International Journal of Social Inquiry  
Volume 4 Number 1 2011 pp. 45-63 
 
 
Blood Donation and Community: Exploring the 
Influence of Social Capital* 
André Smith1 , Ralph Matthews2, Jay Fiddler2 
ABSTRACT  
 
Previous social research on blood donation has found that altruistic 
personality traits are associated with a higher likelihood of donation. 
However, such research does not adequately explain why campaigns 
appealing to altruism have had limited success in significantly increasing 
blood donation rates. Using the concept of social capital, this study 
conceptualizes blood donation as a social phenomenon that is embedded in 
the context of community. It reports on the activities of Canada’s national 
blood donation agency in two cities with substantially above-average rates of 
blood donation. Data were gathered through in-depth interviews with staff 
and selected donors and non-donors in each city and from ethnographic 
observation of blood collection and donor recruitment activities.  These 
activities eschewed conventional appeals to altruism, instead emphasizing 
how individuals could meaningfully enhance their profiles in their 
community and workplace through blood donation. This study offers 
valuable insights into the influence of social capital on blood donation.  
 
                                                     
* Acknowledgements: This study was supported by a grant from the Bayer Canada-Canadian Blood 
Services-Héma Québec, Canadian Institutes for Health Research Partnership Fund. The researchers are 
grateful to the Canadian Blood Services (BC-Yukon division) for their generous and ongoing support of this 
project and to the University of British Columbia’s Centre for Blood Research for their assistance. The 
authors wish to acknowledge the following members of the research team: Anne Tomlinson, Balwinder 
Chokaria, Magdalena Kazubowski-Houston, Jamie Maskill, and Joan Braun. We also acknowledge Sonia 
Elliott, Department of Sociology, University of Victoria, for her assistance in reviewing the research 
literature and policy documents.  
 
1  University of Victoria.  
2 University of British Columbia. 
Keywords: blood donation, social capital, community, donor recruitment 
 
INTRODUCTION 
Each year, Canadian Blood Services (CBS), the agency that manages Canada’s 
blood system, supplies transfusions of whole blood and blood products for a 
wide range of critical medical conditions, including massive blood loss from 
trauma injuries and blood replacement needed in cancer treatment, surgery, 
and organ transplants (Canadian Blood Services, 2011). CBS operates 40 
permanent collection sites and over 20,000 donor clinics annually, and 
oversees the safety of the blood supply and recruits blood donors (Saberton, 
Páez, Newbold, and Heddle, 2009). Despite extensive promotion to encourage 
blood donation, however, the donating population has remained consistently 
low at approximately 3% to 4% of the total Canadian population (Godin et al., 
20005). These low rates of blood donation will likely result in future blood 
shortages as the demand for blood increases due to an aging population, the 
emergence of new medical and surgical procedures requiring blood 
transfusions, and further deferrals of individuals who pose a contamination 
risk to the blood supply (Saberton et al., 2009). While this study focuses on the 
Canadian situation, blood donation programs across industrialized countries 
face similar challenges in recruiting blood donors and maintaining their blood 
supplies (see Davey, 2004; McKeever,Sweeny, & Staines, 2006; Murphy et al., 
2004; Zou et al. 2008). These challenges make urgent the exploration of factors 
affecting blood donation in order to identify effective strategies for increasing 
the donor base and fulfilling future blood needs.  
 
This study examines the blood collection and recruitment activities of CBS in 
two cities with above-average rates of blood donation compared to other cities 
in the same Canadian province. We examine these activities in the context of 
donors’ and non-donors’ community affiliations and theorize blood donation 
as being primarily influenced by the processes of social capital formation. Our 
argument is that individuals engage in blood donation less for intrinsic 
altruistic reasons than because their social networks and communities value 
and reward this activity.   
 
Two broad objectives guide this study. First, we seek to identify the social 
capital processes that influence individuals’ decisions to donate blood and 
how these differ from the processes that lead others not to donate. We argue 
 46 
that blood donation is the contingent outcome of diverse relationships that 
can be mobilized by donor appeals. Second, we examine CBS’s local strategies 
for recruiting donors and diversifying their donation base. While CBS 
conventionally relies on personal appeals to altruism to encourage individuals 
to donate (e.g. “Blood, it’s in you to give!”; “Give the gift of life!”), we report 
on unique strategies used by CBS staff in our sample cities and document how 
these strategies effectively tie donation to meaningful aspects of donors’ 
workplace and community. 
 
In the following section, we provide an overview of the Canadian blood 
system in order to contextualize our study historically and structurally. We 
also discuss the tainted blood scandal, an important context for the 
restructuring of the Canadian blood system into its current state.   
 
The Canadian Blood System  
Canada’s blood system traces its roots back to a partnership between the 
Canadian Red Cross (CRC) and Connaught Laboratories, a company that in 
the 1940s developed a process for manufacturing freeze-dried human serum 
for use on WWII battlefields (Picard, 1998). The CRC became involved by 
supplying Connaught with blood collected from volunteer donors. At the end 
of the war, the CRC began expanding its donor program to supply blood to 
hospitals across the country. In 1973, it received a formal mandate and 
funding from the federal and provincial governments to operate Canada’s 
blood system (Krever, 1997, pp. 43-46).   
 
By the 1980s, the CRC was operating 17 blood centres and a large number of 
mobile clinics supporting blood drives in rural areas, community centres, 
churches, schools, legion halls, and factories. The CRC managed blood 
donation under two services (Krever, 1997, p. 210): Transfusion Services 
oversaw all activities pertaining to donor screening and the collection, testing, 
storage, and distribution of blood and blood products; Donor Recruitment 
Services managed donor recruitment, including advertising blood drives, 
greeting and registering donors, and monitoring donors post-donation. Under 
this organizational structure, the CRC collected sufficient blood from diverse 
donor bases across Canada to readily met the blood needs of Canadians 
(Krever, 1997).   
 47 
This situation changed drastically in the early 1980s, when blood supplies in 
Canada and around the world were contaminated with the Human 
Immunodeficiency Virus (HIV). The CRC’s initial response to this threat was 
timid: the CRC failed to implement measures to exclude individuals 
belonging to groups known to be at higher risk for HIV from donating blood. 
Instead, it asked donors to voluntarily refrain from donating blood if they 
believed their blood might present a risk to the blood supply (Krever, 1997, p. 
286). Because many donors did not know they had been infected with HIV, 
however, they unintentionally donated contaminated blood. It was not until 
1989 that the CRC began actively screening for HIV-related risk factors (e.g. 
asking donors if they had had sex with another man) and implementing tests 
of donated blood for the virus (Weinberg et al., 2002). By the early 1990s, an 
estimated 2,000 Canadians had become infected with HIV through 
contaminated blood transfusions (Picard, 1998). These events primarily 
affected individuals suffering from hemophilia because of their reliance on 
blood products: nearly half the population of Canadian hemophiliacs 
acquired HIV/AIDS from tainted transfusions before the CRC began 
screening and testing blood. This crisis diminished the public’s confidence in 
the Canadian blood system and resulted in a dramatic decrease in rates of 
blood donation (Gilmore and Sommerville, 1999). 
 
To investigate this crisis, the Canadian Federal Government appointed Justice 
Horace Krever to head the Commission of Inquiry on the Blood System in 
Canada (the Krever Inquiry). Between 1992 and 1996, the Krever Inquiry 
heard from 427 witnesses and produced 50,000 pages of testimony. Justice 
Krever (1997) concluded that “the Red Cross did not carry out risk-reduction 
measures assiduously” and deemed the measures taken “ineffective and half-
hearted” (293-294). He argued that if regulatory officials had acted according 
to their mandate, many hemophiliacs would have avoided HIV infection. On 
26 November 1997, Krever tabled a report in the House of Commons that 
contained 50 recommendations for overhauling the collection, processing, and 
management of blood in Canada. Krever (1997) insisted that the principle of 
safety should transcend all other principles and urged the implementation of 
the precautionary principle as a first line of defense against possible threats to 
the blood supply (1049).  
 
In 1998, the federal, provincial, and territorial governments of Canada 
replaced the CRC with two new organizations to oversee the blood system: 
Canadian Blood Services (CBS) and Héma-Québec (HQ). CBS was established 
 48 
in 1998 following a Memorandum of Understanding (MOU), whereas HQ was 
created to oversee collecting, processing, and distributing transfusion-ready 
blood and blood products in the province of Québec. Both agencies are 
nevertheless regulated by Health Canada and follow the same standards. 
Heeding Justice Krever’s recommendation, these agencies have sought to 
restore public confidence in the Canadian blood system and to increase 
donation rates, which remained low in the wake of this health crisis.  
 
As was the case with the CRC, CBS and HQ only collect blood from volunteer 
donors. The belief is that such donors are inherently safer than paid donors, 
who might have “a financial motive for giving blood even if they were not 
healthy enough to do so” (Krever, 1997, p. 211).   
 
This policy of voluntary blood donation has roots in the work of sociologist 
Richard Titmuss (1972), who argued that “a competitive, materialistic, 
acquisitive society based on hierarchies of power and privilege ignores at its 
peril the life-giving impulse towards altruism” (7).  In a landmark study, 
Titmuss compared the commercial blood system in the US with the voluntary 
system in England. He demonstrated that a blood system based on 
voluntarism was less likely to lead donors to misrepresent their health status 
at the time of donation. He also saw voluntary blood donation as an example 
of “the relationship of giving between human beings in its purest form, 
because people will give without expectations that they will necessarily be 
given to in return” (ibid, 8).  For Titmuss, voluntary donation systems 
encouraged people to care for one another, thereby strengthening community 
bonds and, ultimately, contributing to a safer and more efficient blood supply.   
 
Blood donation and social capital  
In this section, we propose a model of blood donation in which the processes 
of social capital play a central role in the decision to donate or not to donate 
blood. This model contrasts with the currently dominant psychosocial 
explanations for blood donation, which postulate intrinsic altruism as the 
primary reason for individuals’ blood donation (see Oswalt, 1977; Lightman, 
1981; Piliavin and Callero, 1991). Much research on donation and altruism 
aims to identify indicators for predicting patterns of repeat donation among 
the donor population. The most influential research in this regard comes from 
Piliavin (1987, 1990) and Piliavin and Callero (1991) who document an 
“altruistic identity” among repeat blood donors. 
 
 49 
If altruism constituted such a strong explanation, however, blood donation 
rates would not vary according to social factors such as ethnicity, gender, 
education, income, occupation, religion, and age (see Shaz et al., 2009; 
Crawford et al., 2008). Altruism also fails to explain why the majority of the 
population does not donate blood or why donor recruitment campaigns based 
on appeals to intrinsic altruism are generally ineffective in significantly 
increasing blood donation rates. Indeed, Healy (2000, 2006) criticizes the 
concept of altruism, arguing that it reifies blood donors as a special class of 
morally superior people. He doubts the conceptual value of altruism in 
explaining donation because the personality traits of repeat donors are also 
commonly found in the non-donor population (Healy, 2000).  
 
Our model rests on the premise that processes of social capital formation exert 
a primary influence on blood donation. Social capital forms in social networks 
when individuals with close social ties engage in behaviour that reaffirms and 
supports valued social relationships and the communities in which these 
relationships are formed (Granovetter, 1973; Putnam, 1995). This model thus 
situates the actions of blood donors and non-donors in the context of their 
social relationships (or “social networks”). Social networks constitute a 
primary source of social capital because network members provide a wide 
range of social support activities for one another (Lin, 2001; Wellman and 
Frank, 2001). These networks also foster patterns of trust and reciprocity 
among members--in that sense, social capital has both an individual and a 
collective aspect (Putnam, 2000: 19-20).   
 
Grounding our analysis in processes of social capital formation, we argue that 
people are more likely to donate blood when they are embedded in trusted 
social networks that value blood donation. The decision to donate blood is 
therefore motivated less by intrinsic altruism and more by donors’ desire to 
act according to network norms and to maintain or enhance their status 
within these networks. Of course, networks can operate in ways that 
discourage individuals from donating blood if they do not support the value 
of donating blood. We propose, however, that blood agencies can seize 
advantage of these social capital formation processes to increase donation 
rates and to diversify their donor bases.   
 
Our approach is inspired by Healy’s (2000) work, which compares the donor 
recruitment practices of state-run systems and those of Red Cross blood 
systems in the European Union. Healy found that state-run systems tend to 
 50 
attract donor bases that represent the overall social composition of their 
countries, whereas Red Cross systems primarily attract donors with strong 
religious and community-service values. For Healy, these differences suggest 
how blood donation agencies influence the social processes of donation by 
representing the value of donation to their donor bases. He argues that the act 
of donating blood is not inherently altruistic; rather, donors come to think of 
their donation as an altruistic act because most blood agencies extensively 
promote this attribute in donor recruitment campaigns. The act of donating 
blood is thus “structured, promoted, and made logistically possible by 
organizations and institutions with a strong interest in producing it” (Healy, 
2004, p. 387). 
 
In a similar vein, Alessandrini (2007) significantly found that Australian blood 
donors tended to volunteer frequently and articulated a strong awareness of 
their influence as community members. Alessandrini posits blood donation as 
an aspect of identity construction whereby donors enhance their identity as 
full-fledged citizens “through participation in volunteering activities that 
provide rewards in and of themselves and also serve to further embed them in 
society through community involvement” (315).  Alessandrini’s study thus 
suggests that blood donation may be prompted more by a desire to reaffirm 
one’s affiliation to community than by the presence of a uniquely altruistic 
personality.  
 
In light of Healy’s and Alessandrini’s research, we propose that a social 
capital perspective on blood donation helps explain not only why some 
individuals choose to donate but also why most individuals choose not to 
donate blood, even in the face of urgent appeals by blood donation agencies. 
Such an explanation is important because any increases in donation rates will 
necessarily come from individuals who are eligible to donate but are currently 
reluctant or unwilling to do so. Existing research reports belief in medical 
ineligibility, apathy, inconvenience, general fear, and specific fear of HIV as 
reasons for non-donation (Oswalt 1977, 1977; Leibrecht et al., 1976; LoBello, 
1990; Piliavin, 1990). However, other evidence casts doubt on the validity of 
these reasons, which people give when asked about why they do not donate 
blood. For example, one poll indicates that 87% of Canadians believe that not 
enough blood is donated, 77% find the blood system safer now than five years 
ago, and 90% believe the process of donating blood to be safe (Ipsos-Reid, 
2001). If so many Canadians think blood donation is crucial, undersubscribed, 
and safe, then why do only 3% of them donate blood? To treat non-donors’ 
 51 
reasons for non-donation as expressions of some objective reality ignores the 
longstanding sociological literature dealing with vocabularies of motives 
(Mills, 1963; Stryker, 1980) and the way in which socially acceptable 
“accounts” (Scott and Lyman, 1968) are provided as reflections of acceptable 
social norms, rather than as inherent causal contingencies. These reasons 
should therefore be considered a “mask” (Strauss, 1959) for more deeply held 
views that donors are reluctant to express for fear of disapproval in their 
social network.  
 
In summary, although intrinsic altruism may play a role in the motivation to 
donate blood, we argue that social context likely exerts a stronger influence in 
this disposition. We therefore explore the formative role of the processes of 
social capital formation in blood donation, focusing on how social context 
operates to make the decision to donate blood more likely and how these 
processes differ from the ones involved in the decision not to donate blood. 
We also examine how CBS uses these processes in its efforts to recruit donors. 
Following Healy’s suggestion that collection regimes produce different donor 
populations, we seek to better understand how donor recruitment practices at 
the CBS constitute “incentives” to donation (Healy, 2000, 1634).    
Methodology  
 
This study constitutes part of a larger research project comparing blood 
collection and donor recruitment among 5 cities with substantial differences in 
blood donation rates. In this paper, we focus on the activities of two donor 
clinics (A and B) operating in two cities surrounded by large, dispersed 
catchment areas. Both clinics operate out of permanent sites but also run 
mobile clinics to serve their catchment areas. We selected these clinics for our 
current investigation because the two cities in which they operate consistently 
report blood donation rates that are 70% higher than those of the other cities 
in our sample. Investigating these clinics allowed us to identify how CBS 
personnel operated to take advantage of, and even create, situations that 
increase blood donation in their communities and how they overcame barriers 
that impede blood donation.  
 
Data collection involved field observation of donor recruitment and blood 
collection activities, as well as in-depth interviews with CBS staff and selected 
donors and non-donors. We observed a range of donor recruitment activities 
in businesses and in not-for-profit and public sector organizations. We 
 52 
observed blood collection activities at the clinics over two periods of 3-days 
each. We conducted 16 in-depth interviews with CBS employees (nurses, 
management personnel, community recruitment staff, and volunteers). We 
also completed interviews with 28 donors and 11 non-donors across both 
cities. We asked these participants about their motivation to donate blood or 
about their reasons for not donating blood.  
 
All interviews were audio recorded and transcribed verbatim. The transcripts 
were line-numbered and coded using the principles of thematic analysis 
(Spencer, Ritchie & O’Connor, 2003). The transcripts were scrutinized for 
recurrent and salient themes, which were then clustered into increasingly 
refined analytical categories on the basis of shared meaning. These categories 
inform our account of participants’ views about blood donation. More 
profoundly, these categories also capture how blood donation and 
recruitment activities are related to the processes of social capital formation in 
our sample. We illustrate these analytic categories with representative 
quotations from interviews with participants.   
 
Findings  
 
In this section, we describe how blood collection and donor recruitment 
activities at the clinics contributed to the embedding of blood donation as a 
valued social activity in the two cities where we conducted our research. We 
demonstrate how collection and recruitment activities relate blood donation to 
meaningful aspects of donors’ everyday lives as members of these 
communities. In the final section, we discuss donors’ and non-donors’ views 
on blood donation and how they link this activity to both social relations and 
personal understandings of obligation and reciprocity.   
 
Blood donation and workplace culture  
We observed several strategies employed by clinic staff to enhance awareness 
of blood donation in the workplace. Central to these strategies was the role of 
the Community Development Coordinator (CDC) at each clinic. The role of 
the CDC is to act as “ambassador” of blood donation in the communities 
served by blood clinics. The CDCs in our sample implemented a donor 
recruitment program that encouraged employees in businesses and not-for-
profit and public sector organizations to donate as a group. They regularly 
visited these organizations to promote awareness of blood donation and to 
cultivate local cultures of donation. This cultivation involved identifying 
 53 
individuals in these organizations with a history of blood donation and 
prompting them to encourage co-workers to donate at least once (and 
preferably on a regular basis).  
 
The CDCs also created a reward system to foster competitions among 
organizations: organizations whose employees donated the most blood would 
be publicly recognized in a newsletter and with a plaque. These organizations 
would also be acknowledged in the local community newspaper. This 
competition benefited the winning organizations by giving them welcomed 
publicity, by instilling pride in their employees, and by contributing to 
increased staff morale. This comment from a donor at Clinic B illustrates this 
point: 
 I think it’s a good opportunity because of corporate image. Especially 
for us, but for any corporation, I don’t think anyone can negatively 
put a spin on it no matter what they do. So I would hope it would 
spread to other communities. I’m not quite sure how it could spread 
but I would say any corporation, if they’re looking for some solid 
corporate citizen-type stuff, it’s a really great opportunity. 
Other donors we interviewed in these organizations spoke of how competing 
for blood donation created peer pressure on employees to consider donating 
blood. The following comment from a first-time donor working in an 
autoshop suggests that this type of peer pressure is more effective in 
organizations with a high level of social cohesion among employees:  
We have a lot of barbeques and we’re a pretty close-knit sort of bunch 
of guys. It’s an unusual setting really because there isn’t any other 
place in the shop that’s like that. It’s just the body shop it’s very uh 
very uh close. You know they want to get things done right ’n they 
see their buddies giving blood so they think oh okay well maybe I’ll 
do it then. 
 
According to the CDCs, this reward program was very successful in 
generating a large number of first-time donors, many of whom became repeat 
donors. Our findings corroborate this assessment: we found that slightly over 
50% of donors we interviewed cited the program as an important reason for 
donating blood.  
 
This donor recruitment program illustrates how the social networks in which 
individuals are embedded can influence blood donation behaviour. The 
program successfully tapped into the processes of social capital formation in 
 54 
the workplace to recruit new donors and to encourage continuous blood 
donation. More specifically, the valued social relationships in these networks 
influenced patterns of blood donation by linking donation to dynamics of 
obligation and reciprocity within the workplace. The program created a 
culture of donation in these organizations whereby employees who had not 
previously considered donating blood felt a certain level of obligation to do so 
in order to maintain their status in a social network that they valued. The 
motivation to donate blood in these cases therefore emerges less from intrinsic 
altruism and more from a desire to act in ways congruent with the values of 
the workplace as a donating site. In this way, social capital exerts a normative 
influence on individuals who are non-donors but become donors as a result of 
their investment in trusted networks of peers. Creating a blood donation 
culture in the workplace thus constitutes an effective tool for increasing blood 
donor rates and meeting blood needs.  
 
Blood donation in the context of community  
Another prominent role of the CDCs was to increase awareness of blood 
donation in the community. For this purpose, they participated in 
commemorative parades and fundraising events on behalf of the blood clinic. 
Clinic A’s CDC described the importance of these activities as follows:  
Volunteering in your community is very, very important. 
We have to look like we’re giving back to the community 
and stop asking: “Come on, come on, give blood, come, 
come, come.” If you network yourself and say, you know 
what, those Canadian Blood Services people were at our 
run for Joe Schmo, then they’re more willing to roll up 
their sleeves. So community involvement is very, very 
important. 
 
Other clinic staff also promoted blood donation within the community, albeit 
in less formal ways. Nearly all of them lived in the catchment area of the 
blood clinic and often reminded people about donating blood whenever they 
were out running errands or shopping. One nurse spoke about how she and 
several of her co-workers who had purchased new cars at a dealership lobbied 
the owner and his employees to donate blood in appreciation of the clinic 
staff’s patronage. These informal donor recruitment efforts proved effective 
primarily because clinic staff had been imbedded as respected members of 
various social networks in their community (e.g. churches, volunteer 
organizations, little league clubs). As one clinic nurse explains:  
 55 
 Well again we’re in a unique position, because we are all 
from this community, have all been here for years and we 
all have connections to the community as does our 
community development coordinator. And so that brings 
local knowledge and connection to the people that walk in 
the door.  
This quotation demonstrates how CBS staff effectively mobilized their own 
social networks to increase blood donation.  
 
Clinic staff also took various initiatives to make their clinic a meaningful 
“community destination” for donors. One initiative involved relocating Clinic 
A to a small strip mall in the core of the city’s shopping district. Staff selected 
this location to increase the clinic’s visibility in the community but also to 
make it more convenient for donors to drop in before heading off to do their 
shopping. The intention was to normalize blood donation as a routine activity 
(like shopping) and dispel the sense of the blood donation procedure as 
medical, painful, and time consuming--all common barriers cited by non-
donors. Another initiative was to hold regular art exhibitions of local artists 
known in the community. These exhibitions often became the focal point of 
animated discussions between staff and donors, discussions that made the 
process of donating blood both pleasant and social.  
 
In addition, clinic staff implemented several strategies to increase the “fun-
factor” of donation. For example, they greeted donors by name and made an 
effort to engage them in friendly banter during the donation process. As one 
clinic nurse remarked:  
I think a lot of us make the rewards come out of the contact 
with the donors. That’s the part where we remember 
people’s names, we remember their birthdays, you know, 
have a chat with them when they come in, so they’re … 
they’re almost like family members when they come back.  
One donor at Clinic B also identified the positive atmosphere at the clinic as a 
factor that encouraged him to donate blood:  
The people there are always friendly, always really quite pleasant 
environment to be in, as long as you don’t mind needles. But you 
know, setting aside that one small thing, you know…they’re all very 
caring. So yeah I’m quite…pleased and impressed and general 
speaking with the set up.  
 56 
Overall, staff in both clinics sought to imbue their clinic with a feeling of and 
support for community. This community atmosphere contrasts with the more 
medicalized atmosphere we found in the other (less successful) clinics in our 
sample. Staff members expressed pride in these initiatives and felt they 
greatly contributed to the clinic’s success in attracting repeat donors. As one 
staff member noted, “We get regular people and I believe personally that a lot 
of the people who come back to our clinic come back because of us.”  
 
Civic reciprocity and repeat blood donation 
First-time donors in our sample spoke primarily of the role of workplace 
dynamics in motivating them to donate blood. We also interviewed long-term 
repeat donors. These donors had been donating blood on a regular basis for 
several years and played an important role in motivating their co-workers to 
donate for the first time. Only 5 repeat donors we interviewed singled out 
intrinsic altruism as the primary reason for donating blood. They used terms 
such as “the gift of life” and “doing the right thing.” For example, one donor 
said: “I guess it’s the proper thing to do, who knows sort of like karma, one 
day I might need and I’d appreciate if somebody donated then so why don’t I 
donate now and if I never need it so much the better.” 
 
Other repeat donors used a different vocabulary of motivation: they spoke of 
donating blood as a way to reciprocate for the benefits they enjoyed by 
belonging to a community that they greatly valued. As one long-term donor 
put it:  
It’s all about community. This is how I choose to give back 
to the community. You can choose to do whatever you want 
to do, but this is how I choose to give back to the 
community, and if you want to join with me and give back 
to the community this way, well hey, wonderful, let’s do it 
together. 
 
Other repeat donors expressed this motivation in similar terms, talking about 
donation as a way to match the kindness of fellow citizens in other areas of 
civic live (e.g. coaching little league baseball, volunteering with seniors). 
These comments suggest that civic reciprocity derived from membership in a 
valued community significantly influences long-term blood donation. Our 
analysis of staff interviews lends support to this interpretation, as illustrated 
by this comment from a nurse: 
 57 
I think it comes back to the local connection in the 
community. When donors donate, they don’t really donate 
nationally, they donate locally. They believe this is their 
blood system. 
Although these donors believe their blood is used locally, it is actually sent 
along with the blood of all Canadian donors to a national laboratory where it 
is tested, pooled, processed, and redistributed as transfusion-ready blood and 
blood products. These donors thus inadvertently donate to a much larger 
community than the local one they identify in their comments on blood 
donation.   
 
In addition to civic reciprocity, some long-term donors talked about donating 
out of a sense of religious obligation. The following quotation from a regular 
donor illustrates this finding: “I would say it’s coming down to my faith. As a 
Christian, they teach you that you should do for others things you can do.” 
This statement highlights the role of reciprocity in the context of diverse 
communities, including more narrowly defined communities such as a church 
or faith group.   
 
Several repeat donors also spoke of being influenced in their decision to 
donate blood by friends, family, or a close relative. The following comment 
from a younger donor suggests the nature of this influence:  
I think originally it was as a student and at the time I think 
my brother was donating and he suggested I donate, and 
we went down and got my first donation and then it just 
then it went from there, then it really became a habit. 
Similarly, another repeat donor credits his parents for teaching him the value 
of donating blood as he grew up:  
I think it’s probably it grew up with me. My parents 
always donated blood and my mother still donates blood 
on a regular basis. It’s just a normal thing in my family, I 
don’t know, and if you grow up in a sharing family, a 
family of sharing, it’s automatic. It’s expected of you. 
 
These quotations suggest that family forms another social network that 
influences the process of blood donation. However, this network exerts 
influence differently from other networks (e.g. community, workplace) in that 
the pressure to donate blood begins at a younger age and is likely more 
intense if family members share a strong bond.  
 58 
 
The decision not to donate blood  
We also interviewed 11 participants who did not donate blood. First, 5 non-
donors said they could not donate because they had been deferred from 
donating for health reasons. The other 6 non-donors mentioned several 
reasons for their unwillingness to donate blood that echoed concerns reported 
in previous surveys about blood donation (for example, see Ipsos-Reid, 2001). 
Two non-donors said they did not donate for cultural or religious reasons. 
Three non-donors specifically cited fear of needles and discomfort at the sight 
of blood as reasons for not donating. The following comment is typical in this 
regard: “I don’t want to. Just plain and simple don’t want to.… [I]f they could 
drain it out some other way I probably would, but no, no, I hate needles.” One 
non-donor mentioned having previously donated but no longer doing so 
because of the donor screening process, singling out its length and the kinds 
of questions asked by staff.  These questions single out risk factors for blood 
contamination such as drug use or sexual practices deemed risky. This non-
donor characterized the screening process as invasive and embarrassing. The 
following comment from a nurse makes clear some non-donors’ discomfort 
with aspects of the screening process:  
There was some stuff around homosexuality in the 
questionnaire that annoyed a lot of people and they said, 
on principle, they didn’t want to donate because of it. 
Some people were quite angry. 
 
Interestingly, several first-time and repeat donors mentioned concerns similar 
to those cited by the non-donors. Nearly 40% percent of donors mentioned 
finding the donor screening process annoying or invasive. In particular, these 
donors singled out having to answer the same identification questions despite 
the fact they had been donating repeatedly for several years at the same clinic. 
The following comment is typical:  
It’s not that I’m there once in a blue moon I’m there every 
third month, and every time I’ve been asked, at least 4 
times in that period: “What’s my name?” and “What’s my 
address?” That’s ridiculous. That’s what annoys me. 
Other repeat donors spoke of still “fearing the needle” despite 
having donated blood dozens of time over the years.  
 
Given non-donors’ various reasons for not donating blood, we surmise that 
non-donors could lack the kind of social capital that would allow them to 
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overcome their concerns about blood donation. The following quotation from 
a first-time donor lends some credibility to this hypothesis: 
I worked for the credit union down there as well, and 
blood donation was something that a bunch of people at 
work had already done, so I thought, okay, there’s only 
one way to get over my fear of blood, and that’s just to 
start giving. So that’s what I did. 
Such donors’ embeddedness in social networks, however, may 
enable them to overcome their frustration about the screening 
process or their concern with the needle, whereas non-donors’ lack 
of social capital prompts them to reject the possibility of donation.  
 
Discussion and Conclusion  
Following Healy’s (2000) suggestion that collection regimes produce different 
donor populations, we explored how CBS used the processes of social capital 
formation to recruit donors in two cites with significantly above-average 
blood donation rates. We described how staff in the blood clinics serving these 
cities and their adjoining semi-rural catchment areas engaged in initiatives 
that tied donation to meaningful aspects of donors’ community and culture. 
We also showed how the clinics’ CDCs successfully fostered cultures of blood 
donation in business, not-for-profit, and governmental organizations through 
a program of competitive blood donations. These activities minimized appeals 
to altruism and instead emphasized how individuals could enhance the status 
of their organization, give back to their community, and perform a civic duty. 
We found these activities to provide a plausible explanation for the success of 
the clinic in attracting a large number of first-time donors. We also discussed 
how individuals construct their motives and orientations toward blood 
donation in the context of valued relationships with others and in relation to 
valued membership in their community. Additionally, we found that family 
and religious networks play an important role in motivating individuals to 
donate blood.  
 
Overall, our study demonstrates the important role played by social context in 
the motivation to donate blood. While we acknowledge earlier findings that 
altruism plays a role in donation, our findings suggest that donation is largely 
contingent on community. Recruitment strategies that tie blood donation to 
meaningful aspects of donors’ social networks and community are thus more 
effective than appeals to altruism. Our findings therefore challenge 
psychosocial research that identifies intrinsic altruism as the primary 
 60 
explanation for blood donation. Instead, we find that the processes of social 
capital formation and civic reciprocity more convincingly explain why people 
engage in this vital activity. Our study therefore has important implications 
for blood donation recruitment strategies, whose success might be 
considerably augmented by focusing on social networks and community 
rather than intrinsic altruism. Further studies will help researchers and blood 
agencies to refine our understanding of the complex phenomenon of blood 
donation in the context of social networks and community.   
 
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