Full text of DOI:10.1046/j.1537-2995.2002.00008.x

B L O O D D O N O R S A N D B L O O D C O L L E C T I O N
Motivations to donate blood: demographic comparisons
Simone A. Glynn, Steven H. Kleinman, George B. Schreiber, Thomas Zuck, Suzanne Mc Combs,
James Bethel, George Garratty, and Alan E. Williams, for the Retrovirus Epidemiology Donor Study
he National Blood Data Resource Center has
reported that the margin between demand for
transfusable blood components and blood col-
BACKGROUND: Understanding blood donor motiva-
tions is crucial to improving effectiveness of donor re-
cruitment and retention programs.
lections in the United States is currently criti-
T
cally low,1 and warnings of blood shortages are frequent
STUDY DESIGN AND METHODS: Data from a 1998
in the popular press.2 Only 5 percent of eligible people
survey of 92,581 U.S. blood donors were used to evalu-
donate yearly in the United States,3 and up to 50 percent
of first-time donors may never return for a second dona-
tion.4 Furthermore, the FDA has estimated that the pro-
posed new deferral criteria for European travelers who
may have been exposed to variant CJD may result in a
4.6- to 5.3-percent donor loss, whereas implementation
of more stringent criteria by the American Red Cross
could potentially result in a 7.8- to 9.1-percent donor
loss.5 Inducing more people to donate blood and increas-
ing retention of and frequency of donations by current
donors have therefore become a priority for most blood
centers. To increase effectiveness of existing donor re-
cruitment and retention programs, factors that encour-
age donation must be identified and evaluated.
ate factors influencing the decision to donate in various
demographic groups. Data were weighted to adjust for
response and sample design.
RESULTS: Of 52,650 respondents, 45,588 gave whole-
blood (WB) donations. Among all demographic groups,
the major reasons to donate were altruism (75-87%)
and awareness of the need for blood (34-43%). Except
for first-time donors and those Յ25 years old, blood
drive organizers and/or recruiters were more important
than family and/or peers in encouraging donors (13-
19% vs. 1-8%). Although 59 to 63 percent of donors
said they would be encouraged to donate by reminders
originating from the blood bank, for some, the contact
would have a negative effect and discourage donation.
Discouragement would be higher if they were reminded
A body of literature has identified altruism as the
primary reason given for donating, with awareness of the
need for blood, social pressure, need to replace blood
used by family or friend, and increased self-esteem and
recognition also serving as important motivators.6-14 Ex-
by a telephone call (14%) rather than by a letter or e-
mail (4%) or an appeal (2%) from the blood bank.
CONCLUSION: WB donations appear to be made pri-
marily for altruistic reasons and in response to appeals
for blood. Ways to build on this humanitarianism and
take advantage of new communication routes, such as
ABBREVIATIONS: REDS = Retrovirus Epidemiology Donor
e-mail, need to be developed.
Study; WB = whole blood.
From Westat, Rockville, Maryland; Ohio Enterprises Interna-
tional, Cincinnati, Ohio; The Oklahoma Blood Institute, Okla-
homa City, Oklahoma; American Red Cross Blood Services,
Southern California Region, Los Angeles, California; and Hol-
land Laboratory, American Red Cross Biomedical Services,
Rockville, Maryland.
Address reprint requests to: Simone A. Glynn, MD, MSc,
MPH, Westat, WB 280, 1650 Research Boulevard, Rockville,
MD 20850; e-mail: simoneglynn@westat.com.
Supported by NHLBI contracts N01-HB-97077 (super-
seded by N01-HB-47114), N01-HB-97078, N01-HB-97079, N01-
HB-97080, N01-HB-97081, and N01-HB-97082.
Received for publication April 4, 2001; revision received
August 28, 2001, and accepted August 29, 2001.
TRANSFUSION 2002;42:216-225.
216 TRANSFUSION Volume 42, February 2002

MOTIVATIONS: DEMOGRAPHIC COMPARISONS
ternal factors such as social pressure from friends or fam-
ily and incentives such as gifts and rewards have also
been described as being important early motivators.15-17
These external pressures become less important as the
donor continues to donate and develops a blood donor
role identity, an event that appears to occur after the
third or fourth donation.15,18 There is also evidence that
first-time donors who give primarily in response to an
external factor are less likely to return than donors who
gave their first donation for intrinsic reasons, including
altruism, personal values and interests, and a sense of
responsibility.15
Whether altruism is really the major motive under-
lying most donations is still under debate. First, most of
the studies that have evaluated donors’ motivations were
conducted before the 1990s, and it is not clear whether
changes in our culture and society in the last decade have
had an impact on the donor’s motives for donating. Sec-
ond, not all studies have found that humanitarianism was
the main reason for donation. For example, Condie et
al.19 reported that peer pressure was the major motivator
in their study population, and they could not find any
difference in the level of altruism or social responsibility
between donors and nondonors.
It is not only important to reassess what currently
motivates individuals to donate, but also whether moti-
vations differ by demographic group. If reasons to donate
are a function of age, gender, and other demographic
characteristics, targeted recruitment and retention pro-
grams tailored to specific subgroups could be of value
and should be considered.
To improve our understanding of the factors that
motivate donors to return and to assess demographic dif-
ferences, we evaluated reasons to donate, influencing
factors, and potential responses to a variety of reminders
in community whole-blood (WB) donors who answered
an anonymous mail survey conducted by the Retrovirus
Epidemiology Donor Study (REDS), a multicenter pro-
gram sponsored by the National Heart, Lung, and Blood
Institute.
TABLE 1. Questions on opinions and beliefs about
donating blood
When you last donated blood, why did you donate?
Felt it was the right thing to do.
Heard that blood was needed.
Wanted to receive an item or gift that was being offered to
blood donors (e.g., time off from work, a T-shirt, a coffee
mug, or some other item of value).
Wanted to receive special recognition or an award for
donating.
A family member, friend, coworker, or someone else close
to me strongly encouraged me.
A blood drive organizer or recruiter encouraged me.
A doctor told me to donate for health reasons.
Believe that donating is good for my health.
Wanted the results from having my blood tested for an
infectious disease (e.g., HIV or hepatitis).
The last time you donated blood, did someone or something
strongly influence you to donate?
If yes, who or what influenced you the most?
A spouse or sex partner.
Some other family member.
A coworker or friend.
My employer.
Radio/TV/newspaper.
A letter or call from the blood bank.
A blood drive organizer or recruiter.
Other (please specify).
There are many ways of reminding donors that their blood is
needed. What effect would each of the following reminders
have on your decision to donate blood in the future? (Donors
could choose between “would encourage me,” “would
discourage me,” and “would make no difference to me” for
each proposed reminder.)
A telephone call from the blood bank?
A letter or email from the blood bank?
An appeal from your local blood bank on TV, radio, or in the
newspaper?
An appeal from a national organization or spokesperson on
TV, radio, or in the newspaper?
A call or letter from an organization such as a religious
group, social club, or fraternal group?
the American Red Cross Biomedical Services Greater
Chesapeake and Potomac (Baltimore, MD; Washington,
DC), Southeastern Michigan (Detroit, MI), and Southern
California (Los Angeles, CA) regions; the Blood Centers of
the Pacific-Irwin (San Francisco, CA); the Oklahoma
Blood Institute (Oklahoma City, OK); the New York Blood
Center (New York, NY); the Lifeblood Mid-South Regional
Blood Center (Memphis, TN), and the Blood Bank of San
Bernardino and Riverside Counties (San Bernardino, CA).
A questionnaire was sent to 8 to 18 percent of eligible
allogeneic donors who had given blood between April
and October 1998 at each participating blood center. Do-
nors were eligible on their first reported donation if the
donation type was WB, directed or apheresis, if age at
donation was 18 years or more, and if either all laboratory
test results were available or one of the available serologic
tests was positive (screened repeat reactive). To compen-
sate for projected lower response rates for various donor
groups, we oversampled first-time donors, donors
MATERIALS AND METHODS
Survey instrument
The 1998 REDS Survey has been described in detail else-
where.20 Briefly, in 1998, REDS conducted a mailed,
anonymous survey of 92,581 allogeneic (WB, directed,
apheresis) donors to improve understanding of the fac-
tors that influence individuals to donate blood. Reasons
for donating, influencing factors, and projected response
(encouraged, discouraged, makes no difference) to a va-
riety of reminders were evaluated (Table 1). Demographic
characteristics, including age, sex, race/ethnicity, and
level of education, were also assessed. Eight geographi-
cally diverse U.S. blood centers participated in this effort:
Volume 42, February 2002 TRANSFUSION 217

GLYNN ET AL.
younger than 25 years old, and donors in minority racial
and ethnic groups.
(yes vs. no), which were as follows: 1) whether a donor
had identified a particular factor as his/her reason to do-
nate, 2) whether the donor had been strongly influenced
by someone or something to donate, and 3) whether a
reminder offered in the future would encourage (vs. make
no difference or discourage) the donor to return. Results
were considered significant if p value Յ0.05 or if the 95-
percent CI around the OR excluded 1.0.
Of questionnaires received, 83.6 percent were ob-
tained from a first mailing and 16.4 percent from a sec-
ond mailing sent to donors who did not return a post-
card, indicating that they had already responded. Ques-
tionnaires were anonymous (no individual identifiers
retained) but had an affixed sticker indicating whether
the donor had given blood for the first time at the center
(first-time) or not (repeat) and whether at least one of the
screening tests routinely performed at time of donation
was reactive. The 1998 REDS survey protocol was ap-
proved by the Institutional Review Board at each center.
RESULTS
Of 92,581 donors sampled, 52,650 returned their ques-
tionnaire (57% response rate). Older, repeat, and women
donors were more likely to respond than younger, first-
time, or men donors. We identified 6704 first-time and
38,884 repeat donors among 45,588 allogeneic WB re-
spondents (7062 donors were not included in this analy-
sis because they had given an apheresis or directed WB
donation). Of the repeat donors, 30,628 (79%) could be
classified by prior donation frequency based on their
questionnaire responses: 23 percent (n = 6931) gave 1 to
5 donations, 52 percent (n = 15,962) gave 6 to 20 dona-
tions, and 25 percent (n = 7735) gave >20 donations in the
past 10 years.
Donor classification
Information about demographics and type of donation
was derived from self report on the questionnaire. Only
donors whose last donation was WB were included in the
analysis. Donors who reported last giving an apheresis or
directed donation were excluded from the analysis.
Repeat donors were defined as donors who either
indicated at the time of donation that this was not the
first time they gave blood at the center or had prior do-
nations documented in the REDS database. In contrast,
first-time donors indicated that this was the first time
they donated at the center and had no prior donation
record in the database. Frequency of donation for repeat
donors was assessed by asking donors on the question-
naire to indicate the number of donations given in the
last 10 years. Based on their response, we further classi-
fied repeat donors as having given 1 to 5 donations, 6 to
20 donations, or >20 donations in the last 10 years.
All allogeneic WB respondents were included in the
analyses presented later here, although results were un-
changed if donors with a reactive screening test (1.6%)
were excluded from the analyses.
Reasons to donate
The percentages of donors who gave for a particular rea-
son are presented stratified by demographic characteris-
tics and first-time versus repeat status in Table 2. The
ORs comparing the odds of donating for a specific reason
within demographic groups are shown in Table 3 ad-
justed for other demographic variables and for first-time
versus repeat status.
Statistical analysis
Prevalence of reasons to donate, influencing factors, and
responses to reminders offered in the future (percent en-
couraged, discouraged, or indifferent) were calculated
with sample weights to adjust for differential sampling
and response rates (WESVAR software program, Westat,
Rockville, MD).21 Missing information was excluded from
the analysis. The highest percentage of missing demo-
graphic data was observed for race/ethnicity, with 2 per-
cent of respondents not reporting this information; 2 per-
cent of donors did not answer the influencing factor
question, whereas Յ6 percent of donors did not indicate
how they would react to a reminder. We computed
weighted chi-squares22-24 to compare demographic re-
sponses. We also calculated adjusted ORs and 95-percent
CIs by weighted logistic regression,21 entering simulta-
neously in the models age as a continuous variable and
all other demographic variables as indicator variables
representing predefined groups (an indicator variable for
first-time vs. repeat status was also included). A separate
model was constructed for each binary outcome variable
As shown in Table 2, the most commonly reported
reasons to donate were because “it was the right thing to
do” (81%), “I heard that blood was needed” (39%), “a
blood drive organizer or recruiter encouraged me” (15%),
and “I believe that donating is good for my health” (9%).
Many donors identified more than one reason to donate,
with only 42 percent choosing that “it was the right thing
to do” as their sole reason to donate, 8 percent choosing
“I heard that blood was needed,” 5 percent choosing a
blood drive organizer or recruiter, and 1 percent choos-
ing “donating is good for my health.” Wanting special
recognition or an award for donating (0.6%) and being
told by a doctor to donate for health reasons (0.4%)
ranked last as reasons for donating. This pattern, or rank-
ing order for reasons to donate (based on the percentage
of donors motivated to give by a particular reason), held
for all demographic groups except for first-time and Յ25-
year-old donors who ranked “donating because of a fam-
218 TRANSFUSION Volume 42, February 2002

MOTIVATIONS: DEMOGRAPHIC COMPARISONS
TABLE 2. Reasons to donate at time of last donation
Donating
is good
for my
Wanted
infectious
disease test recognition
results
Wanted
special
A doctor told
me to donate
for health
It was the
right thing blood was
to do
%
Heard
Blood drive
organizer
or recruiter
Wanted
an item
or gift
Family,
friend,
coworker
needed
%
health
or award
reasons
%
%
%
%
%
%
%
Total*
81.07
39.09
15.46
9.36
5.72
4.96
2.41
0.63
0.35
Age
Յ25
84.00
83.29
81.72
79.95
76.99
74.61
<0.001
39.48
37.92
39.09
38.33
40.93
43.02
0.006
11.60
12.87
15.62
17.57
18.89
19.30
<0.001
8.73
8.32
9.27
7.23
7.76
6.11
4.31
3.44
9.91
6.05
4.53
3.48
2.42
6.23
3.57
1.62
1.18
1.03
1.48
0.44
0.50
0.61
0.46
0.16
0.17
0.30
0.42
0.60
26-35
36-45
46-55
56-65
66+
9.05
12.30
11.79
<0.001
1.78
<0.001
1.90
<0.001
0.44
<0.001
0.64
<0.001
1.18
<0.001
p value
Sex
Man
Woman
p value
80.60
81.57
0.02
34.86
42.93
<0.001
15.57
15.32
0.50
12.38
6.55
<0.001
5.86
5.59
0.29
5.02
4.95
0.75
2.68
2.17
0.001
0.73
0.55
0.03
0.56
0.15
<0.001
Race/ethnicity
Asian
Hispanic
Other
Black
White
81.66
75.51
80.30
77.01
81.80
<0.001
38.23
40.00
34.08
37.04
39.25
0.14
13.38
13.88
12.78
16.76
15.61
0.02
10.29
7.33
10.66
5.80
9.63
<0.001
5.97
6.47
9.51
7.65
5.40
5.16
6.70
7.84
4.42
4.81
3.87
4.02
2.74
3.26
2.12
0.001
1.70
1.15
0.96
0.79
0.55
0.01
0.70
0.13
0.32
0.06
0.37
0.07†
p value
<0.001
<0.007
Education
ՅHigh school
Some college‡
ՆBachelor’s degree
p value
77.01
79.04
84.00
<0.001
39.97
40.18
37.87
<0.001
15.66
14.63
15.99
0.006
9.88
9.95
8.65
5.43
6.60
5.10
6.19
5.26
4.38
2.98
2.47
2.19
0.06
0.81
0.65
0.56
0.24
0.41
0.31
0.35
0.62
<0.001
<0.001
<0.001
Donor status
FT
RPT
77.99
81.99
<0.001
33.63
40.72
<0.001
13.45
16.05
<0.001
6.12
10.33
<0.001
5.85
5.68
0.58
11.71
2.96
<0.001
3.90
1.96
<0.001
0.62
0.64
0.85
0.40
0.33
0.46
p value
FT
77.99
78.31
82.20
86.62
<0.001
33.63
42.85
41.79
39.37
<0.001
13.45
17.83
16.96
13.70
<0.001
6.12
7.88
9.76
14.25
<0.001
5.85
5.94
5.66
5.91
0.84
11.71
5.83
2.44
1.38
<0.001
3.90
2.97
1.68
1.78
<0.001
0.62
0.48
0.53
0.90
0.02
0.40
0.27
0.34
0.38
0.63
RPT 1-5/10 years
RPT 6-20/10 years
RPT >20/10 years
p value
*
The sum of the percentages across reasons to donate is more than 100 percent because donors could indicate more than one reason to
donate.
† Testing white versus non-white donors.
‡ Some college refers to some college level of education or an associate degree.
ily member, friend, co-worker, or someone close to
them” (11.7% first-time, 9.9% Յ25 years old) higher than
“donating because it was good for their health” (6.1%
first-time, 8.7% Յ25 years old). First-time and Յ25-year-
old donors were about as likely to identify family/peers or
blood drive organizers/recruiters as a reason to donate,
in contrast to other demographic groups, in which the
organizer/recruiter had a more influential role.
Some demographic differences that were present in
the unadjusted analyses (Table 2) persisted after adjust-
ment for other demographics and first-time versus repeat
status (Table 3). Younger donors were more likely to re-
port that they “felt it was the right thing to do,” that a
family member, friend, or coworker encouraged them to
donate, that they wanted to receive a gift, and that they
wanted the results from tests for infectious diseases such
as the HIV or the HCV (ORs per 10 year increase of 0.55 to
0.82; Table 3). Conversely, the odds of being encouraged
to donate by a blood drive organizer or recruiter was 1.11
times higher for each decade increase in age (OR = 1.11;
Table 3).
First-time donors were more likely to indicate that
they donated blood because a family member, friend, or
coworker encouraged them (OR = 3.70) or because they
wanted to be tested for infections (OR = 1.41) than repeat
donors. The latter were more likely to donate for any of
the other reasons (ORs from 0.59 to 0.90, p < 0.01).
Donors with a college or higher degree were more
likely to donate because “it was the right thing to do” (OR
= 1.51) but were less likely to donate to improve their
health (OR = 0.74) or because of family-peer influence
(OR = 0.78) than donors with a high school or lesser edu-
Volume 42, February 2002 TRANSFUSION 219

GLYNN ET AL.
TABLE 3. Adjusted ORs* (95% CI) comparing reasons to donate among demographic groups
Family member,
Blood drive
organizer/
recruiter
friend, coworker,
or someone close
to me strongly
Wanted
infectious
disease
Donating is
good for
my health
It was the right
thing to do
Heard blood
was needed
Wanted an
item/gift
encouraged me
encouraged me
test results
OR* (95% CI)
OR* (95% CI)
OR* (95% CI)
OR* (95% CI)
OR* (95% CI)
OR* (95% CI)
OR* (95% CI)
Age (per
10-year
increase)
0.82 (0.80-0.83)† 1.00 (0.98-1.02) 1.11 (1.08-1.13)† 1.00 (0.96-1.04) 0.74 (0.71-0.77)† 0.74 (0.71-0.77)† 0.55 (0.51-0.59)†
0.92 (0.87-0.97)‡ 0.70 (0.67-0.74)† 0.96 (0.91-1.02) 1.99 (1.85-2.14)† 1.16 (1.05-1.28)‡ 1.20 (1.07-1.34)‡ 1.53 (1.33-1.75)†
Sex
Man
Woman
1.0
1.0
1.0
1.0
1.0
1.0
1.0
Race/ethnicity
Asian
Hispanic
Other
0.89 (0.75-1.06) 1.04 (0.90-1.20) 0.93 (0.75-1.15) 1.19 (0.92-1.55) 0.91 (0.70-1.19) 0.68 (0.47-0.97)§ 1.10 (0.73-1.66)
0.68 (0.60-0.77)† 1.04 (0.93-1.17) 1.01 (0.90-1.13) 0.79 (0.65-0.96)§ 1.02 (0.83-1.26) 0.96 (0.76-1.23) 1.29 (0.96-1.73)
0.87 (0.68-1.12) 0.81 (0.66-1.00) 0.87 (0.65-1.15) 1.14 (0.85-1.54) 1.60 (1.17-2.19)‡ 1.24 (0.80-1.92) 0.91 (0.52-1.57)
0.77 (0.68-0.87)† 0.88 (0.77-1.02) 1.13 (0.96-1.33) 0.62 (0.49-0.79)† 1.40 (1.14-1.72)‡ 0.75 (0.58-0.97)§ 1.47 (1.04-2.10)§
Black
White
1.0
1.0
1.0
1.0
1.0
1.0
1.0
Education
ՆCollege
Some college 1.09 (0.99-1.19)
ՅHigh school 1.0
1.51 (1.38-01.66)† 0.95 (0.89-1.01) 1.04 (0.95-1.14) 0.74 (0.68-0.81)† 0.97 (0.84-1.11) 0.78 (0.67-0.91)‡ 0.96 (0.73-1.26)
࿣
1.01 (0.94-1.09) 0.95 (0.86-1.04) 0.99 (0.90-1.10) 1.20 (1.01-1.42)§ 0.90 (0.77-1.05) 0.92 (0.71-1.19)
1.0 1.0 1.0 1.0 1.0 1.0
Status
FT
Repeat
0.72 (0.67-0.78)† 0.73 (0.69-0.77)† 0.90 (0.83-0.97)‡ 0.59 (0.50-0.69)† 0.83 (0.73-0.95)‡ 3.70 (3.25-4.21)† 1.41 (1.19-1.66)†
1.0 1.0 1.0 1.0 1.0 1.0 1.0
*
The adjusted models included age (as a continuous variable), sex, race/ethnicity, education, and first-time/repeat status.
† p value <0.001.
‡ 0.01 <p value Յ0.001.
§ 0.05 <p value Յ0.01.
࿣
Some college refers to some college level of education or an associate degree.
cation. The role of family and peers was slightly more
important in men than in women donors (OR = 1.20).
Men donors also donated more often because they thought
donating was good for their health (OR = 1.99), to get
tested for infectious diseases (OR = 1.53), and to receive
an item and/or gift (OR = 1.16); conversely, women cited
“it was the right thing to do” (OR = 0.92) and having
“heard that blood was needed” (OR = 0.70) slightly more
often.
Black donors were more likely than white donors to
donate to receive an item and/or gift (OR = 1.40) or to be
tested for an infectious agent (overall OR = 1.47; this as-
sociation mainly held true for donors with some college
or higher level of education). Black and hispanic donors
were less likely than white donors to report donating be-
cause “it was the right thing to do” or because it would
benefit their health. Black and asian donors were also less
likely to report being encouraged to donate by a family
member, friend, or coworker, although these associations
were only marginally significant (p = 0.03).
influencing factors identified were a blood drive orga-
nizer or recruiter (7.2%), a letter or call from the blood
bank (6.8%), and a coworker or friend (3.7%), whereas
other factors each influenced approximately 2 percent of
the donors to donate.
Whereas donors with a college degree or higher level
of education were less likely to be strongly influenced
than donors with a high school diploma or lesser level of
education (OR = 0.89, 95% CI 0.84-0.96, p = 0.002), the
odds of being strongly influenced was 1.11 times higher
for each decade that age increased (OR = 1.11, p <0.001).
Women (29%), first-time (34%), and Hispanic (32%) do-
nors were more likely to be strongly influenced to donate
than men (25%, p < 0.001), repeat (25%, p <0.001), and
White (26%, p < 0.001) donors, respectively.
The nature of the influencing factors varied within
demographic groups. Coworkers and friends played a
relatively more important role in Յ25-year-old, first-time,
or hispanic donors. The proportion of influenced donors
that were encouraged by a coworker or friend (Յ25 years
old, 27%; first-time, 29%; hispanic, 21%) was similar or
higher to the proportion obtained for a blood drive orga-
nizer/recruiter or for a letter or call from the blood bank.
These proportions were 21 percent for Յ25 year olds, 23
percent for first-time, and 26 percent for hispanics for a
blood drive organizer or recruiter; and 15 percent for Յ25
Influencing factors
Only 27 percent of donors reported having been strongly
influenced to donate by someone (family, friend/co-
worker, employer, blood bank staff) or something (the
media, letter, or call from the blood bank). The major
220 TRANSFUSION Volume 42, February 2002

MOTIVATIONS: DEMOGRAPHIC COMPARISONS
yeas olds, 4 percent for first-time, and 20 percent for his-
panics for a letter or call from the blood bank. For all
other groups, the blood bank was more influential in at-
tracting blood donors than coworkers or friends, with a
letter or call from the blood bank becoming more impor-
tant as donation frequency increased.
couraged by telephone calls, particularly if originating
from the blood bank, than repeat donors (OR = 0.60).
Donors with a higher level of education (Նcollege) ap-
peared to favor receiving a letter or e-mail from the blood
bank and were generally less encouraged by reminders
not originating from the blood bank than donors with a
high school diploma or less. More highly educated do-
nors were also more likely to be discouraged by a tele-
phone call from the blood bank, irrespective of age (16%
of donors with Նcollege were discouraged compared
with 14% for some college/associate degree and 10% for
Յhigh school).
Donation reminders
Donors were asked what effect various reminders would
have on their decision to donate in the future. The ma-
jority of donors appeared to be encouraged by reminders
originating from the blood bank, with a telephone call
appealing to 60 percent of donors, a letter or an e-mail to
63 percent, and an appeal from the local blood bank on
TV, radio, or newspaper to 59 percent. Donors appeared
less encouraged by a television, radio, or newspaper ap-
peal from a national organization or spokesperson (42%)
or by a call or letter from an organization such as a reli-
gious group, social club, or fraternal group (46%). Al-
though most donors (59-63%) appeared encouraged by
reminders originating from the blood bank, some re-
ported that they would be discouraged from donating by
these reminders. A higher percentage of donors appeared
to be discouraged by a telephone call (14%) than by a
letter or e-mail (4%) or an appeal (2%) from the blood
bank. Furthermore, whereas 12 percent of donors re-
ported that they would be discouraged by a call or letter
from a religious or social organization, only 3 percent of
donors said they would be discouraged by an appeal from
a national organization. As can be seen in Figure 1, this
pattern held for all demographic groups, except for older
donors (Ն66 years old), who would prefer receiving a
telephone call from the blood bank or a call or letter from
a social or religious organization.
Table 4 outlines differences in demographic groups
by comparing the odds of being encouraged (vs. discour-
aged or indifferent) between demographic groups, after
adjustment for other demographics and first-time versus
repeat status. As previously mentioned, older donors
were more likely to be encouraged by a call from the
blood bank (OR = 1.11 for every 10-year age increase) or
by a call/letter from a social or religious organization (OR
= 1.22 for every 10-year age increase). The latter associa-
tion appeared to hold true for all racial/ethnic groups
except for asian donors, where there was no increased
encouragement by a social or religious call/letter with age
(data not shown). Men were always less likely to be en-
couraged than women, regardless of the nature of the
reminder. Asian donors also always appear to be less en-
couraged than white donors except for 1) Յhigh school
asian donors who, in contrast to more educated donors,
were more encouraged by a letter/e-mail from the blood
bank (68%) than white donors (60%) and 2) an appeal
from a national organization on television, radio, or
newspaper. First-time donors were less likely to be en-
DISCUSSION
Compatible with previous reports,9,13 altruism and being
aware that blood is needed are still reported as the most
important reasons for donating. When evaluating wheth-
er reasons to donate differed by demographic subgroups,
we found that the relative importance of the motives did
not change except in first-time and young donors. Both
groups listed altruism and blood need as their primary
reasons to donate but were about as likely to be influ-
enced by a family, friend, or coworker as by a blood drive
organizer and/or recruiter. In all groups, very few do-
nated to get recognition or because they were told by a
doctor to donate for health reasons.
It may also be possible to recruit and retain particu-
lar donor groups if their specific motivations to give
blood are known. Although the demographic differences
we found in reasons to donate were usually small, char-
acterization of these differences may provide a basis for
more targeted recruitment or retention efforts. Messages
highlighting altruistic values and stressing the need for
blood, using, for example, “real” patient experiences,
should appeal to all demographic groups.
Younger, women, white or asian, and more highly
educated donors were more likely to report giving be-
cause they felt “it was the right thing to do” than their
respective counterparts (older, men, black and hispanic,
lesser educated donors). These findings concur with re-
sults from a survey administered in the 1960s to 5581
individuals immediately after their donation showing
that women, college-educated, and young donors were
more likely to give for humanitarian reasons.6
Perceived need for blood was the second most com-
monly identified motive for donating. Giving blood for
this reason may reflect 1) intrinsic or altruistic values,
that is, giving because others need blood, 2) the need to
ensure that blood will be available for oneself, a family
member, or a friend, and 3) whether information relating
to the presence of a blood shortage was easily accessible
to the individual. Women and repeat donors were ap-
proximately 40 percent more likely to donate for this mo-
tive than men or first-time donors. These findings are
Volume 42, February 2002 TRANSFUSION 221

GLYNN ET AL.
Fig. 1. Potential response to reminders by demographics. a) Age. b) Sex. c) Race/ethnicity. d) Donor status: first time versus re-
peat. *A, Asian; H, Hispanic; O, Other; B, black non-hispanic; and W, white non-hispanic race/ethnicity category. †1-5 refers to
repeat donors who have given 1 to 5 donations in the past 10 years, 6-20 to repeat donors who have given 6 to 20 donations in
the past 10 years, and >20 to repeat donors who have given >20 donations in the past 10 years.
compatible with increased perceived altruistic values in
women and repeat donors.
high school or lower level of education. Men were also
more likely to respond to social pressure than women,
and whites and hispanics were more likely to report be-
ing encouraged by family or peers than black or asian
donors. Furthermore, although a blood drive organizer/
recruiter and a letter or call from the blood bank were
usually identified as the strongest influencing factors in
our study, coworkers and friends were found to be a rela-
tively stronger influence in young, first-time, and his-
panic donors. Blood centers should take advantage of the
strong influence of family/peer on these groups. For ex-
ample, student volunteers and family members could
help in college and high school recruitment efforts. That
such programs are probably effective can be exemplified
by a study that found that undergraduate students were
First-time donors were four times more likely to re-
port being encouraged by family, friends, or coworkers
than repeat donors. Piliavin and Callero15 have high-
lighted the importance of social pressure early in the do-
nation process. They reported that 43.8 percent of college
students came without a friend on their first donation,
whereas 70 percent came alone for their fourth donation.
Similarly, Bettinghaus and Milkovich8 found that 40 per-
cent of donors knew at least five friends who donated
compared with 19 percent of nondonors. Consistent with
London and Hemphill’s6 report, we also found that being
encouraged by a friend, family, or peer was a more im-
portant factor for young individuals and donors with a
222 TRANSFUSION Volume 42, February 2002

MOTIVATIONS: DEMOGRAPHIC COMPARISONS
TABLE 4. Adjusted ORs* (95% CI) comparing odds of being encouraged by future reminders among
demographic groups
Appeal from a
national organization
blood bank on TV, or spokesperson on TV,
Call or letter from an
organization such as a
religious group, social
club, or fraternal group
Appeal from local
Telephone call
from blood bank
Letter or e-mail
from blood bank
radio, newspaper
radio, or newspaper
OR* (95% CI)
OR* (95% CI)
OR* (95% CI)
OR* (95% CI)
OR* (95% CI)
Age (per 10-year increase) 1.11 (1.08-1.13)† 0.82 (0.80-0.83)†
1.00 (0.98-1.02)
0.90 (0.89-0.92)†
1.22 (1.20-1.25)†
Sex
Man
Woman
0.71 (0.68-0.75)† 0.80 (0.77-0.83)†
0.62 (0.58-.65)†
10
0.69 (0.66-0.73)†
1.0
0.84 (0.81-0.87)†
1.0
1.0
1.0
Race/ethnicity
Asian
Hispanic
Other
Black
White
0.63 (0.56-0.71)†
0.91 (0.83-1.00)
0.77 (0.65-0.92)‡ 0.83 (0.67-1.02)
1.01 (0.90-1.13)
1.0
076 (0.66-0.88)†
0.85 (0.76-0.96)‡
0.75 (0.64-0.87)†
0.91 (0.81-1.02)
0.84 (0.68-1.05)
0.87 (0.77-0.98)§
1.0
1.00 (0.87-1.15)
1.06 (0.95-1.18)
0.93 (0.75-1.16)
1.06 (0.96-1.16)
1.0
0.64 (0.55-0.74)†
0.94 (0.84-1.04)
0.76 (0.61-0.94)§
0.94 (0.85-1.05)
1.0
0.91 (0.81-1.03)
1.0
Education
ՆCollege
Some college
ՅHigh school
0.92 (0.85-1.00)
0.94 (0.87-1.01)
1.0
1.24 (1.14-1.34)†
1.12 (1.03-1.21)‡
1.0
1.04 (0.95-1.14)
1.08 (0.99-1.17)
1.0
0.78 (0.73-0.85)†
0.95 (0.88-1.04)
1.0
0.84 (0.77-0.91)†
0.93 (0.86-1.01)
1.0
࿣
Status
FT
Repeat
0.60 (0.56-0.64)† 0.95 (0.89-1.01)
1.0 1.0
0.98 (0.92-1.05)
1.0
1.00 (0.93-1.07)
1.0
0.92 (0.86-0.99)§
1.0
*
The adjusted models included age (as a continuous variable), sex, race/ethnicity, education, and first-time vs. repeat status.
† p value <0.001.
‡ 0.01 <p value Յ0.001.
§ 0.05 <p value Յ0.01.
࿣
Some college refers to some college level of education or an associate degree.
more likely to donate if asked by a friend than if asked by
a stranger (31% vs. 14% respectively).25 Media advertise-
ment stressing that giving blood is a socially desirable
behavior that conforms to peer expectations may also be
useful in recruiting first-time donors.
Conversely, we found that social pressure did not
play as important a role in repeat and older donors. Do-
nors who had given very frequently (>20 donations in the
last 10 years) were more likely to give for altruistic rea-
sons, health concerns, or recognition. The donation pro-
cess appears to evolve as Piliavin and Callero15 described.
Initially friends, family, and peers play a crucial role in
inducing an individual to donate; the influence of blood
drive organizers and recruiters then gradually replaces
that of family and peers. Finally, donating blood becomes
a habit with development of a strong role identity and
with altruism, a core value.
In our study, a small percentage of donors gave
blood for personal benefit, with 9 percent reporting that
donating is good for one’s health and 6 percent being
attracted by items of small value. Men were approxi-
mately twice as likely as women to give because it would
be good for their health. It is possible that men donors
were aware that a lower iron level has been reported as
being potentially protective against ischemic heart dis-
ease, a theory consistent with the lower rates of heart
disease in premenopausal women compared with men.26
Men donors were also more likely to be attracted by gifts;
similarly, blacks and donors with some college education
were more likely to have donated to receive a gift than
White and college-educated donors, respectively. Being
encouraged to donate by items of limited value (gifts) has
not been found to be associated with an increased risk of
having a reactive screening test or unreported deferrable
risk behavior.27 Hence, a judicious use of gifts that are not
readily convertible to cash28 may be effective for recruit-
ment of some populations without being detrimental to
the safety of the blood supply.
Finally, a small percentage of donors (2.41%) re-
ported donating to be tested for an infectious agent such
as HIV or hepatitis. Test seeking was 40 to 50 percent
more likely to occur in first-time, Black, or men donors.
Blood banks should stress during initial contact that it is
inappropriate to give blood just to be tested for these
infections and give donors a list of affordable alternative
test sites. Some individuals may also be under the mis-
conception that their blood is not infected and cannot
transmit an infectious agent if negative on screening
tests.29 Donors need to be educated about the possibility
of having a false-negative screening test early in the
course of infection to increase the likelihood of self de-
ferral or to encourage them to choose the confidential
unit exclusion option, when available.
Most blood donors denied having been strongly in-
fluenced by the blood bank, the media, or family or peers
to donate. Donors, if influenced, were more likely to re-
Volume 42, February 2002 TRANSFUSION 223

GLYNN ET AL.
spond to blood center’s staff or programs (letter or call),
although friends played a more important role in young,
first-time, and Hispanic donors. Consistent with these
observations, we found that a high percentage of donors
would be encouraged to return if they received reminders
originating from the blood bank. Interestingly, except for
older (Ն66 years old) donors who would favor receiving a
telephone call from the blood bank, most donors would
prefer receiving a letter or an e-mail from the blood bank
(rather than a phone call). Hence, blood centers should
consider the use of Web pages or advertisement on the
Internet and should evaluate the feasibility of contacting
new generations of donors by e-mail as a possible cost-
effective recruitment or retention tool. Blood drives can
be successfully conducted by using the Internet/e-mail,
as exemplified by the “SF blooddrive.com” program con-
ducted in August 2000 in the San Francisco Bay area that
attracted more than 150 donors in 2 days.30
continue to build on this humanitarianism and take ad-
vantage of the family-peer influences that are especially
strong in young and first-time donors. Although blood
centers should continue to contact their older donors by
telephone, they should consider establishing new com-
munication routes such as e-mail to encourage their
younger and more educated donors to return.
ACKNOWLEDGMENTS
The authors thank Edward P. Scott, MD, at the Lifeblood Mid-
South Regional Blood Center (Memphis, TN), Debra Kessler,
RN MS, at the New York Blood Center (New York, NY), and
Joy Fridey, MD, at the Blood Bank of San Bernardino and Riv-
erside Counties (San Bernardino, CA) for their valuable insight.
We are also very grateful to the staff at all eight participating
blood centers. Without their help, this study would not have
been possible.
Our analysis was subject to some limitations. First,
our results are based for the most part on self-reports.
The questionnaire was anonymous, which should have
allowed donors to report truthfully their reasons to do-
nate. However, as Piliaven and Callero15 noted, donors
may be inclined to give as their primary motivator what
they perceive is a socially acceptable response rather
than their real reason to donate. Further studies that give
the donor an opportunity to grade the importance of
each influencing factor will be needed to address this
issue further. Second, although the statistical analysis
was adjusted for nonresponse, our results are based on
responses given by 57 percent of the sampled donors. It
is possible that respondents were more likely to be altru-
istic than nonrespondents leading to a potential under-
estimation of the number of donors giving for nonhu-
manitarian reasons. Third, because of the large number
of statistical tests done in this analysis, caution should be
used in drawing conclusion for those associations with a
p value exceeding 0.001. Fourth, we found that some re-
minders would encourage most donors to return. It is
difficult to predict, however, whether being encouraged
or intending to donate as a result of a reminder directly
translates into actual donations (although intention is
correlated with action).31 Fifth, when evaluating potential
response to reminders originating from the blood bank,
donors were asked whether a letter or an e-mail would
encourage or discourage them to donate. Hence, we were
not able to separate the effect of a letter from that of an
e-mail. Finally, our survey did not assess why individuals
in the general population do not donate; further studies
of nondonor populations are needed to gather this infor-
mation.
When this study was conducted, the REDS Group was the re-
sponsibility of the following persons:
Blood Centers:
American Red Cross Blood Services Greater Chesapeake and
Potomac Region: A.E. Williams (Holland Laboratory), C.C. Nass
American Red Cross Blood Services Southeastern Michigan
Region: M. Higgins
American Red Cross Blood Services Southern California Re-
gion: G. Garratty, S. Hutching
Blood Centers of the Pacific: E.L. Murphy (UCSF), M.P. Busch
Oklahoma Blood Institute: R.O. Gilcher, J.W. Smith
Medical Coordinating Center:
Westat: G.B. Schreiber, D.I. Ameti
National Heart, Lung, and Blood Institute, NIH:
G.J. Nemo
Steering Committee Chairman:
T.F. Zuck (Ohio Enterprises International)
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