Compensated and Volunteer Blood Donor Models: A Harmonious and Complementary Collections Strategy

Compensated and Volunteer Blood Donor Models: A Harmonious and Complementary Collections Strategy

A point of consideration regarding the strategy of compensated blood donation is the potential loss of non-remunerated volunteers if a paid model is employed. In other words, some think paid donation could “crowd out” donations at not-for-profit (NFP) blood centers. A discussion on this topic follows.

The source plasma industry, which employs 800+ US paid plasma collection centers (often near non-profit, non-remunerated centers) provides evidence suggesting that the potential for crowding out is overstated. Data from Georgetown University1 captured in 39 US cities from 2008 to 2017 compared compensated plasma collections with NFP collections in centers within close proximity. There was generally little to no observed impact on NFP collections. As an example, see Chart 1 below depicting data from St. Louis.

Chart 1This pattern becomes more apparent in Chart 2 when looking at three cities with late entrant paid donor centers in which there was no change in NFP donor participation.

Chart 2The trend continues in other geographies as well, observed in Chart 3.

Chart 3The reason for the lack of an impact on non-remunerated donations is clear: donors participating in compensated donation programs constitute an entirely different cohort as compared to those that participate in NFP systems. Compensated donor systems consist primarily of younger donors (mid-20s to early 40s)2 while data from America’s Blood Centers suggests that “60 percent of blood donations are made by people over 40 years old, and of these, three-quarters come from people over 50.” It is clear the motivations of younger donors are not being captured by existing non-remunerated blood programs, an important point that must be contemplated to address adequate supply for blood components well into the future.

As shown in the Georgetown data, paid plasma donation likely has posed no real threat to blood collections for transfusion. Similar to the plasma industry, Secure Transfusion Services, Inc. (STS) responsibly compensates donors to sustainably increase the supply of difficult to procure components. It has become evident that there is an urgent need to establish a reliable platelet supply chain in the US, and this task is further complicated by the FDA Bacterial Control Strategies for Blood Collection. Increasing access to difficult to source components, like pathogen reduced platelets, via the responsible use of compensation is a strategy that must be seriously considered.


Ellingson KD, Sapiano MR, Haass KA, et al. Continued decline in blood collection and transfusion in the United States – 2015. Transfusion 2017;57 (Suppl 2):1588-1598.

1“Understanding Who Donates and Why”: a presentation by William English, PhD and Peter Jaworski, PhD of Georgetown University

2Transfusion 2017 Vol. 57 Supplement 53 (p 110A)

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Federal mandates may constrain platelet availability even more4,9

The safety of platelet transfusions is critical, and recent US Food and Drug Administration (FDA) mandates on bacterial risk mitigation require platelet collections to undergo proactive safety protocols, such as large volume delayed sampling or pathogen reduction. Platelet volume loss due to methods such as these may further erode the platelet supply.4,9