  future  donation  by 
highlighting the current donation as a prosocial act 

Deferred 
tasks and information 

donors –  alternative 

Mixed (/Χ) 

Providing  an  alternative  prosocial  act  was  ineffective, 
whereas information why they were deferred was effective 

Paid days off work 

 

This cannot be applied to those who are not employed, and 
we have to consider if this leads to inequality and bias, or if 
an equivalent incentive is needed for those not employed 

Health checks 

Mixed (/Χ) 

cholesterol 

A 
comprehensive health check was effective 

test  was 

ineffective,  whereas 

a 

Gift vouchers 

Money 

 

Maybe  because  they  are  perceived  as  a  gift  exchange 
rather than a financial exchange 

Mixed (/Χ) 

Effective  for  non-donors,  but  crowds  out  donations  in 
women 

Table 8  summarises  the  main  findings  related  to  the  effects  on  donor  behaviour  of  different  behavioural 
interventions. 

There  are  several  take-home  messages.  Further  research  is  needed  on  messages  indicating  to  donors  that 
their  blood  has  been  used.  It  is  not  clear  if  the  mode  of  delivery  (text  or  email)  makes  a  difference  and  if 
highlighting the prosociality of blood donation can crowd out future donations by morally licensing the donor 
not to donate. Gift vouchers appear to have value as an incentive, perhaps by highlighting the gift exchange 
nature of blood donation. However, more work is needed to explore the cognition, motivations and emotions 
that vouchers afford relative to money. Offering simple paid days or time off work is also effective but raises 
ethical  issues  (it  (1)  may  be  construed  as  payment  and  may  be  coercive  and  (2)  applies  only  to  those  in 
employment). Simple warm-glow messages are effective to increase return rates from first-time to second-
time donors. 

Importantly,  there  is  a  scarcity  of  evidence  on  the  effect  of  the  usage  of  advancements  in  information 
technology  (i.e.  applications,  donor  management  technology  and  similar)  on  blood  donor  recruitment  and 
retention and it would be interesting to understand better if and how information technology can help in this 
respect. 

68 

 
 
In  addition  to  summarising  results  from  theoretical  and  empirical  studies,  we  describe  and  report  on  the 
current practices used across the EU Member States (the EU-27 blood donation overview). Namely, we show 
that there is considerable organisational variation across Member States. In some Member States, a national 
health service is responsible for collection of blood and blood components; in other Member States, hospitals 
or community blood banks have this responsibility solely or share it with the Red Cross. In one Member State, 
blood  collection  is  organised  by  a  non-profit  organisation.  Furthermore,  we  gained  an  understanding  from 
blood  establishments  directly  that  the  most  common  strategies  to  recognise,  reward  and  incentivise  blood 
donors  among  EU  Member  States  are  paid  days  off  work  (used  by  63 %  of  Member  States),  refreshments 
(used by 56 % of Member States) and small tokens or symbolic gifts (used by 52 % of Member States). Using 
the blood donor statistics for 2021 for 22 Member States, we learned that the average rate of current blood 
donors, at any one time, in the general population was 2.41 %. 

8.1.  Final thoughts and future direction 

8.1.1.  Early-stage trials 

Although large-scale field studies and randomised controlled trials (51) are described in this report, it has been 
argued  that  a  ‘clinical  trial  model’  should  be  adopted  to  develop  effective  behavioural  interventions,  with 
early-stage  studies  and  experiments  designed  to  identify  new  intervention  targets  that  are  likely  to  be 
effective with no unforeseen consequences (Ferguson, 2021b; Ferguson, 2022). There are examples of early-
stage  experiments  that  also  show  promise.  For  example,  reciprocity  messages  involving  potential  donors 
considering  the  question  ‘Would  you  accept  a  blood  transfusion  to  save  your  life?’  increase  non-donor 
propensity to donate (Ferguson, Edwards and Masser, 2022). Enabling donors to reliably signal to others that 
they are a good, kind and altruistic person may also be an effective way to attract new donors. Indeed, Lam 
et al. (2021) investigated how men wearing a blood service bandage versus a plain bandage or no bandage 
were rated in terms of altruism, generosity and health. Men wearing a branded bandage were rated as more 
generous, moral and healthy by women. These examples offer potential interventions that can be scaled up to 
larger trials. 

8.1.2.  Considering heterogeneity and ethnicity 

This review shows clearly that blood donors cannot be considered a homogeneous group. They vary in terms 
of their donor career progress (e.g. non-donor to novice to habitual donor) and demography. Furthermore, it is 
imperative to align the characteristics of the donor population with those of the general population to ensure 
equitable  distribution  of  resources,  impartiality  and  optimal  treatment  efficacy.  For  example,  at  present  the 
number  of  ethnic  minority  donors  is  low  and  one  of  the  objectives  of  blood  services  is  to  encourage  more 
blood donors from ethnic minority communities (Spratling and Lawrence, 2019). A recently reported approach 
involves increasing trust among members of a defined community, thereby encouraging them to donate blood 
(Ferguson et al., 2022). This can be achieved through conditional cooperation, which occurs when individuals 
cooperate in proportion to the level at which they observe others cooperating (Fischbacher et al., 2001). Thus, 
behavioural interventions showing people that others in their social group have signed up to donate could be 
effective.  Success  in  implementing  this  approach  has  been  demonstrated  using  Facebook,  specifically  in 
regard to individuals enrolling in an opt-in system for organ donation (Cameron et al., 2013). In all cases, a 
fully co-designed and co-production approach, working with community groups at all stages of development, 
design and evaluation, should be adopted (Telenta et al., 2020). 

8.1.3.  Emotions, transitions and cognitions 

There  is  a  clear  temporal  and  dynamic  aspect  to  the  blood  donor  career.  However,  there  is  also  a  growing 
recognition that donors’ emotions change over the course of a single donation, as well as between donations 
(Ferguson  and  Masser,  2018;  Masser  et  al.,  2020;  Williams  et  al.,  2018),  which  can  be  modelled  and 

(51) 

A  randomised  controlled  trial  is  a  type  of  field  experiment  that  is  commonly  used  to  evaluate  the  effectiveness  of  policies  or 
interventions. It is a powerful tool for establishing causality and controlling for other factors that may affect outcomes. 

69 

 
 
 
                                                        
understood using momentary ecological analysis (van Dongen et al., 2020). This approach moves away from 
models such as the TPB (treating donors more as rational decision-makers) to consider the emotional life of 
the  donor  and  the  reactive  components  of  donation  (Masser  et  al.,  2020).  This  opens  up  the  possibility  of 
exploring,  for  example,  if  it  is  the  emotions  experienced  at  the  start  (arrival),  middle  (donation)  or  end 
(recovery) of the donation process that best predicts who returns to donate. By identifying the specific stage 
of the blood donation process (arrival, donation or recovery) during which donors are most likely to experience 
negative  emotions,  blood  donation  agencies  can  develop  targeted  interventions  to  help  manage  those 
emotions and ultimately increase donor return rates. This information can be obtained through various means, 
such as surveys or monitoring of physiological  responses. Interventions could include  educational materials, 
social  support  networks  or  even  relaxation  techniques  to  help  alleviate  donor  anxiety  and  enhance  their 
overall  donation  experience.  Furthermore,  it  opens  the  possibility  of  exploring  how  donors  construct  their 
memories  of  their  previous  donation  and  how  these  constructed  memories  influence  return  rates.  Thus,  we 
can move to a more dynamic conceptualisation of the donor and the intervention process. 

8.1.4.  Exploring mechanisms 

As  detailed  above,  it  is  not  clear  if  the  mode  of  delivery  (text  or  email)  makes  a  difference  in  messages 
indicating  to  a  donor  that  their  blood  has  been  used.  A  simple  comparative  study  could  be  conducted. 
Furthermore,  it  would  be  useful  to  better  understand  if  and  how  information  technology  (i.e.  applications, 
donor management technology and similar) could help in donor recruitment and retention. It is also not clear 
if  highlighting  the  prosociality  of  blood  donation  crowds  out  future  donations;  again,  this  can  be  tested.  It 
would also be useful to know if gift vouchers support perceptions that blood donation is a gift exchange and 
monetary rewards support the perception that blood donation is a financial transaction. This would mean that 
it  would  be  possible  to  test  if  the  effectiveness  of  vouchers  is  mediated  by  enhancing  the  perception  that 
blood donation is a gift exchange. 

8.1.5.  Caveats 

It must be acknowledged that this is a narrative review of the published literature. Therefore, there is likely to 
be  reporting  bias,  because  studies  with  significant  effects  are  more  likely  to  be  published.  It  would  be 
extremely helpful if blood services worldwide could make available data on the effectiveness of interventions 
that they have used, so that a fuller and broader understanding of what has been tried and what has been 
found to be successful, and what has not, could be shared. The studies have predominantly been conducted in 
the  EU  on  predominantly  white  communities.  Thus,  any  generalisability  to  other  regions,  ethnicities  and 
communities must be made with caution. 

8.2.  Policy implications 

The issue of securing enough blood and plasma donations has been a long-standing concern for healthcare 
systems  globally,  including  in  Europe.  There  is  an  ongoing  need  for  an  adequate  supply  of  safe  and  high-
quality blood to meet the demands of patients in need. However, there are several challenges that impede the 
availability of sufficient blood  supply, such as the ageing population, changing lifestyle patterns and recent 
pandemics. 

The  primary  objective  of  this  narrative  literature  review  was  to  provide  a  comprehensive  overview  of  the 
latest  research  in  the  field  of  blood  donation,  highlighting  new  perspectives  on  factors  strongly  associated 
with blood donor motivations, intentions and behaviour. With the aim to link theory and practice directly, this 
review additionally describes blood donation systems in EU Member States, including their organisation, blood 
donation models, types of incentives offered to blood and plasma donors, and donor statistics for 2021. 

There are several take-home messages for policymakers to consider. 

  Understanding donor motivations is essential for developing effective and targeted interventions for 
different  categories  of  donors  (e.g.  new,  experienced  and  inactive).  General  principles  that  are 
effective can provide a starting point when considering the challenges facing blood services, such as 
the need to recruit donors with specific blood phenotypes and replace the loss of older donors with 
younger donors. 

70 

 
 
 
  The use of behavioural interventions such as solicitation letters, phone calls, warm-glow messages, 
donor registries, reminders, active decision elicitation mechanisms, and gift vouchers can be effective 
in increasing blood donations. 

  More  research  is  needed  on  the  effects  of  technology  advancements,  applications  and  donor 

management technology on blood donor recruitment and retention. 

  Paid days off work, refreshments and small tokens or symbolic gifts are the most common strategies 

used to recognise, reward and incentivise blood donors among EU Member States. 

  To increase the  rate of blood  donation,  blood services need to adopt a  multifaceted  approach that 
involves  a  better  understanding  of  donor  motivations  and  the  use  of  effective  behavioural 
interventions. 

71 

 
 
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framework 

Donation: 

action, 

Blood 

for 

A 

81 

 
Abbreviations 

EDQM 

European Directorate for the Quality of Medicines & HealthCare 

EU 

JRC 

TPB 

TTM 

European Union 

Joint Research Centre 

theory of planned behaviour 

transtheoretical model 

82 

 
 
List of figures 

Figure 1 – Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 flow diagram 
(Page et al., 2021) – databases, websites, reference lists and other sources searched to identify studies ........ 10 

Figure 2 – Categorisation of studies based on targeted population............................................................................................... 11 

Figure 3 – Classification of studies based on methodology ................................................................................................................ 12 

Figure 4 – Typology of blood donors based on frequency and recency of last donation (adapted from 
Ferguson, 2004) ............................................................................................................................................................................................................... 15 

83 

 
List of tables 

Table 1 – Interventions investigated in this review and their associated categories .......................................................... 20 

Table 2 – Summary of non-monetary and monetary blood donation incentives used in the EU Member States
 .................................................................................................................................................................................................................................................... 61 

Table 3 – EU Member States’ blood donor statistics for 2021 .......................................................................................................... 62 

Table 4 – Plasma donor statistics for 2021 (subset of Member States) .................................................................................... 63 

Table 5 – Categorising the incentives offered to blood donors in EU Member States using the typology 
proposed by Chell et al. (2022) .............................................................................................................................................................................. 64 

Table 6 – Summary of non-incentives and non-monetary and monetary incentives used to encourage plasma 
donations in a selection of EU Member States ............................................................................................................................................ 65 

Table 7 – Information technology used by EU Member States for blood donor management, donor recruitment 
and retention ...................................................................................................................................................................................................................... 66 

Table 8 – Summary of the main findings from studies utilising behavioural interventions and following a 
behavioural science research agenda ................................................................................................................................................................ 68 

84 

 
 
 
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