In the following, non-cash incentives will be understood to be any gift, good, or token, either of non-monetary value or of small monetary value, donors receive conditional on donation. In this paper, it will be assumed that a cash payment can be distinguished from other forms of non-cash incentives in normatively meaningful ways. The term ‘incentives’ covers a broad range of both financial and non-financial payments, gifts, goods, or tokens. With a focus on blood donation in developed countries, a way to achieve such a compromise is sketched in this paper: namely implementing well-designed non-cash incentives which cut across the dichotomy of altruistic donation versus self-interested paid donation, while at the same time paying more attention to the motives, the choice architecture, and the setting in donation. It is important to find a compromise which allows for devising and implementing acceptable and successful policies to increase the blood supply. While such a situation is fascinating and challenging from a philosophical point of view, from a policy perspective the need for blood calls for overcoming the opposition. This is at least partly due to the fact that from each of the opposing sides in the controversy, it is possible to make good arguments. Despite this fact, the theoretical debate about paid blood donation has quieted down a bit in recent years, probably because it has become somewhat stuck. Nonetheless, payment remains one of the most effective ways to raise donation rates, and several countries would not be able to fulfil their demand for blood without it. International regulations reflect a strong stance against paid donation systems bodies such as the International Society of Blood Transfusion, the WHO, the European Union or the Council of Europe all call for fully altruistic donation. Partly in response to this debate, most countries in the developed world have abandoned paid blood donation and now have either fully altruistic donation systems or mixed systems with altruistic donation, some forms of financial compensation for expenses, and/or other incentives. A controversial debate between proponents and opponents of paid donation has been going on for several decades now. Ever since, the discussion of raising the number of blood donors using payment as an incentive has followed along these lines. Richard Titmuss' influential work «The Gift Relationship» (1971) most prominently established the dichotomy of an economic framework for blood donation with paid donors versus a solidary system of altruistic unpaid donors. Hence, the well-worn questions of how more people could be persuaded to become blood donors, and whether payment or other incentives could increase the blood supply, are still pressingly relevant. Ensuring a sufficient blood supply remains difficult. In recent years, some countries have experienced serious blood shortages due to, among other things, a decrease following 9/11 (after an initial surge in donation) and the attention surrounding a potential transmission risk of prion disease. One of the most controversial problems in the field has at all times been how to increase the number of donations. Ethical issues in blood donation have been discussed for a long time.
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