Hektoen International

A Journal of Medical Humanities

Defining donation

Ahmad Shakeri
Howsikan Kugathasan
Toronto, Canada

Money for blood can be another tool we consider in solving shortage. Image: “Today’s blood on an old receipt – merry christmas!” Photo by carloscappaticci, Dec. 24, 2007, on Flickr. CC BY-NC-ND 2.0.

Money was tight in college for my roommate and me. I had a book buying habit and he frequented restaurants. Both of us were tutors but our financial strategies and our part time jobs were not the only things that united us. There was blood.

Every few months, the American Red Cross would encourage people to donate by giving away an Amazon gift card to donors. I would jump at the chance for an opportunity to buy more books. My roommate would do something similar: he would sell his plasma for nearly ten times as much as I would make, in cash.

At a first glance, our actions do not seem too dissimilar. We were both motivated by financial need and both gave blood to satisfy that need. Both of us engaged in a transaction, he with the plasma center and a pharmaceutical company, and I with the Red Cross. And most importantly, we both called this a donation. But in many ways, these donations resemble sales.

The question is, how do we define donation, and what does this definition mean to policymakers and the Red Cross for the future? Donations and charity are underwritten by the notion of altruism, which is doing good for the sake of others alone. And in the case of blood donation, there is a very literal aspect of giving up part of yourself for others.

Most blood donors are not like me. In fact, the overwhelming majority of blood donors surveyed donate because they wanted to help others,1 not for gift cards, t-shirts, trinkets, and snacks. On the other hand, the donation (in name only) of plasma is often exclusively for the money.2

Is self-interest the demarcating line between a donation and a sale? If that is the case, then blood donations should be void of self-interest. And this may not be the case, even when we consider the majority of donors who ostensibly donate altruistically. One view, stemming from economics, denies that altruism even exists in humans. Carl Menger from the Austrian school built this idea with his subjective theory of value: the idea that two parties only engage in a transaction if each feels better off than before.3 In the case of plasma, this frame is clear: donors value the money more than their plasma, and plasma companies prefer plasma more than money. With blood donations however, what is it that donors value more than their blood?

Consider the dictator game, a common psychological experiment that involves two players, one the proposer and the other the responder. The proposer is given an amount of money and is asked to split it whichever way he chooses. The responder has no say in the decision making and must accept the split by the proposer (hence the name dictator).4 When blood donors played a modified version of this game where they donated to charities instead of another player, post-experimental surveys indicated that their donations were motivated by a desire to feel good about themselves.

These feelings of goodness are incentives classified as “warm glows.” According to the warm glow theory, the altruism of donors is clouded by the fact that they pursue this satisfaction.5 We can categorize warm glows into two groups: intrinsic and extrinsic. Intrinsic warm glows are personal feelings of being a good person, like the ones expressed in the dictator game. Extrinsic warm glows, on the other hand, function as social signals. Humans are social creatures and indicating to others that we are good plays an important role in group stability.6 In this case, an extrinsic warm glow occurs from the act of donating: donors can signal their virtue to others, ranging from mentioning the donation to wearing “I Donated” stickers, t-shirts, and social media posts about their deed.

In the light of this, the experiences of my roommate and I, and blood donors broadly, are not that different after all. Instead, what we have now is a difference of degree and type of incentives: warm glow feelings and money. When considering trends, we can see that the plasma industry is booming,7 while the Red Cross frequently faces shortages of blood.8 Incentives such as gift cards do entice donors as they enticed me, and the prosocial nature of other donors make them receptive to other incentives such as stickers and t-shirts, but there remains much more we can do in capitalizing on self-interest and money to bring forth more donors. With science and economics backing it up, perhaps it is time that we redefine donation.


  1. Mohammed S, Essel HB. Motivational factors for blood donation, potential barriers, and knowledge about blood donation in first-time and repeat blood donors. BMC Hematol. 2018;18(1).
  2. Valiente A, Abdelmalek M, Pearle L. Why Thousands of Low-Income Americans “Donate” Their Blood Plasma to For-Profit Centers.https://abcnews.go.com/US/thousands-low-income-americans-donate-blood-plasma-profit/story?id=44710257. Published 2017. Accessed January 12, 2020.
  3. Murphy R. Subjective-Value Theory. 2011.
  4. Kahneman D, Knetsch JL, Thaler RH. Fairness and the Assumptions of Economics. J Bus. 1986;59(S4):S285.
  5. Ferguson E, Taylor M, Keatley D, Flynn N, Lawrence C. Blood donors’ helping behavior is driven by warm glow: More evidence for the blood donor benevolence hypothesis. Transfusion. 2012;52(10):2189-2200.
  6. Scharf K, Smith S. Relational altruism and giving in social groups. J Public Econ. 2016;141:1-10.
  7. MarketWatch. Blood Plasma Market 2019 Global Analysis By Share, Size, Growth, Trends And Regional Forecast To 2024.https://www.marketwatch.com/press-release/blood-plasma-market-2019-global-analysis-by-share-size-growth-trends-and-regional-forecast-to-2024-2019-10-30. Published 2019. Accessed January 12, 2020.
  8. American Red Cross. Red Cross Issues Public Plea for Blood Donations. 2019.

AHMAD SHAKERI is a student at the Leslie Dan Faculty of Pharmacy, University of Toronto, specializing in the field of pharmacoepidemiology and health services research. His interests are bioethics, pharmacology and toxicology, and epidemiology.

HOWSIKAN KUGATHASAN is a student at the Department of Mathematics and Statistics, York University. He has a strong interest in bioethics, economics, and law.

Submitted for the 2019–2020 Blood Writing Contest

Winter 2020 



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