This Thursday, June 14, blood centers and health organizations around the globe will celebrate World Blood Donor Day (WBDD). As a day of appreciation for blood donors, WBDD is a wonderful opportunity to reflect on the impact that donors have on their communities, and on the simple but extraordinary act of altruistic giving that helps save lives every day.
This year, in addition to taking a moment to express gratitude for blood donors, the World Health Organization (WHO) — which serves as a global public health watchdog, policy-maker, and international support organization — is hoping to raise awareness for the importance of volunteer donors in ensuring the safety and sustainability of the blood supply.
WHY VOLUNTARY BLOOD DONATION MATTERS
In various regions of the world, donating blood may be a markedly different experience. At a high level, there are three categories of blood donation systems: volunteer, replacement (donating for a family member/friend), or remunerated (paid). Many regions or countries have some mixture of one or more donation types; and, in regions where populations are smaller and more spread out, some portion of replacement and/or remunerated donations may continue to be required to ensure patients have the blood they need when they need it. However, for many years, WHO and other international blood banking organizations have been striving toward achieving a 100% voluntary donor base across the globe — and for very good reason.
Remunerated (paid) blood donation can potentially incentivize an individual who should not be donating blood to — for example — conceal a recent infection, thus creating a safety risk for transfusions. And in more remote or developing regions where access to comprehensive testing services may be inadequate, it is essential that blood donors be healthy to prevent the transmission of pathogens to vulnerable patients.
Replacement donor systems in populations where family and close friends may not be available or eligible to donate translates into a lack of available blood products that can quickly become a life-threatening problem. In some parts of the world, when a friend or family member cannot serve as a replacement donor, people have turned to a de facto paid donor solution, offering their own private funds to attract anyone who can help in an emergency.
In most cases, the patient’s relatives are requested by hospital staff to donate blood but, in some settings, it is compulsory for every patient who requires transfusion to provide a specified number of replacement donors on emergency admission to hospital or before planned surgery. Although donors are not paid by the blood transfusion service or hospital, there may be a hidden paid donation system in which money or other forms of payment are actually provided by patients’ families. 
Replacement donors feeling pressure to help a loved one may also be too embarrassed to admit risky behavior to blood collection personnel.
In some countries, patients may prefer direct donation by family members or friends rather than “strangers” because they believe this will eliminate the risk of transfusion-transmissible infection. However, prevalence rates of transfusion-transmissible infections are generally found to be higher among family/replacement donors than voluntary donors. 
Conversely, volunteer donor systems where donors give blood without compensation or knowledge of the recipient, offer both safety and the assurance of a ready blood supply.
Regions and countries with well-structured health systems and blood transfusion services based on voluntary blood donation … must constantly strive to maintain adequate blood stocks in the face of rising clinical demands, increasingly stringent donor selection criteria and the loss of older donors who are no longer eligible to give blood. Nevertheless, even though there may be periodic or seasonal shortages, access to safe blood for all patients requiring transfusion can generally be taken for granted. Overall, developed countries are likely to have effective blood donor [programs], more voluntary donors, higher donation rates and more available blood. 
Donors who give blood for altruistic reasons rather than for compensation or for a family member in an emergency are more likely to be healthy at the time of donation, and more likely to be transparent about any health concerns that may pose a risk either to themselves or to the recipient of their blood products.
VOLUNTARY BLOOD DONATIONS ON THE RISE
Some regions with smaller or more spread out population centers have enlisted creative technology to solve the sustainability problem and encourage volunteer donation, including developing mobile phone applications  that link donors to a patient in need, or using unmanned aerial vehicles (commonly called drones)  to deliver blood products to remote areas from more populous areas.
Data reported to WHO shows significant increases of voluntary unpaid blood donations in low- and middle-income countries:
- An increase of 10.7 million blood donations from voluntary unpaid donors from 2008 to 2013 has been reported by 159 countries.
- 74 countries collect more than 90% of their blood supply from voluntary unpaid blood donations This includes 57 countries with 100% (or more than 99%) of their blood supply from voluntary unpaid blood donors. 
We are extremely fortunate in the U.S. to have a volunteer donor base, avoiding the pitfalls and insecurity of remunerated or replacement systems. Nationally, 98.8% of whole blood donations are allogeneic (donated for an unspecified recipient)  and at Stanford Blood Center (SBC), that percentage is even greater — 99.2% allogeneic whole blood donors in 2017, with the remaining fractions split between autologous/therapeutic (donating for oneself) and directed (donating for a specific recipient).
Stanford Blood Center does not offer compensation for any type of blood donation. If desired, donors are able to specify a recipient for their whole blood donation with advance planning through either autologous, therapeutic or directed donation. However, it is our allogeneic blood donors that make it possible for SBC to serve the needs of our full patient community. Blood products have a limited shelf life, so the only way to ensure that we have a safe and ready blood supply for all who need it is to have a steady flow of healthy blood donors doing a simple but remarkable thing: giving altruistically, anonymously, and consistently to ensure the common welfare of all.
As always — thank you, Stanford Blood Center donors for your lifesaving gift. We couldn’t do what we do without you.
[3 ] https://www.theguardian.com/global-development/2018/jan/02/rwanda-scheme-saving-blood-drone
 Data sourced from Blood Centers of America, 2016