Donor associations, a key link between donors and blood centres

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  • 3B-SO2-1

E-mail: mikkelsen.fiods@gmail.com

Why start a voluntary donor association?

The mission of a donor organization is to ensure that there is always sufficient blood and blood products to all patients in all hospitals within a defined area. In this article, I will try to outline why and how a volunteer association can help to ensure full sufficiency in safe blood.

A donor association can defend ethical and political interests of the blood supply (and hence the patients) and protect donors against exploitation. A national donor organization may benefit from international co-operation – and it can represent donors with the government, the blood service, other voluntary organizations etc. But focus must be on donor recruitment and retention, not on specific donor interest; otherwise, the association will quickly disappear, as voluntary donors in their overall majority are altruistic people, not looking for protection of their own narrow interests.

Donor associations should be funded by the government and not by private sponsors, as volunteers should use their energies on information, recruitment and retention and not on fund-raising. All Ministers of Health have promised to work for full sufficiency in safe blood, and funding of recruitment and retention of donors is a vital function in any blood supply.

If the association shall provide a steady inflow of volunteer donor recruiters and voluntary, non-remunerated donors, the act of blood donation must be surrounded by the highest respect, so there shall be no profit in handling the gift of blood. But services rendered by blood establishments and paid assistants to the volunteers may, of course, be reimbursed at generally acceptable levels.

Essential replications of an efficient donor organization

  • 1Self-sufficiency in safe blood assures patients a safe and cheap treatment.
  • 2Donor associations help to develop a culture of co-operation and solidarity.
  • 3Donors and volunteers develop higher self-esteem and respect,
  • 4Young people get a possibility to contribute to their society, even when they have small economic resources.

Volunteers bring resources and expertise from outside the blood establishments, normally to a very low costs for society.

Sustainability

Several studies show that new donors in average contemplate for over a year whether to become donors, so blood donation must be continually present in the minds of the public at regular intervals during the year. So a coherent media approach must be developed between the government, blood services and donor associations.

But the final decision to become a donor is taken after direct personal contact, so large personal networks are essential for donor recruitment. Networks are also important for donor retention, as the feeling of belonging to the blood supply via the donor association is essential for many donors to continue to give blood. Safety increases with the frequency and duration of donations over the years – and some blood services only use regular donors, thereby obtaining maximum safety in donor selection.

Well-functioning donor associations can provide the necessary networks outside the blood establishments directly to their members and through co-operation with other large popular organizations. Networks make it possible to sustain a constant inflow of donors, and when extra donors are needed, the networks can step up the recruitment at a speed agreed with the receiving blood service.

Strong networks make more donors continue to come back to the blood services, and as new donors are found by direct personal contact, present donors are by far the best suited to recruit new donors.

Voluntary organizations generally have low costs, helping to achieve economical sustainability in the blood supply, but of course both donor recruitment and donor retention does cost money!

Building a strong donor association – and hence a sustainable supply of safe blood – may take years and much patience, and sustainable funding, recognition from the surrounding society and close co-operation with the blood services is essential to achieve long-term self-sufficiency in blood.

Full support of the government is essential

WHO, ISBT, IFRC and FIODS all recommend that each country should be self-sufficient in blood from voluntary, anonymous non-remunerated donors. The World Health Assembly resolution 28·72: urges all Member States to promote the development of national blood transfusion services based on voluntary non-remunerated blood donation! The WHO aide memoire on Blood Safety states that ‘It is the responsibility of governments to ensure a safe and adequate supply of blood!’. So all Ministers of Health have accepted that it is a governmental obligation to obtain a safe and sufficient blood supply.

All health ministers have subscribed to Resolution 28·72, but many interests compete for ministerial attention, so a donor association can be an important advocate with the ministry for a safe blood supply. Few politicians have anything against voluntary, non-remunerated blood donation, but if necessary, donor associations can alert the media to the need for a safe blood supply, and then – very often – responsible politicians listen.

Health ministers have direct impact on the national blood services, and they can also spread the message about the need for voluntary donor associations and for donors through the media.

Ministers must ensure that blood banks are up-to-date, which is an absolute necessity to attract voluntary donors. Sloppy blood banks scare the donors away, so ministers must ensure, that blood establishments receive the necessary funding to be modern and efficient – otherwise donors just won’t give blood to the blood service.

Paid blood must be outlawed

To avoid unhealthy competition from paid blood collection or import of products from paid blood from poor people in other countries, governments must pass legislation outlawing paid blood. This will enhance the general respect for the act of voluntary, non-remunerated blood donation, and almost all studies show that paid blood or blood stemming from replacement donors is less safe than blood from voluntary non-remunerated donors.

Family pressure for replacement donation and exploitation of poor blood sellers constitutes fundamental breaches of basic human rights – and as paid blood is less safe than unpaid blood, it also undermines the basic right of patients to receive the safest blood possible.

To operate without the undermining effect of paid blood, donor associations (and blood services) should contact lawmakers to convince them to outlaw paid blood, eventually by addressing this problem through the media or by direct lobbying.

Good quality and efficiency in blood services

Efficiency in blood services (including Good Management Practices) is a must, if a voluntary donor organization shall be able to provide a continued supply of safe blood. If donors experience inefficiency when they give blood, or when scandals destroy the reputation of the blood service, donors simply will not come back to give blood.

So donor associations must work hard with the staff in the blood centres to guarantee good service to the donors, whenever the blood centre is in contact with donors.

Blood collection facilities must not only be safe, following legally defined standards for safe blood letting. There should also have a friendly environment with donor friendly opening hours, pleasant rooms, modern beds and well-equipped waiting rooms. Efficient service at the blood collections include that taxi-pickups arrive in time, opening hours are respected and sufficient parking-spaces are reserved for the donors. The beverages and food served before and after donation must be of good quality, and most important: THERE MUST BE NO WAITING, as the donors we seek, often are busy people!

The overall reputation of the blood services must be protected

The media will immediately fall upon any disfunctioning in the blood services (and within the donor association) so there must be no waste of blood and minimal outdating of blood components.

There must be as high safety for the donor as possible, and when accidents happen, the donor involved must immediately receive a proper medical diagnosis and help by qualified physicians, which are not necessarily transfusionists, but rather physiologists, orthopaedians etc.

To many donors, proper functioning of their arms is essential for earning a living, so to cover the economic effect of accidents, donor insurance is a must. Good service to wounded donors make them and other donors come back – and it helps to avoid unpleasant stories appearing in the media.

Donor associations should also monitor (and hence guarantee) that donor data is kept properly protected within the blood banks. But the names and addresses of donors belong to the donor association, as donors constitute the membership of the organization, which must be able to inform their members properly directly at home, when necessary.

Donor organizations can have great help from patient’s organizations

Donor associations exist, of course, first and foremost to help patients. Often patients groups are small and per definition occupied with survival, research, direct support to patients and their families etc. But co-operation with patients organizations can help i.a. to improve the image of blood donation, for instance through publishing of stories about patients, who have been saved by blood components. Donor associations should also work with patient’s organizations about media strategies, contacts with lawmakers, pressure for optimal performance from blood establishments etc.

So good co-operation between blood banks, donor associations and patients organizations can motivate all involved for a better blood service and improve donor recruitment and retention!

Donor recruitment costs money!

Governments can either pay the donors, pay for marketing or spend the money on volunteer recruitment and retention. Direct payment for blood (or plasma) is, however, highly unethical and gives the blood system a low reputation, and paid blood is not good for safety either.

Marketing can be helpful in keeping the focus of potential donors on the necessity of blood donation, but marketing is often very expensive and hence not very cost-effective. Direct media contact with well-intentioned journalists is often a cheaper and more sustainable solution, and if the message comes from a non-governmental, humanitarian donor association, it is often more easily accepted by journalists for promotion.

Volunteers work for free and bring expertise to the blood banks from the outside society. Only direct costs to the donor associations need to be covered, and of course there must be proper accounting and transparency of the work of donor associations – also to avoid negative stories in the media and with politicians.

Use local donor organizations!

Let volunteers help! Each blood collection centre should have a local donor association, run by volunteers, and all donors in a given area should belong to the local donor association without paying any membership fee.

Instead, the local donor organization should receive a (small) payment for each bag collected by the centre and/or a payment for each donor recruited, as there are direct costs involved with both activities.

Donors should be well informed

In a modern society, there is an enormous competition for the attention of the citizens, so easily accessible information to donors and to potential donors is a must.

Leaflets, posters and questionnaires distributed by the donor association should be 100% correct – and reflect the points of view of the blood service. Logo and information materials should be modern in accordance with standards of the surrounding society.

In countries with widespread access to the Internet, emails and websites should be used for information up-date of donors – supplementing printed materials.

The blood service and the donor association must have a comprehensive media approach and professional media experts (journalist, web-designers etc.) must be involved. Information to donors is the key to all donor recruitment and retention – and the resources used for donor information come back in saved working hours at the collection centres and fewer unsuccessful blood donations. A well-informed donor only turn up when he/she knows that she/he will in fact be able to give blood – so by constantly updating, the knowledge of the donors, unnecessary donor transport, questioning, blood bags and expensive tests can be avoided.

Be visible!

The donor association should choose its name and contact data carefully! It shall act proactively in the media, and it must assure that the information spread, e.g. on a home page, is constantly updated!

Graphics and language of written information materials should also be up-to date, and a donor magazine should be distributed directly to all the donors regularly. This ensures that donors continuously receive relevant information, and it gives the recipients a feeling of belonging to the donor association and hence to the blood supply. Donors often pass the magazine to others helping recruitment of new donors – and this gives a practical way of following donor moves – as donors are often lost for the blood service, when they change address.

The association should engage a journalist to spread information, e.g. distributing regular newsletters to volunteers and the press and prepare solo-articles for other journalists. Most countries now have a yearly national campaign leading up to the World Blood Donor Day, 14 June, and this should be supplemented by local campaigns using recruitment cards, e.g. at polling stations during elections, at local markets, in marathons, at rail-stations, at rock-festivals, and sports-events.

Donors should be recognized continuously, so the donor association should use directed press-coverage at donor jubilees to higher the self-esteem of the donors – and if possible also obtain recognitions from the Head of State or other well-known role model at donor jubilees. Most important, the donor association must make sure that the blood collector says thanks after each donation.

Campaign towards young people

As the population is ageing in many societies and the blood needs accordingly keep rising, it is essential to ensure a steady inflow of young donors.

Many countries have had success establishing groups of trained young volunteers, sometimes organized as young ambassadors or as CLUB 25s, and these volunteers can make an enormous difference with their presence in schools, at festivals etc. Their efforts should be supplemented by advertisements in school calendars, football books, study-books, teenage-magazines etc. and by poster competitions, FACEBOOK groups etc.

If possible, print a book with comprehensive information on blood directed towards young people and produce leaflets and cards addressed directly to young people.

International co-operation, such as the FIODS Youth Forums, or conferences between Club 25s can help motivate young volunteers, and there must be periodical training sessions for young volunteers.

Why use volunteers in blood donor recruitment and retention?

Two of three donors are recruited by direct personal contact, so blood services (including professional recruiters) cannot do it alone. It is almost impossible to recruit donors by telephone, so they must be contacted directly and in person. For this, large networks of recruiters are needed, and an important role of a donor association is to take contact with other voluntary organizations like the scouts, Rotary, Lions, church groups, labour unions, sports organizations and large companies. They can have blood donation as a good side-activity to their main work, and using the already existing networks is essential! Volunteers should come from all walks of life, so that they can bring different prospects of society to the blood service.

Never forget that donors are thinking human beings, and while altruism is good, respect for the donor is even better, and it is best shown by being efficient! A donor organization should be modern, respected and well run, and it will need professional staff to do some tasks, which volunteers cannot or will not do.

Of course, volunteers have their own ways, and as they are unpaid, there must be continued motivation to keep them active. A clear mission and training is essential here.

International partners

To underline the mission – and provide training and motivation – contact with volunteer donor recruiters in other countries can be helpful. As examples of this, the WHO has developed donor manuals, and the IFRC organize donor recruitment colloquiums. FIODS organize regional training conferences, and the FIODS Solidarity Foundation co-finances training projects. The ISBT Foundation may also help with projects, and we all work together on World Blood Donor Day to bring new motivation to donor recruiters around the globe.

Volunteers do work!!

My experience after many years in this field is that efficient work and close co-operation of government, blood bank staff and volunteer associations is the key to success in blood donor recruitment and retention! I would like to quote my Brazilians friends, who say that ‘if you cannot give blood, you can give sweat!’.

Donor associations are all about giving blood and sweat!

Sources and suggested readings

Van der Poel, Cees: The importance of Voluntary non-remunerated donations, WHO Global Consultation on 100% Voluntary Donation of Blood and Blood components, Melbourne, Australia, 2009

Lemmers, Karin: The systematic recruitment of new blood donors: ISBN 978907867555-6, F6N Eigen Beher, Maastricht, The Netherlands, 2009

PAHO: Eligibility for Blood Donation, Recommendations for Education and Selection of Prospective Blood Donors, Washington DC, USA, 2009 (also exists in Spanish, French and Portuguese)

WHO + IFRC: Towards 100% voluntary blood donation, A global framework for action, WHO press, 20 ave. Appia, Geneva, Switzerland, 2009

EDQM: Guide to the preparation, use and quality assurance of blood components, 15th Edition, Council of Europe, Strasbourg, France, 2010 (also exists in French and the 16th edition is under way.)

Mikkelsen, N: Promotion activities in blood donation. ISBT Science Series 2007; 2: 92–97

Mikkelsen, N: Donor rights and expectations. ISBT Science Series 2006; 1: 40–45

Mikkelsen, N: Donor Recruitment and Education, Advances in Transfusion Safety, Karger ed. New York, USA, 2005

Ray, Debabrata: National Guidebook on Blood Donor Motivation, 2nd ed., NACO, Government of India, New Delhi 110 001, India, 2003

Mikkelsen, N: Success Factors in Donor Recruitment and Retention in Denmark, Vox Sang 2002; 83 (suppl. 1): 243–246

Misje, Aksel H: ‘Altruisme bak hver dråpe?’, Sociologisk Institut, Universitet i Bergen, Norway, 2001

Hagen, Peit J: Transfusion sanguine en Europe, un livre blanc, Conseil de l’Europe, Strasbourg, France, 1993

Rossi, U, Fresia, V, Ciprani, I, ed.; Mass media and blood donation, Council of Europe and Commission of the European Communities; Rome, Italy, 1992

Rossi, U, Fresia, V, Genetet, B, ed.; Voluntary blood donor Associations, present and future, Council of Europe and Commission of the European Communities; Cernobbio, Italy, 1990

Disclosures

None.

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