I would think they could just screen frequent donors with rare blood types for infections. Once the donor is known safe, compensate however is needed to get their blood. I believe there are private industries doing this. This one will be opening soon in my town, though I guess just for plasma: http://www.biolifeplasma.com/become-donor/compensation.html

I'm a regular whole blood and plasma donor and I'm quite sure that I'd be much less likely to donate if I was being paid for it. I'm not really sure exactly why I feel that way, but I guess that if you put a dollar value on it I'd be calculating whether it really was worth my time. Right now, because there is no compensation (aside from a muffin and a cup of tea afterwards), I get the emotional benefits of having performed a purely altruistic deed.

You're not alone. I listened to a podcast a while back on this subject, and the reason that the blood "market" runs solely and strictly on donations it's because earlier in history, when the medical establishment paid for blood, they were only able to get skid row types to contribute, and needless to say, the quality of the blood wasn't good.

http://freakonomics.com/2013/06/05/is-paying-for-blood-a-goo...

An interesting point, but for me at least there is a significant difference between earnings and reimbursement. One might be more likely to donate if they're not being paid, but if they knew that donating involved spending a non-trivial amount of money that would not be reimbursed I think it would be a deterrent.

I had trouble parsing this. "People are okay with not being paid (for charitable effort). People dislike not being reimbursed (for charitable effort)."

Reimbursement seems a non-sequitur in the context of donating blood. Without an alternative market for blood, framing it as foregone reimbursement would be actively antagonistic on the part of the charitable recipient [within the culture in my area]. eg, "we could pay you, but you shouldn't want us to."

Unless you are referring to a situation, expressed below, like not reimbursing significant travel expenses for mr blackfan-anemia. It's not clear to me.

I think the situation is about travel expenses, as that's the major issue that the article brings up. It's not an issue for people with common blood types. Just donate anywhere. But for dealing with rare blood types, it might help if rare donors didn't have to pay their own air travel bills.

I am referring to eg. being reimbursed for travel expenses, or any other expenses which would not have been incurred by not donating. Being "made whole" on money you spent.

If someone has to drive across an international border and take a day off work to donate their (very rare) blood, it makes sense to compensate them for their travel costs.

The donor wouldn't have to also be "donating" gas money, just blood and time.

Two other possibilities:

* In the private health-care world, if you're getting paid, you might feel like someone else is profiting off your blood (how else could they pay you?)

or

* In the public health-care world, if you're getting paid you might feel like money is being ill-spent when it could/should be used to better pay healthcare workers etc. since people are typically willing to donate blood for free.

Except, in most cases you donate the blood to a blood bank that will sell it to wherever it is needed. The blood banks are profiting from your blood and hospitals are ill-spending money. You get the worse of both worlds.

It costs money to keep the lights on and pay employees, refrigeration, databases, transportation (we get blood shipped from ARC three hours away twice a day), etc. And if you're not making money, you're losing money. Money is how societies manage these costs. Most blood banks are associated with a hospital or university. Some centers are free standing, like Blood Source or American Red Cross (ARC), and they are often the ones doing the heavy lifting: managing rare units, sending 100 units of platelets to a disaster zone, etc.

On the flip side, blood banking is a small community. Each chief blood banker knows how much the products cost, often from working on both sides of the transaction at various times in their careers, and they see each other regularly. The head of our blood bank was previously the head of Blood Source. She has obligations to the university to not waste money, and she knows how much it costs to get a unit from Blood Source.

The ceo of the red cross makes $600k, with plenty of the execs making over $400k (form 990 available [1]; page 49). I don't know if I can draw a bright line, but I think that's excessive compensation for running a medical charity.

Let's say that we put a cap in there: no executive in the Red Cross can make more than $200k. Let's further say that, over time, the quality of the executives goes down as a consequence, to the point that the Red Cross is less effective at its mission. So, we have a compensation cap that "feels" more appropriate for a medical charity, but the charity is now less capable of accomplishing its mission. Do you think this is an improvement?

Now, I am not saying this is necessarily what will happen, but it's certainly possible. I also assume that executives at the Red Cross are already making less than what they could at for-profit companies. Non-profits have to compete with for-profits when it comes to employees; that's just a natural consequence of how labor and capital exist in our economy. I think this means that we will sometimes have to pay employees at non-profits more than what "feels" right in order to have good, competent employees.

Let's say we can the glibertarian nonsense, because anything is possible (under your metric of oh, it may not happen... but it's possible). Why, we should pay the executive $10m/year -- because otherwise, the quality of the executives will go down, to the point that the Red Cross is less effective at its mission. I'm not saying this is necessarily what will happen, but it's certainly possible.

I'm actually far from a libertarian. I want strong government regulation in many areas (finance, food, healthcare, etc.), a broad social safety net (which would ideally include government healthcare for all), and I'm willing to raise taxes to achieve all of those.

But we do live in a capitalist society. So we have to, well, live with it. And part of living with it is recognizing that private entities that do work we would typically consider for the greater good of society have to compete against entities that exist for their own benefit. The reason that they don't pay the execs at the Red Cross more is that the rate of $600k is arrived at through a combination of what they have to pay to get a good executive, what they can pay, and the pay cut the execs are willing to take to work at a non-profit with high social value.

My argument is that the pay they've arrived at balances all of those things, and if we tried to cap it, we could harm the mission. Your argument is that the pay they've arrived at feels wrong, and we should ignore the dynamics of the labor market for execs.

They pay nothing for their by far most important input, and in fact actively guilt people into giving it to them. For free.

You also appear to have a, well, econ for the gullible version of how executives get paid. Reality is much closer to managing to stack the board with friends, etc -- read eg Jack Welch.

Your argument about the dynamics of the labor market for execs is specious -- arrived at by assuming the current state, then proceeding to demonstrate the current state is necessarily optimal because we are in it.

Ok, propose an alternative scheme of executive pay. Does it work? How about the head of the French Red Cross or Doctors without Borders: how does their pay compare?

Surely we all expect a charitable organization like ARC to pay market rates for electricity, paperclips, postage, clerical personnel, and medical technologists. Why should they not pay something approaching market rates for executive leadership? I'm certain a corporate CEO of the caliber needed to run ARC would command well over a million in salary plus stock options, so they are already well under the market.

It's one of the biggest global enterprises around. And they work in a very high tech sector.

Those numbers are not really stratospheric, offering less may make the positions impossible to fill.

Not necessarily. This isn't the case in the UK (where I am) for example, where blood donations are taken by the NHS.

Just say keep the money, altruism restored.

Well, truly altruistic until you tell someone that you're a regular blood and plasma donor. But, like said before, you could simply refuse the compensation.

If that would disqualify then so would feeling good about it without telling people, it's the same kind of compensation. And he could even tell people the same thing without really donating, so the act itself is actually altruistic after all.

I'm not sure if that's the same for me. Just feeling good about it yourself says more about how you wish to view yourself as a good or moral person. Telling others about your charitable acts reflects more on how important we find showing that we are good and moral people to others.

Of course I don't intend to bring the character of the parent to question, I think it's great when anyone engages in charitable acts.

It's just interesting to me to think about the fact that compensating someone for what was once charity could dissuade them from donating. If compensation causes you to avoid giving blood, which is saving lives, because you no longer get the warm fuzzies were you ever acting altruistically to begin with?

I don't know.

don't think of it as altruism, then, think of it as the relative values of money and warm fuzzies.

You could still donate for free, of course. Additionally, others would be more likely to provide blood for compensation. The overall supply would be greater.

It's unclear to me why paying individuals with very rare blood types for the blood they provide to the medical industry would in any way alter the landscape of general blood donations. I understand why it's a bad idea to attempt to pay for regular blood donations in general, but rare blood is not a "regular donation" - the individual is in possession of an insanely lucrative product. It just happens to be their blood, instead of something more "normal" like artistic talent.

My wife knew a person in college who got paid for their blood, something like $500 a month. Not enough to retire on, but a nice second source of income.

I would have guessed that the reason for prohibiting payment for blood would be the same as the reason prohibiting payment for organ donations. Interesting that in this case it is blamed on trying to minimize donations from people with HIV.

It's not just HIV. It's any infectious disease (there is a thick book of reasons to disallow a donation). The problem is that these infectious diseases are socially disruptive, therefore these folk, unfortunately, tend to have less marginal income. Therefore, they are exactly the people who would respond to a small monetary incentive. This has been studied. If anyone is acutely aware of the problem, it's blood banks. So this issue is revisited routinely. Here is a recent review on the topic:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2847338/

I'm advocating tax deductions as an incentive.

If I give $350 in cash to the American Red Cross, I can take that charitable deduction from my annual filing. If I donate a unit of blood that gives ARC $350 in products, that's not deductible.

The incentive side steps the donor-with-marginal-income problem, unless I'm missing something.

IRS Pub 526 on Charitable Contributions, Page 2:

  Not Deductible As Charitable Contributions:
    Cost of raffle, bingo, or lottery tickets
    Dues, fees, or bills paid to ...
    Tuition
    Value of your time or services
    *Value of blood given to a blood bank*

It's amazing how many details the IRS pubs cover. I like your proposal though.

That's a clever way to pay richer people progressively more for their blood.

Organs don't regenerate like blood does. Blood is very valuable and blood is paid for all the time. The only restriction is on paying the original creator. Once the blood is extracted, it is sold and re-sold for high prices.

That's modern medical 'ethics' for you: damn the consequences, what matters is what it looks like and whether it offends anyone.

No, it's about the safety of the blood supply. It's a weird quirk of human psychology and economics that paying for donations means fewer healthy people and more people with infectious diseases donate when it's fee-for-blood.

If you were designing based on consequences, would covering basic expenses for rare blood donors result in so many people signing up with infectious diseases that it exceeds the deaths from the Rube Goldberg scheme described in OP which limps along with just a few rare blood donors?

I get what you're saying. I'll ask our blood banker when she gets back from ASHI.

For an example of that, HIV likely crossed into the US from Haiti via the blood trade[0][1] which acted as both amplifier and transport after haitians had to leave DRC, and some got infected in the time they spent there.

And of course thousands of haemophiliacs in the 80s got infected with HIV and HepC because of contaminated Factor VIII: http://en.wikipedia.org/wiki/Contaminated_haemophilia_blood_...

[0] http://www.onereads.org/spillover-david-quammen?page=0,208

[1] http://lambsbloodblog.wordpress.com/2013/01/11/hemo-caribbea...

However, that effect does not extend to many kinds of gifts. Which is why I receive some stuffed animal or similar every 10th donation (I politely refuse them, not to add to the waste in the world).

People with rare blood could be gifted things like emergency taxi rides without adverse consequences and it's just bureaucracy, not science, that is in the way.