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The Gift of Life doesn't have to hurt

by Jeffrey P. Kahn, Ph.D., M.P.H.
Director, Center for Bioethics
University of Minnesota

All through college, my part-time job was in the university hospital blood bank, which meant I got to see firsthand how important the supply is of that lifesaving resource. Recent reports indicate that the nation's blood supply is dipping to critically low levels much more frequently and for longer periods than in the past. What accounts for the change, and what can we do about it?

One explanation for the shortage is a lack of public understanding about the need for a supply of donated blood. But there is still no viable substitute for human blood in medical care, where it is used for transfusions for everything from bleeding disorders to trauma, surgeries, and organ transplant. In addition to an ongoing need, maintaining a sufficient blood supply is complicated by its limited shelf life. Unless it is frozen, donated blood must be used within a few weeks or it will spoil. So patients' ongoing needs for blood require both an adequate and a fresh supply. How have we maintained a sufficient supply up to now?

Relying on altruism

The blood supply has long relied on volunteer donation for a number of reasons, most notably safety. The argument is that paying donors creates an incentive to donate even if they know their blood is tainted by illness, disease, or unhealthy lifestyle, but that there is no such incentive for true volunteers.

But while voluntary and unpaid donation may encourage safety, the system endorses blood donation as altruistic and gift giving. Altruistic acts are unexpected and certainly not required, often referred to as being "above and beyond the call of duty." In fact we are often taken aback by acts of altruism, and look for ulterior motives in those who perform them. Given the history of blood donation as altruism, we can see how, in an era in which altruism is in short supply -- and even viewed with suspicion -- the blood supply might come up short.

Why not a duty to donate?

Requiring people to donate blood is not unprecedented -- in combat situations, healthy soldiers have been ordered to donate blood for their wounded compatriots. And in this era of ever more sensitive tests for disease, it seems far less likely that tainted blood could get through the screening processes in place. So why not turn blood donation into something closer to a civic duty, like voting, than treat it as an unexpected gift?

In many societies, and certainly in the United States, public policy shies away from requiring good deeds of its citizens. So-called "Good Samaritan" laws have until very recently focused on protecting people who come to the aid of others, such as making sure that a do-gooder has immunity from lawsuits stemming from his actions. But very few jurisdictions have laws that require citizens to come to the aid of strangers in need. The difference is that a Good Samaritan is considered heroic or virtuous instead of doing what we would expect from anyone.

So at the very least, let's treat blood donation as a good deed that we'd hope most people would perform. In terms of its risk, donating blood is more like offering a hand to someone who has fallen into a swimming pool than diving in after her. Do we want to be a society made up of people who have to think about whether they'll offer a hand, or in this case extend their arm, to save a fellow citizen?

Donating blood is truly giving the gift of life, at very little cost to the donor. Those who've been on the receiving end know this best, and often become lifelong donors themselves. They are living proof of what we all ought to remember: when it comes to blood, it is truly better to give than to receive.

Visit the
"Ethics Matters" Archive
where you'll find other columns from Jeffrey Kahn
on a wide range of bioethics topics.

"Ethics Matters" is a biweekly feature from the
Center for Bioethics and CNN Interactive.


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