New Zealand needs 40,000 new blood donors, so should we pay people to give?

Blood donation in Aotearoa is at a “tipping point”, prompting concern that if more people can’t be encouraged to donate, we may no longer continue to be self-reliant on blood and blood products.

New Zealand Blood Service is seeing a “steady increase” in demand: need for whole blood increased about 3%​ in the past 12 months, and demand for plasma is forecast to increase 8-10%​ annually.

Meanwhile, less than 4%​ of the eligible population donate, and the donor registry – numbering about 117,000​ Kiwis – has only grown by 9000​ in five years.

The service says it needs 40,000​ new donors in the next 12 months to ensure it can remain self-reliant and meet demand. So should we be paying people to give their blood?

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NZBS chief medical officer Dr Sarah Morley​ said “we’re managing”, but there are concerns “about our ability to maintain that 10% increase in plasma demand”.

If we can’t meet demand, New Zealand “will be forced” to compete internationally for plasma, which our size and location will make “extremely challenging”.

So, should we pay?

Morley said voluntary, unpaid donation is the safest form of donation.

Globally, there are three types of donors: volunteer, paid and family/replacement (the latter requiring a patient to provide their own donor).

According to the World Health Organisation, 79​ countries collect more than 90%​ of their blood supply from voluntary unpaid donors; while 54​ collect more than 50%​ from family/replacement or paid donors.

In the United States, while it’s legal to pay donors for transfusable products, it’s “highly discouraged”.

Since 1978​, the FDA has required blood centres to label donations from paid or volunteer donors. If a donation is paid for, hospitals are “unlikely to use it” due to safety concerns, according to Stanford Blood Center.

WHO has a framework to achieve 100% voluntary blood donation, based on the recognition that “voluntary, non-remunerated blood donors are the foundation of a safe, sustainable blood supply”.

Morley said payment has the potential to negatively affect donors, or lead to negative outcomes.

An important part of blood donation is screening: ensuring someone is fit and eligible.

Donors share information “freely” because they’re “motivated… to help people”. Some things they share may mean they’re unable to donate that particular day.

“One of the potential challenges with paid donation is it may change that dynamic,” Morley said.

While donors who give blood voluntarily have little incentive to lie about medical history or potential risk factors, in a paid system there’s money on the line.

It’s thought this could lead to people withholding pertinent information and making it through the screening process, even when they should not be eligible.

Another concern is if individuals start to become reliant on income from donation, as paid donors are vulnerable to “exploitation and commercialisation of the human body”, WHO says.

Ultimately, Morley said the desire to help others voluntarily is “embedded in the whole model [that] blood donation relies on”.

What about those who can’t donate?

At present, certain groups are permanently ineligible to give blood in Aotearoa.

This includes:

• Those who lived in the UK, France or Republic of Ireland for six months or more between 1980-1996​
• People who are HIV-positive, or have an HIV-positive partner
• Those who carry the hepatitis B or C virus
• Those who have haemophilia or related clotting disorders, and have received treatment with plasma-derived clotting factors
• People who have ever injected drugs not prescribed by a doctor.

Men who have sex with men (MSM) are not able to give blood for three months following oral or anal sex with another man, whether or not a condom was used.

Morley said they’re always looking at safe ways to expand eligibility – for example, recently lifting upper age limits.

One sticking point is the deferral for those who lived in the UK in the 1980s/90s, because of the human form of so-called “mad cow disease”: Creutzfeldt-Jakob Disease (CJD) or Variant Creutzfeldt-Jakob Disease (vCJD).

As there are no tests to detect these conditions in blood donations, many countries restrict donations from these groups.

However, that’s starting to change: Australia and the US lifted their deferrals in July and November 2022, respectively.

It’s thought our vCJD deferral impacts as many as 10% of potential donors.

Morley said this deferral is under review, and they believe it “has the potential to be removed”.

A number of steps need to be undertaken before any criteria is changed. A detailed review of data and risk will go to Medsafe, which ultimately makes the call.

Morley advised the service is also reviewing the three-month deferral for MSM.

“If safe to do so, we would love to reduce restrictions on blood donation steadily over time,” she said.

Wednesday marks World Blood Donor Day, and the blood service is asking those on the fence about donating to “find their why”.

“We hope to use this theme to break down barriers around blood donation, and motivate more of our eligible population to roll up their sleeves and join our whānau of lifesavers,” marketing and communications manager Asuka Burge​ said.

Even if it’s just for a cup of tea and a biscuit afterwards, “that’s enough for us”.