AFTER TITMUSS,1 whole blood donation has
historically been marketed as “perhaps the
purest example”2 (p 46) of altruistic or prosocial
behavior.3 The debate as to whether whole blood
donation should be characterized as a wholly
altruistic act or merely a prosocial act is beyond
the scope of this article; however, it is noteworthy
that whole blood donation (and apheresis donation
in Australia) is a behavior that people undertake
voluntarily with few obvious or immediate rewards.
As Healy4 noted in his recent ysis of blood
and organ donation, blood is “an odd kind of gift”
(p 84). The method of giving and the personal
nature of what is given make it different to other
altruistic or prosocial acts such as donating money
to charity (cf Lee et al5). In an age of increasing
stringent exclusion criteria stemming from fears
about blood safety (eg, variant Creutzfeldt-Jakob
disease [vCJD]), it is a rare type of gift in that it is
one that may routinely be refused. As Healy4 notes,
the “call for all,” evident historically in much blood
donor marketing (cf ARCBS Winter 2007 campaign),
contrasts sharply with the selectivity that
blood collection agencies around the world now
have to exercise.6 As a result of such selectivity,
blood collection agencies around the world struggle
with how to recruit and retain “life's best gift
givers,” those eligible to donate blood.
In recent decades, a number of excellent reviews
have been undertaken to consider both structural
(eg, organizational level factors4,7,8) and individual7,9-
11 level factors that may impact on the
decision to donate blood. Reflecting the general
body of literature in the area, these reviews have
typically considered influences across the donation
life span while noting that there are likely to be
differences in the type and strength of the key
motivators of new, early career, and well-established
donors.7,10,12 An emphasis of recent research has
been on the role of structural factors in facilitating
blood donation.4,7,8,13-16 In contrast to this emphasis,
the current review primarily focuses on the role
of psychological factors in explaining, predicting,
and promoting blood donation behavior. Although
we agree with Healy4 that structural features should
be configured to maximize the opportunity for
donation, we contend that, ultimately, the resolution
to (repeatedly) donate blood remains an inherently
personal decision.17 For the individual who is
considering donating blood, it is the perception
and relative weighting of many factors that will
ultimately determine his or her behavior.18,19
In addition to a specific focus on the role of
psychological factors in blood donation, this review
explicitly focuses on the psychology of repeat
blood donation and considers how donors move
from being novice donors to early career status and
then to established repeat donors. In considering theoperational context, one of the key challenges for
blood collection agencies across the world is donor
retention. Comparable with other westernized
countries, in Australia, although 43% of Australian
s donate blood at least once in their lifetime,
at any one time, the proportion of active ageeligible
donors in the population is only 3.5%.20,21
Of those who donate whole blood, only around
60% of new donors return within 2 years to make
a further donation, with the retention percentage
lower for new plaa donors.21 As Chamla et al13
noted, from a blood collection agency perspective,
repeat donors provide 2 key advantages over firsttime
or once-only donors. First, repeat donors
provide a relatively stable and comparatively safe
supply of blood.22,23 Second, a body of repeat
donors provides the long-term opportunity for
blood collection agencies to save on costs
associated with continual recruitment of new
donors. As such, an understanding of the psychology
of repeat blood donation and, specifically,
how donors move from being novice donors to
early career status and then to established repeat
donors is likely to be of particular use and benefit
to blood collection agencies.
THEORETICAL FOCUS
Although the need for a better understanding of
blood donor behavior has been noted to be of key
importance for blood collection agencies internationally,
24 much of the previous applied research on
donor behavior has failed to draw clearly or
systematically on contemporary theories of behavioral
decision making.Theories in applied
contexts are necessary tools: they integrate and
order existing empirical findings as well as serve to
guide research by generating new predictions.To
that end, a number of sociological, psychological,
and organizational theories have been applied to the
behavior of blood donation.7,11 Of those theories,
Ferguson et al7,9,12 noted that the Theory of
Planned Behavior (TPB) (an extension of the
Theory of Reasoned Action18 [TRA]) has been
one of the most enduring theories in predicting
blood donation intentions and behavior.
