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it is by definition a “social” act [4]. It is not surprising that social factors and issues have a strong influence on blood donation. Social norms of the community affect donation behavior. For example, general publicity about blood donation in the community creates the perception that blood donation is an active part of the community, thus setting the stage for positive decisions by individuals to donate. This, together with “intrinsic” motivational appeals, builds a community norm for blood donation.

      Volunteerism plays a major role in blood donation. A sense of social connection is gained, a feeling of helping others, and a history of volunteerism in the family or during their school years characterize blood donors [10].

      The differing factors of social media’s influence on blood donation cannot be understated [35]. Most blood collection centers now have a dedicated strategy for social media representation and recruitment. Many centers turn to these media in times of inventory crisis, to contact engaged donors to turn out to drives and fixed sites. Because centers are doing with less financially, they can get messages out to donors in large numbers, many times at no cost. This is especially useful in expanding drive hours, or in the event of adverse conditions closing or canceling a drive or closing a center (early).

      Family history of donation or blood use

      Blood donors are more likely to have had family members who were blood donors [4]. It is not clear whether blood use by a relative or close friend influences the likelihood that one will be a blood donor [6].

      The donation situation

      Blood is collected in both fixed and mobile sites. Fixed sites are facilities that are permanently outfitted to serve as a blood donation center. These sites are usually within the blood center or hospital but may be in freestanding locations, such as office buildings or shopping malls. The proportion of blood that is collected in fixed sites is not known and may vary greatly based on different blood centers’ collection strategies. In the Southern parts of the United States, mobile collections operations may predominate based on favorable logistic and climate conditions. A very large portion of the US blood supply is collected in mobile sites. A mobile site is a location that usually serves a purpose other than blood donation. Examples are offices, high schools, social clubs, churches, colleges, manufacturing companies, public buildings, or shopping malls. At the mobile site, or “bloodmobile,” all of the equipment and supplies necessary for blood collection are portable and are brought in for a few hours or days for the blood collection activity, or is a bus specially outfitted for blood donation. Donors at mobile sites are more likely to be first‐time donors, giving under social pressure, and thus with less internal motivation to donate, and they are more likely to experience a reaction or less‐than‐optimal experience [4]. However, the influence that these settings have on the likelihood that an individual will donate or will have a good experience and be willing to donate again is not well understood. There are differences between those who donate at fixed sites and those who donate at mobile locations [4]. Donors at fixed sites report more internal motivation, whereas those at mobile sites report more external motivation. This would be consistent with the structure of mobile sites, which are usually arranged around a blood “drive” of some sort involving a community group or a particular need, thus providing the “external” motivation. At fixed sites, the donor is usually called by blood center staff and the donation scheduled as part of the general ongoing blood collection activity, but there is no relation to a particular community or social group or patient.

      Organizational influences

Different types of organization are involved in collecting blood and providing the nation’s blood supply (see Chapter 2), and these may influence people’s willingness to donate. Such preferences could be because of the nature of the organization or the individual donor’s motivation. One major difference among organizations is hospital‐based donor programs versus community‐based freestanding blood centers. Because the community‐based blood center serves multiple hospitals, the organization (and, by extension, a donation made to it) carries an image of service to the general medical community, along with a feeling of community pride and allegiance. The nature of the community organization may also influence the individual’s willingness to donate. About half of the blood collection in community centers is carried out by the American Red Cross. The other half of blood collection is performed by freestanding organizations whose mission is the provision of blood services. In contrast, a hospital‐based program is associated with a specific medical center and can take advantage of the image of that center and its physicians, programs, and patients. Although there are no definitive studies, it seems likely that these factors influence the types of donor and their motivation for donating to different organizations. The differences between organizations involved may also affect the setting in which the blood is collected, and thus may indirectly influence the donors or their motivation. For instance, hospital‐based donor programs are more likely to use fixed sites for blood collection. Although community‐based blood centers use some fixed sites, they use mobile sites more extensively than hospital programs.

      Role of incentives

      A variety of incentives, ranging from small trinkets, such as key chains, coffee mugs, or T‐shirts, to tickets to events to cash, have been offered to donors in hopes of motivating them to continue to donate. In almost every study worldwide, paying donors results in donors with a higher likelihood of transmitting disease [32, 36]. Thus, organizations such as the American Association of Blood Banks, the American Red Cross, the International Society for Blood Transfusion, the World Health Organization, and most countries that have a national blood policy stipulate that blood for transfusion be obtained from volunteer donors. The definition of volunteerism in blood donation is whether the incentive is transferable, refundable, or redeemable, or whether a market for it exists [37]. If none of these applies, it is presumed that the incentive could not be converted into cash.

      In some very specific situations, it is possible to pay donors without increasing the risks for transmissible disease [38, 39], although this is not recommended. Blood testing for cholesterol, prostate‐specific antigen, or blood “credits” may be an incentive for many donors [40, 41], and incentives help to attract first‐time and younger donors. Some blood banks have used a blood “credit” system in which nondonors are charged a higher fee for the blood as an incentive to replace blood used. This practice is no longer used in the United States, but in many countries with an inadequate blood supply, versions of this practice are used [42]. A plurality of strategies that would include various incentives has been proposed [43].

      There has been some evolution here in the past few years, as blood shortages have become more commonplace and the overall recruitment of donors has become more complicated and costly. Discussions have begun to consider paid donors again, particularly platelet donors.

3.4 Whole blood donor recruitment strategies

It is generally believed that the most effective way to get someone to donate blood is to ask directly and personally [4, 7, 44]. For instance, in one study comparing two recruitment techniques, the direct “foot in the door” approach was found to be superior to a general request to participate in a donor program [45]. When people were asked their reasons for not donating, the most common response was “no one ever asked” [7]. The wide variety of settings in which blood is collected may also affect an individual’s willingness to donate. Different motivations may apply to donation in different settings, or the setting may influence an individual’s willingness to donate. However, for either the fixed or the mobile site, substantial efforts are made to specifically ask the individual to donate and, if possible, schedule the donation. This request may be made by paid staff of the donor organization or by volunteers. It is not clear whether either type of individual is more effective. Many blood centers with large donor programs have implemented computerized calling systems that integrate the donor files with the donor’s history along with automated dialing systems to maximize the efficiency of the telephoning process.

      Usually

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