Introduction
The issue with blood donation in Canada, as well as around the world, is that the supply of blood peaks during times of crisis when the need for blood is at the forefront of the public’s attention. This often outpaces the demand and goes to waste due to the small shelf life of blood. There is a steady demand for blood donation year-round and is often under-supplied. Should Canada use a monetary incentive to improve the supply and demand imbalance for blood donation?Blood Donation In Canada Canadian Blood Services (CBS) looks after the blood donation efforts within all Canadian provinces. Its aim is to preserve a satisfactory blood supply. The Canadians start donating blood at age17 and continue to donate until age 71. About 60% of Canadians are looked upon to be eligible donors. However, less than 4% of eligible 1 Canadians donate blood actively every year. The aging population rise in Ontario predicts a higher demand in the coming years. Results show that blood demand will outstrip supply, with a number of red blood cell transfusions to rise in the 70+ age group. However, with careful management of the blood supply and use of new medical techniques can remove the future concerns. There is a need to hire new donors to the system and encourage responsible cooperation among collection, maintenance, and distribution of blood products. Canadian Blood Services (CBS) 2 is already appealing to its population and the eligible donors to make active blood donations. The reason behind is that the blood inventory in the nations has reached a critically low point. All blood donors, especially type O and A blood are needed.
__________________________1Newbold, K. Bruce Newbold, Paez , Antonio Heddl, Nancy Heddl (2012) Forecasting Ontario’s blood supply and demand. Transfusion. (52)366-374.2 Newbold, K. Bruce Newbold, Paez , Antonio Heddl, Nancy Heddl (2012) Forecasting Ontario’s blood supply and demand. Transfusion. (52)366-374.
The national inventory got depleted faster because of extremely low donations at blood donor clinics and the higher demand of blood. The national blood inventory has been the lowest since 2008. CBS is facing difficulties to meet the expected hospital demand and is relying heavily on its citizens to come forward. Soon, the Canadian Blood Services will have fewer than three days’ worth of inventory of the major blood groups in their inventory. London Health Sciences Centre is the fifth heaviest user of blood and its components in Canada3.How Demographic are changing in the world The population structure in most countries, including the Western world is fast changing and shifting from younger to older age groups. Better health care, high birth rate and an increase in life expectancy lead to greater number of older patients. There needs to be an adequate balance supply of blood donations and the demand for blood transfusions. The requirements for blood has increased over the past two decades due to therapeutic advances, as well as a rise in the numbers of surgical procedures.
Blood supply is the transfer of blood from the population donor population to the recipient population. The demographic structure 4 of these two populations differs considerably. While the donor population is made of young, healthy individuals, those in need of blood are aged 60 or above. This is causing pressure on the donor population that is comparatively lesser in number as camped to the recipient population. Moreover, there are always risks of safety issues regarding pathogen transmission.
__________________________3 London Health Sciences Centre. “Blood inventory in critical condition”, http://www.lhsc.on.ca/About_Us/LHSC/Publications/Homepage/Canadian-Blood-Services-facing-critical-shortage.htm
4 Greinacher, Andreas, Konstanze Fendrich, and Wolfgang Hoffmann. 2010. Demographic changes: The impact for safe blood supply. Transfusion Medicine and Hemotherapy 37 (3): 141-8.
There are concerns that the changes in blood donation ratio will impend the accessibility of adequate amounts red blood cells. The demographic shifts will certainly pose a huge challenge for the transfusion medicine in the coming decades. Analysis of demographic data5 in recent studies indicates increased need for blood and blood products in the future and a reduction in blood donations. If the medicine community is not able to increase the number of donors, it will not be able to compensate for those shortages. The number of aged is expected to rise in the subsequent years, and will lead to higher demand of blood donation. Another approach could be to control the growing deficits in blood supply with improved medical practice and procedures.
People may donate blood due to self-motivation and unselfish humane behavior 6. Many blood camps run on monetary incentives for the blood donors. The altruistic donors may feel less inclined to donate blood if they found that incentives were offered to donate blood. However, it is argued that non-monetary rewards would serve a better purpose. There are plenty of talks on the subject of motivating blood donation through incentive mechanisms. As the shelf life of blood is short, the focus is always on getting a regular supply of blood donors at all times.World Health Organization Reports
World Health Organization (WHO) in 1997 recommended that all blood donations should come from voluntary donors. When 124 countries were surveyed, it was found that only 49 had established this as a standard and their percentage of active donors varied. The issue of offering rewards for blood donation and the inherent nature of the altruism has often been debated.
__________________________5 Greinacher, Andreas, Konstanze Fendrich, and Wolfgang Hoffmann. 2010. Demographic changes: The impact for safe blood supply. Transfusion Medicine and Hemotherapy 37 (3): 141-8.6 Costa-Font, Joan, Jofre-Bonet, Mireia, T Yen, Steven. 2012. Non-monetary rewards could be used to incentivize blood donation.
A study done to measure the perspectives of the population on this subject revealed that the group that believes in incentives for blood donation is also less likely to donate. While, the other group that favored non-monetary rewards, or no rewards is more likely to have donated blood. Thus, the results show that the non-monetary rewards could be used to incentivize blood donation. It has also been found that males and females favor blood donation, but it is the males 7 who are more likely to be donors because of their higher body weight, no issues of pregnancy, and lower chances of being anemic. However, males also are in favor of monetary rewards.
Will incentives work?
Incentives have always been used to improve certain behavior or achieve certain goals. The basic laws hold that the higher the incentives; the higher will be the motivation and performance. Employers often offer incentives to motivate their workers and extract certain behaviors from them.
However, can incentives be used in aspects like blood donations, and if yes, how successful will it be? The applications of incentives in such fields as education and health have provoked heated debate. Opponents of using incentives argue that incentives in those areas will destroy the intrinsic motivations of altruistic behavior in blood donors8. The motivations have to come from inside and not form outside. How large these incentives should be and what kind they should be, are another topic as meager incentives may lead to undesired effects. In some cases, the desired outcomes may last for a shorter time and still weaken intrinsic motivations.
__________________________7Costa-Font, Joan, Jofre-Bonet, Mireia, T Yen, Steven. 2012. Non-monetary rewards could be used to incentivize blood donation.8 Gneezy, Uri, and Stephan Meier. 2011. When and why incentives (don't) work to modify behavior. The Journal of Economic Perspectives 25 (4): 191-209.
The study was done on the influence of monetary incentives to get the desired behavior in the field of education, contributions to public goods and to motivate people.
Monetary incentives seem to carry two different effects, one is a standard direct impact and the other is an indirect psychological effect. Sometimes, the psychological effect 8 works in the opposite direction of the price effect. Any individual gets motivated to act because he enjoys doing the activity; he cares about his image or values extrinsic rewards. This image motivation will depend on the degree of care the individuals has his reputation. Individual enjoyment of tasks may differ from person to person. Offering incentives in the field of education is not attractive, as it will send bad signals to the subject and can lower the intrinsic motivation of the agent. Moreover, the higher personal benefit associated with a certain behavior, may also affect the reputation of a person. In such cases, offering materialistic rewards may backfire, where the image motivation carries a stronger role.
There could be many more examples, where the incentives give may in fact lower the motivation to doing a particular task. What motivates people to do a task depends on their needs of survival and extrinsic rewards9. When the nature of intrinsic and extrinsic motivation was explored, it was assumed that the intrinsic motivation always thrusts behavior in the same direction as extrinsic motivation. It has been argued that motivating people by paying them to donate blood would break established social norms and undermine the value of voluntary contribution.
__________________________8 Gneezy, Uri, and Stephan Meier. 2011. When and why incentives (don't) work to modify behavior. The Journal of Economic Perspectives 25 (4): 191-2099 Gneezy, Uri, and Stephan Meier. 2011. When and why incentives (don't) work to modify behavior. The Journal of Economic Perspectives 25 (4): 191-209
It might also lower the number of people who like to donate voluntarily and without the need of any incentives. Another good example is that no matter how significant the incentive is., you cannot make people accept the presence of a nuclear waste site, as the risks involved are too high.
Prosocial Behavior and Incentives The prosocial behavior comprises of making voluntary contributions and without selfish motives, such as volunteering, donating blood or protecting the environment. Any individual who is not self-motivated and is selfish is not expected to contribute to the public good. A question arises if offering incentives for such segment of the population can work in the betterment of the society and lead to the optimal level of contributions? Some economists argue that offering monetary incentives to encourage blood donations, will in fact, may crowd out such donations. Another study shows that providing small monetary incentive to children for voluntary acts of charity lowers their intrinsic motivation to do better for the society.
Prosocial behaviors involve trust, and the relationships are delicate. However, explicit incentives can usher in distrust as shown in a number of laboratory experiments. The results have shown that the incentives can be perceived as negative or positive. The voluntary cooperation and trust gets lower in the long run. Even if those incentives are not seen as a sign of distrust, it is the control over the incentives that gives plenty of reasons to harbor suspicions
As they say, one of the noblest activities of life is to donate blood. According to the World Health Organization statement, the blood gets donated hundreds and millions of times annually, and there are exemplifying examples of human empathy and altruism. However, one often sees a seasonal supply shortage of blood or excess supply of blood, especially after a natural calamity. Clearly, there are imbalances in the supply and demand that reflects the lack of good market practices. Today, tackling these imbalances is a major challenge in blood markets, and it is getting critical to bridging the gap7 between aggregate supply and demand. Blood products are made of platelets, whole blood, plasma, and its fractionated parts. These components of blood are regularly needed for many routine treatments, along with surgeries, transfusions8, etc. Transfusions of blood and plasma can help save millions of lives and improved health outcomes. Even with a large supply of voluntary donation of blood, there is a critical deficiency of blood in most countries. The multibillion–dollar blood industry is only getting bigger and expanding at a fast rate to meet the growing demands. The hospitals buy these blood products, store them and charge the patients for their use.
A survey shows that high-income countries Greece, Saudi Arabia, and Lithuania have below 50 % blood supplied by volunteers, while the lower-income countries Mexico, Latin American and African countries are the ones with below 50 % blood9 supplied by volunteers. Generally speaking, about37% of all countries get their blood supply from volunteers. With the limited storage length and no market price for whole blood, one often sees excess supply and shortages in the market. The imbalance in the market
Spikes in donations, limited shelf life, technical constraints for collection and proper storage of blood often leads to destroying the blood supply.
__________________________7 Slonim, Robert, Carmen Wang, and Ellen Garbarino. 2014. The market for blood. The Journal of Economic Perspectives 28 (2): 177-96.8 Slonim, Robert, Carmen Wang, and Ellen Garbarino. 2014. The market for blood. The Journal of Economic Perspectives 28 (2): 177-96.9 Slonim, Robert, Carmen Wang, and Ellen Garbarino. 2014. The market for blood. The Journal of Economic Perspectives 28 (2): 177-96.
Millions of units of the blood collected are eventually discarded. This points to the need to reform the procedures of collection and storage 10 as well as supply of the blood line. The red cells can be collected and stored for six weeks. With improved transport systems, the supply can be shipped to other locations in need of blood. The collection agencies should turn away volunteer donors, once they have the right information in time. The hospitals can prioritize their usage and postpone elective surgeries based on the supply.
The discussions suggest that the market of whole blood donation in wealthy countries is characterized by volunteer supply that is primarily motivated by altruism. With no price mechanism to direct supply and demand, the supply and demand remain in imbalance. Sending a donation invitation among blood donors who have not donated blood for the past one year often works. Offering small gifts like pens, gift cards, t-shirts11, etc., can increase the blood donation supply, without affecting future donations. However, offering substantial material incentives in many countries remains a questionable option in many countries.
In the current blood donation market, the lack of any market price means that donors might donate when blood is not required and not donate when it is wanted. The blood donors are an independent group who base their decisions on their intrinsic motivation and the limited information they have. The blood services should employ a combination of strategies based on media and telemarketing to communicate and address shortages.
__________________________10 Slonim, Robert, Carmen Wang, and Ellen Garbarino. 2014. The market for blood. The Journal of Economic Perspectives 28 (2): 177-96.11 Slonim, Robert, Carmen Wang, and Ellen Garbarino. 2014. The market for blood. The Journal of Economic Perspectives 28 (2): 177-96.
After Sept. 11 terrorist attacks, more than 200 000 units of whole blood 12 had to be discarded. The US blood banks have placed a special task force to make sure that this does not get repeated again. The donated blood has to be thrown away if it remains unused after forty-two days.
The blood donations in the nation have plummeted, and about one-third of the nation's blood banks carry a day's supply or less. The New York Blood Center 13 sees 13% fewer donors.Conclusion When incentives are placed in areas like education, forming good habits or doing well for a society like blood donation, there is a possibility of a conflict arising. How these incentives will impact the behavior of an individual, or crowd out his intrinsic motivations can vary. However, there are no concrete positive impacts seen on the prosocial behaviors in the society in the long run because of this incentives. They seem to have a moderate success in education or encouraging people to donate blood. Therefore, one must be very careful when designing the incentives, as they are directly related to the image concerns and trust, and both these aspects are very important for any individual in a society. Thus, when incentives are discussed by economists, they should broaden their focus. The effects of the incentives, whether they are to be monetary or nonmonetary 14, where and how much to be given are some of the issues that are very important. Incentives do work sometimes and in unexpected ways.The market for blood is controlled deeply by the social norms and ethical concerns. The supply
__________________________12 Slonim, Robert, Carmen Wang, and Ellen Garbarino. 2014. The market for blood. The Journal of Economic Perspectives 28 (2): 177-96.13 Milan Korcok. 2002. Blood donations dwindle in US after post-sept. 11 wastage publicized. Canadian Medical Association. Journal 167 (8): 907-.14 Gneezy, Uri, and Stephan Meier. 2011. When and why incentives (don't) work to modify behavior. The Journal of Economic Perspectives 25 (4): 191-209.
and demand for blood donations are highly reliant on volunteer donations. The countries with higher volunteer donors may still not be able to provide safer blood. There are limited experiments to incentivize blood donation, but their positive impacts are yet to be seen. It is unlikely that countries will move toward remunerated systems.
The US plasma market is dominated by commercial operations and rely on volunteer plasma15 .Market innovations can help improve the balance supply and demand as the social norms evolve over time. There is a need to motivate those marginal blood donors to donate when the supplies fall below the demand and motivate them. Blood collection agencies need to improve their clearinghouse functions, and help improve the welfare significantly.
BLOOD DONORS AND BLOOD COLLECTION
Forecasting Ontario’s blood supply and demand_3280 366..374
Adam Drackley, K. Bruce Newbold, Antonio Paez, and Nancy Heddle
BACKGROUND: Given an aging population that
requires increased medical care, an increasing number
of deferrals from the donor pool, and a growing immi-
grant population that typically has lower donation rates,
the purpose of this article is to forecast Ontario’s blood
supply and demand.
STUDY DESIGN AND METHODS: We calculate age-
and sex-specific donation and demand rates for blood
supply based on 2008 data and project demand
between 2008 and 2036 based on these rates and
using population data from the Ontario Ministry of
Finance.
RESULTS: Results indicate that blood demand will
outpace supply as early as 2012. For instance, while
the total number of donations made by older cohorts is
expected to increase in the coming years, the number
of red blood cell (RBC) transfusions in the 70+ age
group is forecasted grow from approximately 53% of all
RBC transfusions in 2008 (209,515) in 2008 to 68%
(546,996) by 2036. A series of alternate scenarios,
including projections based on a 2% increase in supply
per year and increased use of apheresis technology,
delays supply shortfalls, but does not eliminate them
without active management and/or multiple methods to
increase supply and decrease demand.
CONCLUSIONS: Predictions show that demand for
blood products will outpace supply in the near future
given current age- and sex-specific supply and demand
rates. However, we note that the careful management
of the blood supply by Canadian Blood Services, along
with new medical techniques and the recruitment of
new donors to the system, will remove future concer
BLOOD DONORS AND BLOOD COLLECTION
Forecasting Ontario’s blood supply and demand_3280 366..374
Adam Drackley, K. Bruce Newbold, Antonio Paez, and Nancy Heddle
BACKGROUND: Given an aging population that
requires increased medical care, an increasing number
of deferrals from the donor pool, and a growing immi-
grant population that typically has lower donation rates,
the purpose of this article is to forecast Ontario’s blood
supply and demand.
STUDY DESIGN AND METHODS: We calculate age-
and sex-specific donation and demand rates for blood
supply based on 2008 data and project demand
between 2008 and 2036 based on these rates and
using population data from the Ontario Ministry of
Finance.
RESULTS: Results indicate that blood demand will
outpace supply as early as 2012. For instance, while
the total number of donations made by older cohorts is
expected to increase in the coming years, the number
of red blood cell (RBC) transfusions in the 70+ age
group is forecasted grow from approximately 53% of all
RBC transfusions in 2008 (209,515) in 2008 to 68%
(546,996) by 2036. A series of alternate scenarios,
including projections based on a 2% increase in supply
per year and increased use of apheresis technology,
delays supply shortfalls, but does not eliminate them
without active management and/or multiple methods to
increase supply and decrease demand.
CONCLUSIONS: Predictions show that demand for
blood products will outpace supply in the near future
given current age- and sex-specific supply and demand
rates. However, we note that the careful management
of the blood supply by Canadian Blood Services, along
with new medical techniques and the recruitment of
new donors to the system, will remove future concer
__________________________
15 Slonim, Robert, Carmen Wang, and Ellen Garbarino. 2014. The market for blood. The Journal of Economic Perspectives 28 (2): 177-96.
BIBLIOGRAPHY
Costa-Font, Joan, Jofre-Bonet, Mireia, T Yen, Steven. 2012. Non-monetary rewards could be used to incentivize blood donation.
Greinacher, Andreas, Konstanze Fendrich, and Wolfgang Hoffmann. 2010. Demographic changes: The impact for safe blood supply. Transfusion Medicine and Hemotherapy 37 (3): 141-8.
Gneezy, Uri, and Stephan Meier. 2011. When and why incentives (don't) work to modify behavior. The Journal of Economic Perspectives 25 (4): 191-209.
London Health Sciences Centre. “Blood inventory in critical condition”, http://www.lhsc.on.ca/About_Us/LHSC/Publications/Homepage/Canadian-Blood-Services-facing-critical-shortage.htm
Milan Korcok. 2002. Blood donations dwindle in US after post-sept. 11 wastage publicized. Canadian Medical Association. Journal 167 (8): 907-.
Newbold, K. Bruce Newbold, Paez , Antonio Heddl, Nancy Heddl (2012) Forecasting Ontario’s blood supply and demand. Transfusion. (52)366-374.
Slonim, Robert, Carmen Wang, and Ellen Garbarino. 2014. The market for blood. The Journal of Economic Perspectives 28 (2): 177-96.
