Titmuss's (1970) seminal work The Gift Relationship compared the UK system of voluntary blood donation to the US system using for-profit enterprises and argued that a non-market altruistic system is more effective than one that treats human blood as a commodity. The HIV-contaminated imported blood that infected haemophiliacs (BBC News, 2019) illustrates the dangers of incentivised rather than altruistic blood donation. That said, NHS Blood and Transplant is increasingly concerned that the COVID-19 pandemic is deterring regular donors, especially those with high-demand blood types.
Nilsson Sojka and Sojka's (2008) survey of 531 Swedish blood donors found that donors had an altruistic motivation and first-time donors were influenced by family, friends and the media. In contrast, Ferguson et al (2008) found that benevolence (both donor and recipient benefit) rather than altruism (only recipient benefits) explained donor behaviour among British donors. Later, Ferguson (2015) argued that altruism is a complex construct and, in relation to blood donation, encompasses both ‘warm-glow givers’, where the donation is emotionally rewarding, and reluctant altruists, who use donation to excuse other less generous behaviours. Whatever motivates British blood donors, it is hoped that they continue to donate in these difficult times.
In addition to blood donation, people donate organs and tissues, but the shortage of donated organs in the UK has resulted in a change to assumed consent on death in England, with the passing of the Organ Donation (Deemed Consent) Act 2015. Those wishing not to have their organs or tissues used on death must now opt out. Equally important to the continued development of health services and medical science is research participation. Boylan et al (2019) argued that many people make contributions other than bio-samples, in the form of personal data, such as biometrics, lung function and cognitive function, as well as surveys and narratives, all of which require participants to donate time and effort.
Poignantly, the development of the COVID-19 vaccines is wholly dependent on volunteers from across the world, including the UK, participating in the various vaccine trials to test both the safety and efficacy of the potential vaccines, especially in the large phase 3 trials. The BioNTech/Fosun Pharma/Pfizer vaccine trial has recruited 43 998 volunteers; University of Oxford/AstraZeneca has recruited 40 051 participants; and Noravax plans to recruit 30 000 participants. It is likely that different vaccines will be needed to protect people with different health and age profiles, and the development and testing of potential vaccines will continue for several years; the development of the polio vaccine took years (Baicus, 2012). To boost the pool of UK participants, the Government has set up the COVID-19 Vaccine Research Registry (https://tinyurl.com/y2nyveub). In particular, it is seeking volunteers older than 65 years, those with stable comorbidities and those of a Black, Asian and Minorty Ethnic (BAME) heritage, so that the vaccines are tested on representatives of those most likely to need protection from SARS-CoV-2.
Healthcare staff are paid and appreciated but, perhaps, we also need to cherish those who contribute in less visible ways, such as blood and organ donors and research participants. Without these volunteers, there would be no prospect of a COVID-19 vaccine nor the constant development of medical science to improve clinical outcomes.
‘Poignantly, the development of the COVID-19 vaccines is wholly dependent on volunteers from across the world participating in the various vaccine trials to test both the safety and efficacy of the potential vaccines, especially in the large phase 3 trials.’