Motivational Factors in Blood Donation - A Systematic Review

Special Article: Transfusion Medicine

J Blood Disord. 2024; 11(1): 1083.

Motivational Factors in Blood Donation - A Systematic Review

Bianca Andrade Borsato1; Caroline Bitencourt Silva Miranda1; Hayssa Silva Bizotti1; Maria Eduarda de Moura Soares1; Rafaela Labiapari1; Daniela de Oliveira Werneck Rodrigues1,2*

1Departamento de Clínica Médica, Centro Universitário Presidente Antônio Carlos. Juiz de Fora, Minas Gerais - Brazil

2Hemocentro Regional de Juiz de Fora, Fundação Hemominas, Juiz de Fora, Minas Gerais, Brazil

*Corresponding author: Daniela de Oliveira Werneck Rodrigues Fundação Hemominas, Juiz de Fora, Minas Gerais, Brazil. Email: danielawerneckhemato@hotmail.com

Received: December 01, 2023 Accepted: January 06, 2024 Published: January 13, 2024

Abstract

The primary motivating factor for blood donation is altruism and its derivatives, such as empathy and social responsibility. However, no conclusive answers were obtained from the analysis of these articles, indicating the need for further studies focused on this topic. In Brazil, blood donation is voluntary, unpaid, and anonymous. Despite being a reference in Latin America for improving voluntary donation rates and expanding the age range of potential donors, there are still many challenges related to this practice, as only 1.9% of the Brazilian population are blood donors. This article aims to identify, through a literature review, the main motivations for blood donation. For this purpose, a systematic review was conducted, including studies published in English, Portuguese, and Spanish between 2013 and 2023, from the PubMed, SciELO, and LILACS databases, using MeSH queries with the descriptors “blood donors,” “donor motivation,” and “motivation.” Original articles and review articles were included. A total of 207 articles were identified in February and March 2023, and after applying the inclusion criteria, 25 articles were selected for the study. This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO- CRD42023431808) and concluded that the main motivator for blood donation was altruism and its “derivatives,” such as empathy and social responsibility. No conclusive answers were obtained from the analysis of these articles, which necessitates further studies on this topic.

Keywords: Blood donors; Motivation; Donor motivation

Introduction

Blood has played a significant role throughout the history of humanity, being associated with life, and expressed through myths and symbols in different cultures. The history of blood transfusion can be divided into three distinct periods: prehistoric, pre-scientific, and scientific. The scientific period was marked by the discovery of blood groups in the early 20th century. Over time, blood transfusion became an essential therapeutic practice for saving lives, leading to the emergence and organization of hemotherapy [1].

In Brazil, the first blood banks emerged in 1940, and since then, the act of donating blood has acquired meaning not only culturally but also religious, economic, social, and even political significance. Over time, people have developed motivations and impediments related to this practice [2]. In the 1940s, the use of blood and its derivatives had a high market value and was considered a profit-oriented act. Consequently, it led to an increase in the number of blood donations in Brazil [3]. However, this practice was prohibited by the Brazilian Society of Hematology and Hemotherapy and the Brazilian Medical Association in 1979, making blood donation strictly a voluntary act. This decision was made because the increase in the number of people who began donating blood for monetary gain made it difficult to control the donors' identity and compromised the donor's viability. As a result, the donor pool became non-specific1. Therefore, since donation became a voluntary act in the country, the number of donors experiences significant instability, highlighting the need for strategies to attract donors to meet blood banks’ demands [2].

The World Health Organization (WHO) estimates that 3% to 5% of the population should be blood donors, which is not the reality in most countries [4], especially in those where donation is a voluntary act. The National Blood Donor Program (PNDS) has set goals to mobilize society towards the need for spontaneous and regular blood donation, aiming to ensure an adequate supply to meet the country's demand and improve the quality of blood, its components, and its derivatives. If these objectives are achieved, they will gradually foster a new culture of blood donation in Brazilian society, resulting in a gradual increase in voluntary donations, donor loyalty, and an increase in the coverage percentage of blood components. This, in turn, will reduce the final cost due to a decrease in clinical and serological ineligibility rates [5].

In countries where donation is voluntary, the search for donors is a challenging process as there is often a deficit in the number of donors and maintaining an adequate blood supply, which impacts the ability to perform surgeries and puts lives at risk [6]. Several studies are underway to understand the motivations and obstacles within society regarding the blood donation process. The authors conducted a literature review and presented in this study the compiled data from Brazil and international literature on the motivational factors of blood donation.

Material and Methods

This review included original research articles and review articles available in English, Portuguese, and Spanish from the years 2013 to 2023. The articles were required to be fully accessible and free of charge, and they had to address the pre-established PICO (Population, Intervention, Comparison, Outcome) criteria. We opted to conduct a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO-CRD42023431808). The literature search was performed using the PICO approach.

P (population): Blood donors.

I (intervention): Factors that motivate donors. C (comparison): Different types of motivations.

O (outcome): Identification of the main motivations for blood donation.

A search was conducted in the LILACS (Latin American and Caribbean Health Sciences Literature), SciELO (Scientific Electronic Library Online), and PubMed databases during the months of February and March 2023. The following keywords were used: "blood donors," "motivation," and "donor motivation," as per the Medical Subject Headings (MeSH). The Boolean operator "AND" was used to connect these keywords.

The following criteria were used for the exclusion of studies works that did not belong to the theme, studies involving other types of donations, studies without an abstract, and those that did not include at least two of the descriptors addressed in this review in the title or abstract. Additionally, books, book chapters, editorials, experiential reports, correspondences, letters to the editor, comments, opinion articles, and guidelines were excluded as it was not possible to verify the peer review process, as is the case with scientific articles.

Results

The study selection was conducted in stages by the reviewers. In the first stage, the titles and abstracts of the 207 references identified through the search strategy were evaluated. After removing duplicates, only studies from the PubMed and SciELO databases remained. Potentially eligible studies were pre-selected, and duplicates were excluded.

In the second stage, the 50 pre-selected studies were evaluated and read in full to confirm their eligibility. After applying the inclusion and exclusion criteria, 25 articles were selected to be included in the scope of this study (Table 1). With these articles, the third phase of the Systematic Review began, represented by the detailed analysis of each article organized in a synoptic framework with specificities of each publication, such as article title, objective, database, and results that allowed analysis with bibliometric characteristics.

Table 1: List of titles of the articles, objective, database, and results.










  


    
Article Title


    
Objective


    
Database


    
Results


  


  


    
Social marketing of blood donation: an analysis of new donors’    predisposition.7


    
To understand the motivational factors that influence individuals to    donate blood, to support social marketing actions aimed at recruiting new    donors.


    
SciELO®


    
It was found that fear has a negative influence and reference group has a    positive influence on people's predisposition to donate blood. This indicates    that marketing actions are more effective in encouraging new donors if they    focus on these two factors.


  


  


    
Motivation, blood donor satisfaction and intention to return during the    COVID-19 pandemic.8


    
To describe the reasons, donation experiences, and intention to return    for future donations among German whole blood donors who donated at the onset    of the COVID-19 pandemic.


    
PubMed®


    
More than half of the participants wanted to contribute to the fight    against the pandemic by donating blood. The majority were satisfied with    their last donation experience and felt safe. However, some donors would like    more information on how to deal with the pandemic. The intention to return    was strongly associated with overall satisfaction and a feeling of safety    during the donation.


  


  


    
Motivations and deterrents of blood donation among blood donors during    the COVID-19 pandemic in Hong Kong.9


    
Investigate the motivators and demotivators for blood donation among    current blood donors during the COVID-19 pandemic.


    
PubMed®


    
Most participants were demotivated to donate blood during the COVID-19    pandemic. The data revealed that sociocultural forces and government policies    for pandemic prevention strongly influenced the participants' motivations.


  


  


    
Defining and measuring blood donor altruism: a theoretical approach from    biology, economics, and psychology.10


    
A psychometric evaluation derived theoretically from altruism is    developed in this study and can be used to help inform our understanding of    the altruistic motives of blood donors and recruitment intervention    strategies.


    
PubMed®


    
The results show that altruism in the context of blood donation is    multifaceted and complex and does not solely reflect pure altruism. This has    implications for recruitment campaigns that solely focus on pure altruism.


  


  


    
Whole blood and apheresis donors in Quebec, Canada: Demographic    differences and motivations to donate.11


    
Compare demographic data and donation motivations between plasma/platelet    donors and whole blood donors in a voluntary and non- remunerated context.


    
PubMed®


    
The belief that helping others is inherent in their nature is more    prevalent among plasma/platelet donors. Four other motivators distinguish    this group from whole blood donors.


  


  


    
Motivating Factors and Potential Deterrents to Blood Donation in High    School Aged Blood Donors.12


    
Understanding the factors that motivate and hinder individuals from    donating can help centers develop targeted recruitment campaigns.


    
PubMed®


    
Motivating factors that reflect pro-social, empathetic, and altruistic    thoughts and beliefs were highly rated by the students. However, some    incentives were also evaluated as appealing.


  


  


    
"Blood for Blood"? Personal Motives and Deterrents for Blood    Donation in the German Population.13


    
To investigate the prevalence and sociodemographic pattern of blood    donation throughout the lifespan.


    
PubMed®


    
The most cited reasons for blood donation were "altruism,"    "social responsibility," and "charity," while the most    cited barriers were "health condition," "age," and    "lack of time."


  


  


    
Motivational factors for blood donation, potential barriers, and    knowledge about blood donation in first-time and repeat blood donors.14


    
The aim is to understand the motivators and barriers of donors to recruit    and retain suitable regular unpaid voluntary blood donors, as well as their    knowledge regarding blood donation.


    
PubMed®


    
Nearly all donors indicated that they were motivated to donate when    someone they knew needed blood. Additionally, the positive attitude of the    staff and the desire to help were also relevant motivators.


  


  


    
Motivational Differences between Whole Blood and Apheresis Donors in    Quebec, Canada: A Questionnaire-Based Survey in a Voluntary Nonremunerated    Context.15


    
Providing a quantitative analysis of motivations among regular    plasma/platelet donors compared to regular whole blood donors.


    
PubMed®


    
The motivator chosen by most donors, regardless of the type of donor, was    the altruistic motivation of "my blood can save lives."


  


  


    
Donor's Perspectives on Blood Donation During Covid-19 Pandemic.16


    
To understand the knowledge, attitudes, and perceptions of blood donors    during the Covid-19 pandemic.


    
PubMed®


    
The three main motivational factors for blood donation were direct    requests from patients to donate, followed by the need of family/friends, and    social media campaigns.


  


  


    
Attitude toward blood donation among medical and nonmedical students    across Karachi.17


    
To evaluate the factors that motivate and discourage medical and    non-medical students from voluntary blood donation, as well as to assess the    level of awareness and knowledge about blood donation.


    
PubMed®


    
The most important motivating factor among medical students was the sense    of self-satisfaction, while among non-medical students, it was the need for    blood transfusion by family/friends.


  


  


    
Blood donation among individuals of African origin in the Netherlands:    how are barriers and motivators associated with Intention?18


    
To understand the barriers and motivators of blood donation among    individuals of African origin and evaluate how they are associated to donate    blood.


    
PubMed®


    
The highest-ranked barriers and motivators were not necessarily the best    predictors of donation intention.


  


  


    
Knowledge, attitude, and practice towards blood donation and associated    factors among adults in Debre Markos town, Northwest Ethiopia.19


    
To assess knowledge, attitude, and practice regarding blood donation and    its associated factors.


    
PubMed®


    
The prevalence of knowledge and practice of blood donation is higher    compared to a similar study conducted in Mekelle, while the level of attitude    is lower.


  


  


    
Incentives for Blood Donation: A Discrete Choice Experiment to Analyze    Extrinsic Motivation.20


    
To contribute to the discussion on how to increase donation rates.


    
PubMed®


    
Most of the sample responded positively to incentives and expressed    willingness to accept incentives.


  


  


    
Knowledge, Misconceptions, and Motivations Towards Blood Donation Among    University Students in KSA.21


    
To determine the knowledge, misconceptions, and motivations for blood    donation among university students in KSA.


    
PubMed®


    
The knowledge about blood donation is not adequate, and there are many    misconceptions among young students at Saudi University.


  


  


    
Use of social media in the Blood Donation Process in Saudi Arabia.22


    
Evaluate inhibitors, motivations, and the possibility of using social    media to enhance blood donation practice in this country.


    
PubMed®


    
Human solidarity was the most important motivation for blood donation,    while health condition was the main inhibitor. Social media can help improve    blood donation practice.


  


  


    
Institutional Incentives for Altruism: gifting blood in China.23


    
Investigate the nature and outcomes of some institutionalized mechanisms.


    
PubMed®


    
Blood donation was not solely driven by altruism but also carried a    system of benefits and rewards for donors and their families.


  


  


    
Tapping into a vital resource: Understanding the motivators and barriers    to blood donation in Sub-Saharan Africa.24


    
Analyze the current literature on blood donation in ASS to identify    motivators and barriers to donation and highlight specific interventions that    have increased the number of donors in this region.


    
PubMed®


    
Due to the scarcity of research on this topic, the understanding of blood    donor behavior in ASS is limited. However, it is concluded that local    traditions and cultures closely shape individuals' propensity for the    donation process.


  


  


    
Motivators and deterrents to blood donation among Black South Africans: a    qualitative analysis of focus group data.25


    
Identifying culturally specific factors that affect donor motivation in    South Africa


    
PubMed®


    
Pro-social motivation (altruism) was the most mentioned individual    motivator, and as reported by many authors, fear and lack of awareness were    strong barriers.


      However, skepticism arising from perceived racial discrimination in blood    collection was unique to the South African context.


  


  


    
Determinants of blood donation willingness in the European Union: a    cross-country perspective on perceived transfusion safety, concerns, and    incentives.26


    
To examine whether the willingness to donate blood is associated with    attitudes towards blood transfusion, personal motivations, and incentives,    and to determine if these factors vary among European Union (EU) countries.


    
PubMed®


    
The willingness to donate varied among countries and was associated with    the perception of safety. Helping people was the most powerful motivator in    all countries. The number of participants willing to donate to alleviate    shortages or contribute to research varied widely among countries. The desire    to receive specific incentives does not appear to be related to the    willingness to donate.


  


  


    
Systematization of interviews with altruistic blood donors during the    mobile campaign. 27


    
Identifying sociocultural characteristics that enhance or hinder    voluntary or altruistic blood donation.


    
PubMed®


    
Most interviewed donors approached the blood donation tent without    targeted promotion. Healthcare professionals showed greater identification    with altruistic blood donation. They considered accessibility to the blood    donation tent as a determining factor for altruistic blood donation.


  


  


    
What would it take to convince you to donate? A survey study of the    relationship between motivators, barriers, and payment for whole blood,    plasma, and platelet donation.28


    
Examine the level of payment needed to motivate whole blood, plasma, and    platelet donation based on donation history, sample, and gender, as well as    the association between donation motivators, barriers, and payment level.


    
PubMed®


    
Despite reporting a strong commitment to non-remunerated blood donation,    many interviewees with and without a history of blood donation indicated that    money would convince them to engage in whole blood, plasma, and platelet    donation.


  


  


    
Motivators, barriers and communication channels for blood donation in    relation to students at a university in Spain.29


    
To know the motivators, barriers, and preferred communication channels    for blood donation among university students, and to determine the factors    that explain why donors donate blood.


    
PubMed®


    
The study identified differences in motivators, barriers, and choice of    communication channels among university students regarding blood donation, as    well as the factors that explain blood donation.


  


  


    
Knowledge Level, Motivators and Barriers of Blood Donation among Students    at Qatar University.31


    
To evaluate the level of awareness and knowledge about blood donation and    identify the factors contributing to the willingness to donate blood among    young adults.


    
PubMed®


    
Increasing awareness about blood donation, along with the provision of    more mobile blood donation units in public locations, will help increase the    frequency of blood donation among young adults.


  


  


    
Attitudes and behaviours of Greeks concerning blood donation: recruitment    and retention campaigns should be focused on need rather than altruism.31


    
To determine the opinions of Greeks regarding blood donation, to identify    the reasons for the lack of motivation to donate, and enable experts to    establish better recruitment campaigns to enrich the pool of donors.


    
PubMed®


    
The significant percentages of occasional and rare donors compared to the    low proportion of active donors in the Greek donor pool indicate that    "need" is a more important motivation for blood donation than    altruism in Greece.


  


















Table 1: List of titles of the articles, objective, database, and results.

Figure 1: Flowchart of the article selection process.


    


    

    


    


    Figure 1: Flowchart of the article selection process.

Discussion

Blood donation is a crucial aspect of the functioning of healthcare services worldwide. However, the blood donation rate varies considerably among countries and often falls short of demand. The systematic analysis of articles revealed both positive and negative factors influencing blood donation motivation. Among them, altruism was consistently identified as the main factor, as observed by Finck R et al. (2016) [12], Greffin K et al. (2021) [13], Charbonneau J et al. (2015) [15], Yu C et al. (2013) [23], and Noriega-Mendoza EDY et al. (2023) [27]. Additionally, Weidmann C et al. (2022) [8] cited "safety" as a key motivator, Charbonneau J et al. (2015) [11] and Elisabeth MJ Huis In 't Veld et al. (2019) [26] found "helping others" as a result, Mohammed S et al. (2018) [14] identified "desire to help someone known" as an important factor, and Tripathi PP et al. (2022) [16] stated that a direct patient request to donate would be the primary motivation, followed by the need of family/friends and social media campaigns. Furthermore, Anwer MO et al. (2016) [17] highlighted "self-satisfaction," Sadler A et al. (2018) [20] found "external incentives," and Tanja Z Zanin et al. (2016) [24] identified "local traditions and cultures" as factors responsible for motivation.

On the other hand, negative aspects related to the practice of donation were also found, such as "fear," as exposed by Barboza SIS et al. (2014) [7], as well as sociocultural forces and government policies for pandemic prevention, as mentioned by Siu JY et al. (2022) [9]. Some authors did not reach a consensus, such as Alanzi T et al. (2019) [22], who stated that health condition was the main inhibitor, while human solidarity was the most important incentive, also mentioned by TN Muthivhi et al. (2015) [25], who, despite this, highlighted fear, and skepticism as negative factors. Greffin K et al. (2021) [13] cited "social responsibility" and "charity" as major motivators, but also noted that "health status," "age," and "lack of time" were reasons that hindered donation. On the other hand, France CR et al.(2022) [28], in their study conducted in the United States, where financial compensation for donating is allowed, concluded that most respondents were influenced by financial compensation, which does not apply to the context of blood donation in Brazil and, therefore, becomes irrelevant for the analysis at hand.

Some researchers have further analyzed specific motivators, such as Evans R et al. (2014) [10], who defined altruism as "multifaceted," meaning it does not have a single definition but is characterized as a set of attitudes. Research studies like Klinkenberg EF et al. (2021) [18] stated that barriers and motivations were not necessarily the best predictors of donation intention, while Jemberu YA et al. (2016) [19] found that knowledge level about the subject was higher than the attitude toward donating itself. However, Baig M et al. (2013) [21] highlighted that knowledge about blood donation among young students was inadequate. Padilla-Garrido N et al. (2021) [29], Ibrahim AA et al. (2021) [30], and Kalargirou AA et al. (2014) [31] only analyzed the act of donation and the need to raise awareness and increase the number of active donors.

Based on the obtained results, we found evidence that altruism stands out as the primary motivational factor for blood donation, followed by the desire to help others, whether anonymous or known (such as friends and family), as well as the feeling of safety during the donation process. However, despite the many positive findings in the literature, many articles did not define a specific factor as an enabler or inhibitor; they merely mentioned them to emphasize the need to raise awareness and find regular donors to increase the blood and blood derivative supply.

As a suggestion for future studies, it is important to explore factors beyond altruism and delve deeper into understanding this motivational factor and its other definitions to advance research in this area. Most of the articles analyzed aimed to investigate, describe, or understand the factors that motivate donation and return, with the goal of fostering donor loyalty for blood and blood derivative products.

Conclusions

This analytical study provided an overview of the literature and aimed to identify the possible motivations among blood donation candidates and donors based on scientific sources.

Altruism and its "derivatives" were observed as the main motivational factors mentioned in the studies to justify the act of donating blood. It can be observed that donors' behavior cannot be solely defined by individual desires to do well or help others. Cultural, social, demographic, and even incentive contexts are capable of shaping and modifying donors and, as a result, their motivations.

Further investigation into donor motivations is needed. More studies focused on this topic are necessary to better understand donor behavior, enabling blood banks to develop better strategies for blood collection, donor recruitment, and retention, ultimately ensuring an adequate blood supply in the future.

Author Statements

Declaration

Declaration of Generative AI and AI assisted technologies in the writing process: during the preparation of this work the authors used “chat GPT” in order to check the translate the article into English. After using this tool/service, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.

Author Contributions

The project was designed by DOWR. BAB, CBSM, DOWR, and RL researched and wrote the review. BAB assembled and organized the table. MEMS and HSB made the corrections and editorial changes. Finally, all authors participated sufficiently in the work, read, and approved the final manuscript.

Funding

This research received no external funding.

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Citation: Borsato BA, Miranda CBS, Bizotti HS, de Moura Soares ME, Labiapari R, et al. Motivational Factors in Blood Donation - A Systematic Review. J Blood Disord. 2024; 11(1): 1083.