Blood donation: The gift relationship

Just under 120 million blood transfusions are given each year worldwide, saving and enhancing the lives of tens of millions of people. Around 40 per cent of these occur in high-income countries comprising only 16 per cent of the world’s population. These are largely from altruistic non-remunerated donors who will never know the people whose lives they have helped to save.

In the UK, just under two per cent of the population are regular blood donors, whereas 25 per cent of the population will receive a blood transfusion at some point in their lives and all of us are ‘at risk’ of requiring a transfusion. Unfortunately, the blood donor base across most high income economies has been declining and ageing over the past several decades, raising concerns around the sustainability of the current blood donation model.

Across most of the rest of the world, particularly in low-income countries, blood supply is already insufficient to meet clinical demand, requiring reliance on family, friends, or paid donors for those who can afford it and failure of supply for those who can’t.

Similar considerations pertain to donors of other substances of human origin, such as cells used for bone marrow transplantation, tissues such as bone, heart valves, and corneas and organs such as kidneys and livers.

So why not pay donors? First, there are clinical considerations. Substances of human origin are not free of the risk of transmission of infections circulating in the general population and this risk is managed through a combination of donor selection and microbiological screening. In the past, failures in these procedures have led to the infection and deaths of many thousands of people worldwide. Donor selection is predicated on trust in the honesty of the donor in respect of potential risk factors in the context of which financial inducement provides a conflict of interest. Blood testing can only partially compensate for weaknesses in donor selection and, in some countries, comprehensive testing may be unaffordable or alternative donors unavailable.

Second, there are ethical considerations. Is it right to commercialise parts of the human body? The international consensus is that it is not. For example, the World Health Organization (WHO) Guiding Principles on Human Cell, Tissue and Organ Transplantation forbid the purchase, sale, or offer to purchase cells, tissues, or organs for human transplantation.

There are also societal considerations. Human communities are built on mutual trust. In 1970, Richard Titmuss, a Professor at the London School of Economics, published The Gift Relationship: From Human Blood to Social Policy. He argued that altruistic gift-giving enhances social cohesion and supports mutual trust, reciprocity, and equity. In many ways he builds on the work of the early French sociologists Émile Durkheim and Marcel Mauss on exchange systems in societies, where gift-giving and receipt involve obligations in respect of reciprocity and mutual solidarity. Even in modern societies, there is a material difference between giving someone a gift for their birthday and selling someone a gift for their birthday…

In his seminal work After Virtue (1981), Scottish-American moral philosopher Alasdair MacIntyre reconstructed Aristotle’s virtue ethics, which focus on the qualities one should encourage to support human flourishing, rather than the rules one should follow (deontology), or that give rise to the best consequences (utilitarianism). He argued that moral virtues arise from social practices embedded in communities which sustain internal goods such as honesty, integrity, trust, and compassion.

I would argue that the altruistic non-remunerated donation of blood and other substances of human origin is more than an effective and safe way of providing vital lifesaving and life enhancing medicines. It is fundamentally a gift relationship, which supports human flourishing and enhances the mutual trust and compassion that underpins the cohesion of our communities. Our world needs more altruistic donors.

Professor Marc Turner FRSE, Director of the Scottish National Blood Transfusion Service

This article originally appeared in ReSourcE Spring/Summer 2026.

The RSE’s blog series offers personal views on a variety of issues. These views are not those of the RSE and are intended to offer different perspectives on a range of current issues.