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Research published in the journal Science suggests no-strings offers of T-shirts and gift cards can boost donor rates without compromising the blood supply.Toby Talbot/The Canadian Press

Offering straight cash for a blood donation may be a no-no, but research suggests that other incentives such as free T-shirts and gift cards can boost donor rates without compromising the safety of the blood supply.

Writing Thursday in the journal Science, an international team of economists says Canada and other countries that prohibit monetary incentives to blood donors may want to rethink that position, based on recent research.

"For a long time, there has been a sort of aversion to any form of reward, or economic incentive, to stimulate blood donations, based on the idea that this might actually reduce motivation because this is not an altruistic act," said study co-author Nico Lacetera, assistant professor of strategic management at the University of Toronto.

There's also been concern among the World Health Organization and many blood-collection agencies that incentives could attract donors who might be more likely to carry transmissible diseases, which could find their way into the pooled blood supply, he said.

Policies that prohibit monetary incentives have been based primarily on population surveys in which respondents were asked if they would donate blood if offered a cash reward, and the majority nixed that idea. But Lacetera said responses were based on a hypothetical premise, not on studies of actual potential donors who were offered an incentive.

"If you look at more recent field studies based on actual behaviour – observational studies or large field trials – then the story is quite different," he said. "All of these studies based on actual behaviour … show that incentives do seem to attract more donations with no impact on the type of donor."

Lacetera and two other economists, from the United States and Australia, looked at more recent research in the U.S., Argentina, Italy and Switzerland.

They found that in Italy, for example, offering blood donors a paid vacation day from work led to a 40-per-cent rise in annual donations. Tempting potential Swiss donors with a five-franc ($5.35) lottery ticket raised donations to 47 per cent from 42 per cent, while the offer of a $10 gift card increased U.S. donations to 20 per cent from 13 per cent.

"The reward is not conditional on an actual donation," he said. "It's conditional only on showing up to a blood drive or a blood donation centre. The idea here is these organizations want to minimize the risk that someone misrepresents their health status or their past behaviour in order to receive the reward. So if you get the reward anyway, regardless of whether you actually donate or not, then once you come to fill the health history form they ask you to fill out, then you don't have any incentive to not tell the truth."

Dana Devine, vice-president of medical, scientific and research affairs for Canadian Blood Services (CBS), said many blood-collection systems in developed countries that prohibit cash-for-blood payments are starting to consider non-monetary incentives.

"We do occasionally put up material items that are available to people who come to a clinic, and receiving those material items is not dependent on giving a donation," Devine said Thursday form Ottawa.

"It's the idea of seeing whether those kinds of T-shirt or coupon-type incentives actually draw people into the clinic so they can see what it's all about and have a first-hand experience and get engaged," she said.

The items' value usually run around the $10 range, although CBS has also held contests for bigger-ticket items – even a car as a top-end prize – to get people into clinics to put in entry forms, again without requiring them to offer up their arms to give blood.

"So it's a different kind of motivator perhaps and also a different audience," Devine said. "This is probably not particularly appealing to the people who are already committed blood donors because they're coming in for some reasons that are more related to pure altruism."

In Canada, less than four per cent of people eligible to give blood are regular donors. Put another way, about one in two Canadians could be donating blood, but only one in 60 actually does. However, Canadian donors give more frequently on average than donors elsewhere in the world.

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