Who is my stranger?

This chapter explores the social and economic aspects of gift-exchange as a universal phenomenon. Examples drawn from both complex and traditional societies indicate that the personal gift and counter-gift, in which givers and receivers are known to each other and personally communicate with each other, is characterised by a great variety of sentiments and purposes. At one end of the spectrum, economic purposes may be dominant as in some forms of first-gifts which aim to achieve a material gain or to enhance prestige or to bring about material gain in the future. At the other end are those gifts whose purposes are predominantly social and moral in that as ‘total social facts’ they aim to serve friendly relationships, affection, and harmony between known individuals and social groups. Meanwhile, social gifts and actions carrying no explicit or implicit individual right to a return gift or action are forms of ‘creative altruism’.

The demand for blood in England and Wales and the United States

This chapter examines the demand for blood in England and Wales and the United States. Between 1948 and 1967, the annual number of donations of blood in England and Wales rose by 269 per cent. Some part of this increase in supply has met the increase in the amount of blood actually demanded and used per 100 patients treated in hospitals. Meanwhile, estimates have been made that 5,100,000 pints of blood were collected in the United States in 1956 and around 6,000,000 pints in 1966–7. Some of the factors responsible for this world trend relate to the major life-saving role of blood. Others are adding yearly to the relatively new role for human blood of acting as a vital preventive and therapeutic agent. Surgery in its many branches has, for example, been given a new lease of life by increases in the volume of blood available and the advent of effective blood transfusion services.

The transfusion of blood

This chapter discusses the transfusion of blood. Beliefs and attitudes concerning blood affect in varying degrees throughout the world the work of transfusion services in appealing for and recruiting blood donors. A deeply rooted and widely held superstition is that the blood contained in the body is an inviolable property and to take it away is sacrilege. In parts of Africa, for example, it is believed also that blood taken away cannot be reconstituted and that the individual will therefore be weakened, be made impotent, or be blinded for life. The growth of scientific knowledge about the circulation of the blood, the composition and preservation of blood, and the distribution of blood group genes throughout the human race has provided a more rational framework. However, it is only more recently that scientific advances have made a blood transfusion service an indispensable and increasingly vital part of modern medicine.

Introduction: human blood and social policy

This introductory chapter provides an overview of the study of the beliefs, attitudes, and values concerning blood and its possession, inheritance, and use and loss in diverse societies. The study originated and grew over many years of introspection from a series of value questions formulated within the context of attempts to distinguish the ‘social’ from the ‘economic’ in public policies and in those institutions and services with declared ‘welfare’ goals. As such, this book centres on human blood: the scientific, social, economic, and ethical issues involved in its procurement, processing, distribution, use, and benefit in Britain, the United States, the Soviet Union, South Africa, and other countries. Ultimately, it considers the role of altruism in modern society. It attempts to fuse the politics of welfare and the morality of individual wills.

Blood and the law of the marketplace

This chapter discusses the application of the values of the marketplace to human blood. American and British economists are making an economic case against a monopoly of altruism in blood and other human tissues. They wish to set people free from the conscience of obligation. Although their arguments are couched in the language of price elasticity and profit-maximisation, they have far-reaching implications for human values and all ‘social service’ institutions. However, the moral issues that are raised extend far beyond theories of pricing and the operations of the marketplace. They involve the foundations of professional freedom in medical care and other service relationships with people; the concept of the hospital and the university as non-profit-making institutions; and the legal doctrine in the United States of charitable immunity.

The gift

This chapter looks at the nature of the gift of blood. The gift of blood has certain unique attributes which distinguish it from other forms of gift. The gift of blood takes place in impersonal situations, sometimes with physically hurtful consequences to the donor. Moreover, the recipient is in almost all cases not personally known to the donor; there can, therefore, be no personal expressions of gratitude or of other sentiments. If the principle of anonymity were generally abandoned, the consequences could be disastrous for givers and receivers as well as for all blood transfusion services. The chapter then presents a classification of the different types of blood donors: the paid donor; the professional donor; the pain-induced voluntary donor; the responsibility fee donor; the family credit donor; the captive voluntary donor; the fringe benefit voluntary donor; and the voluntary community donor.

The supply of blood in England and Wales and the United States

This chapter assesses the supply of blood in England and Wales and the United States. It presents the main national statistics in the increase in blood donation between the introduction of the National Health Service in 1948 and 1968. Whereas in some countries at the end of the 1940s blood transfusion services were in an early stage of development, in England and Wales they had been expanded earlier. The effects of the Second World War, particularly the large quantities of blood required to deal adequately with the expected and actual civilian air raid casualties, greatly stimulated the growth of a blood transfusion service on a national scale. Unfortunately, it is not possible to present any series of statistics for the United States similar to those provided for England and Wales. It is not even possible to estimate with any degree of precision the total annual volume of blood collections, transfusions, and wastage.

The right to give

This concluding chapter provides some interpretative comment on the responses of the voluntary blood donors recorded in the preceding chapter and relates certain issues of principle and practice raised in this book's study to the potential role that governmental social policy can play in preserving and extending the freedom of the individual. Practically all the voluntary donors employed a moral vocabulary to explain their reasons for giving blood. They acknowledged that they could not and should not live entirely as they may have liked if they had paid regard solely to their own immediate gratifications. However, none of the donors' answers was purely altruistic. The chapter then argues that policy and processes should enable men to be free to choose to give to unnamed strangers. They should not be coerced or constrained by the market.

Economic man: social man

This chapter examines criteria of economic efficiency, administrative efficiency, costs per unit of blood, and purity, potency, and safety in relation to the blood distributive systems in the United States and Britain. Looked at simply in economic terms, the ‘cost’ of any activity is the most valuable use to which the resources devoted to it might otherwise have been put. Estimates made by the National Blood Resource Program and other authorities indicate that in the American market, something like 15–30 per cent of all blood collected is lost annually through outdating, involving ‘a multi-million dollar annual loss’. Some part of this poured away waste is due to unnecessary surgical operations and unnecessary transfusions. However, it must be pointed out that no money values can be attached to the presence or absence of a spirit of altruism in a society.

Blood donors in the Soviet Union and other countries

This chapter focuses on blood donors in the Soviet Union and other countries. About half of all blood supplies in the Soviet Union are obtained from unpaid donors at factories, offices, colleges and palaces of culture, and other institutions. They are recruited by the Union of Red Cross and Red Crescent Societies. Donors are allowed a day off work to give their donation and a free meal afterwards; they are also given an extra day's holiday which, if they choose, they may add to their annual vacation. Other reports suggest that in some places donors may be rewarded with free public transport for a month, higher priority for housing, and other ‘fringe benefits’. Meanwhile, the other half of all blood supplies comes from paid donors who attend blood-collecting stations. Although they get a day off work for donating, they are not given a free meal or other benefits.