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This chapter focuses on the characteristics of blood donors in the United States. Despite all the statistical inadequacies in the data presented, the trend appears to be markedly in the direction of the increasing commercialisation of blood and donor relationships. Concomitantly, proportionately more blood is being supplied by the poor, the unskilled, the unemployed, Negroes, and other low-income groups, and — with the rise of plasmapheresis — a new class is emerging of an exploited human population of high blood yielders. Redistribution in terms of ‘the gift of blood and blood products’ from the poor to the rich appears to be one of the dominant effects of the American blood-banking systems.

This chapter looks at the nature of the gift of blood. The gift of blood has certain unique attributes which distinguish it from other forms of gift. The gift of blood takes place in impersonal situations, sometimes with physically hurtful consequences to the donor. Moreover, the recipient is in almost all cases not personally known to the donor; there can, therefore, be no personal expressions of gratitude or of other sentiments. If the principle of anonymity were generally abandoned, the consequences could be disastrous for givers and receivers as well as for all blood transfusion services. The chapter then presents a classification of the different types of blood donors: the paid donor; the professional donor; the pain-induced voluntary donor; the responsibility fee donor; the family credit donor; the captive voluntary donor; the fringe benefit voluntary donor; and the voluntary community donor.

This chapter explores the characteristics of blood donors in England and Wales, considering a study made in the summer and autumn of 1967 with the assistance of the Ministry of Health and the National Blood Transfusion Service. The study examines regional trends and statistics relating to donor populations and donor reporting rates for the general public, institutions — comprising factories, offices, and universities — and the Defence Services. The general conclusion which emerges is that the donor sample broadly resembles the population in respect of age, sex, and marital status when account is taken of the possible effects of the age-incapacity and reproductive factors. Moreover, for most age groups, the general public donor is more representative of the national population than the institutional donor or the total of all donors. The institutional and Defence Services donor tends on the whole to be younger.

This chapter focuses on blood donors in the Soviet Union and other countries. About half of all blood supplies in the Soviet Union are obtained from unpaid donors at factories, offices, colleges and palaces of culture, and other institutions. They are recruited by the Union of Red Cross and Red Crescent Societies. Donors are allowed a day off work to give their donation and a free meal afterwards; they are also given an extra day's holiday which, if they choose, they may add to their annual vacation. Other reports suggest that in some places donors may be rewarded with free public transport for a month, higher priority for housing, and other ‘fringe benefits’. Meanwhile, the other half of all blood supplies comes from paid donors who attend blood-collecting stations. Although they get a day off work for donating, they are not given a free meal or other benefits.

This chapter discusses the transfusion of blood. Beliefs and attitudes concerning blood affect in varying degrees throughout the world the work of transfusion services in appealing for and recruiting blood donors. A deeply rooted and widely held superstition is that the blood contained in the body is an inviolable property and to take it away is sacrilege. In parts of Africa, for example, it is believed also that blood taken away cannot be reconstituted and that the individual will therefore be weakened, be made impotent, or be blinded for life. The growth of scientific knowledge about the circulation of the blood, the composition and preservation of blood, and the distribution of blood group genes throughout the human race has provided a more rational framework. However, it is only more recently that scientific advances have made a blood transfusion service an indispensable and increasingly vital part of modern medicine.

This chapter draws on ethnographic research in Kolkata and Delhi. It follows voluntary blood donor organizations seeking to convey to the janata (people) that the body produces more blood than it needs and that a portion of this excess blood can be given without the body losing anything. This is an insight at odds with conventional understandings of blood excorporation in the region as involving irrecuperable loss, understandings that inform continuing perceptions of blood donation as a sacrificial gesture. To give blood without risking irrecuperable loss would seem to fundamentally undercut the gesture of blood donation as sacrifice. An imagination of blood as excess and surplus thus involves the antisacrificial redescription of blood donation.

This chapter looks at a study of blood donor motivation in South Africa, which was commissioned by the Natal Blood Transfusion Service and carried out in Durban. Much of the fieldwork was done by six trained Bantu graduates which helps to explain the perceptive nature of some of the interview data elicited from poor and semi-literate Bantu workers. The study shows that the Bantu donor is statistically rare. They come mainly from institutional groups such as factories and schools and tend to be younger, better educated, and with higher incomes than the average Bantu adult in Durban. The concepts of blood held by the average manual worker Bantu closely link blood with health and are unfavourable to blood donation. Moreover, in the Bantu population at large there is widespread ignorance about, and fear of, blood donation. A marked characteristic of the Bantu blood donors is that they tend to give blood only once or twice.

This concluding chapter provides some interpretative comment on the responses of the voluntary blood donors recorded in the preceding chapter and relates certain issues of principle and practice raised in this book's study to the potential role that governmental social policy can play in preserving and extending the freedom of the individual. Practically all the voluntary donors employed a moral vocabulary to explain their reasons for giving blood. They acknowledged that they could not and should not live entirely as they may have liked if they had paid regard solely to their own immediate gratifications. However, none of the donors' answers was purely altruistic. The chapter then argues that policy and processes should enable men to be free to choose to give to unnamed strangers. They should not be coerced or constrained by the market.

This chapter discusses Israel's ban on Ethiopian blood donors. Due to the possibility that Ethiopian Israelis have a 50-fold higher chance of HIV infection relative to non-Ethiopian Israelis, Israel's blood supply from Ethiopian Israelis were all discarded. The chapter begins with a brief review of recent estimated HIV incidence in both Ethiopian and non-Ethiopian Israelis. It then presents a simple model of the probability of infectious donation and estimates this infectious donation risk for both Ethiopian and other Israelis. Using this model, the impact of exclusion of Ethiopian donors on the annual number of infectious donations to the Israeli blood supply is evaluated and the result is used as an implicit cost-effectiveness analysis. The analysis shows that on average, excluding Ethiopian donors prevents at most one HIV infectious donation every ten years.

In this chapter, Robert Pinker explores the conditionality and ‘mix’ of altruism and egoism and provides theoretical and rational rather than ideological or doctrinaire justifications for welfare pluralism. He begins by discussing The Price of Blood, a monograph that reviewed the arguments for and against paying blood donors and developing a role for competitive markets in the sale and purchase of blood products. Pinker challenges Richard Titmuss's analysis of the moral qualities that underpin exchange relationships in his 1970 book The Gift Relationship. He also reflects on his works Social Theory and Social Policy (1971) and The Idea of Welfare (1979) which, together with The Gift Relationship and Julian Le Grand's Motivation, Agency, and Public Policy (2003), illustrate the ways in which the normative debate about the ends and means of social policy and its entire institutional framework has changed.