Paying donors and the ethics of blood supply

Throughout history the most sacred, the most fantastic, the most prosaic properties have been attributed to blood. Today medical and technical advances have made blood a therapeutic resource of extraordinary importance and, thus far, an irreplaceable one. A safe, ample blood supply is a cornerstone of any health care system, and the lifeline of that supply is its donors. Donors can be divided into two broad categories: paid and unpaid, the latter most commonly referred to as voluntary. In this article I will point out the drawbacks of paying donors which have prompted many nations to adopt all-volunteer systems. But an all-volunteer model is not exempt from defects and I shall attempt to explain some of these defects and explore the question of when resorting to paid donors may be acceptable. I leave open the possibility of making certain exceptions to the principle of an all-volunteer system on the basis that so-called practical problems of blood-supply models, such as the shortage of blood and plasma, are loaded with compelling moral considerations. In weighing the ethical problems surrounding paid donors, it is important to consider not simply the payment per se but also the blood-supply system as a whole. In the following pages I will try to highlight the most central issues that need to be bome in mind when shaping blood-supply strategies.