Understanding, predicting and influencing blood donation: an introduction to the special issue on donor behaviour

Our understanding of blood donors and donation behaviour has grown markedly over the years and is now of considerable interest to researchers, policy makers and blood collection agencies (BCAs). Long considered an exemplar altruistic behaviour, people around the world donate blood and blood products to save the lives of others, usually strangers, and typically without reward or recognition. Until an effective and cost-effective synthetic substitute for blood is available, patients will continue to be dependent on these life-saving donations. An understanding of why people donate blood and how to intervene to increase donation rates is critical to ensure a sufficient supply of blood and blood products. These research insights can inform BCAs in their efforts to recruit particular types of donors, for example those with rare blood types or those most likely to be able to donate without experiencing an adverse event. Blood collection agencies have recognized the importance of maintaining a panel of repeat donors to ensure a stable supply of blood, and researchers have responded by conducting studies to understand and predict repeat donation and testing approaches to keep donors engaged and returning to donate regularly. This is not a static field, with BCAs facing new challenges and opportunities over time. To illustrate, medical advances and changes in patient blood management have resulted in many BCAs reducing whole blood collections and increasing their apheresis collection targets; findings from research on the facilitators and barriers to donation of plasma have underpinned the development of some apheresis programmes. And the current pandemic presents a significant challenge to blood supply worldwide; knowledge of factors related to blood donation during this period of crisis can assist BCAs to respond effectively to maintain supply over the short and longer term and assist them to prepare for future crises. The International Society of Blood Transfusion (ISBT) has long recognized the critical importance of blood donors in the blood supply chain and the need to continually advance knowledge of the selection, assessment and retention of donors. This is demonstrated in the activities of the ISBT Donors and Donation Working Party, and in the dedicated Donors and Donation streams that are routinely scheduled in ISBT international congresses. Special issues on donor-related topics have previously been published in ISBT Science Series [1] and Vox Sanguinis [2]. Reflecting the growth in the field and continued advancements made by researchers, ISBT Science Series has dedicated the current issue to blood donation behaviour. This special issue shows the breadth of research on donor behaviour currently being conducted. We selected articles from across the globe, including from Asia (Japan and India), Europe (Germany and the Netherlands), North America (Quebec, Canada), Australia and Africa (South Africa). The ten articles in the special issue aim to understand and predict who donates blood versus those who do not, as well as which donors choose to return to donate again, and also aim to influence blood donation behaviour. Reflecting the increasingly need for segmented and targeted approaches to donor management, and an understanding that a one-size-fits-all approach is insufficient, the participants in the studies reported in this special issue are heterogeneous, including non-donors (or potential donors), whole blood donors, plasma donors, firsttime donors, younger donors, older donors, ethnic minority donors, deferred donors and family/replacement donors. And, as a result of the interest in blood donation from researchers with diverse backgrounds, either working within BCAs or in academic settings, they have applied a range of different methodologies. Qualitative and quantitative studies are included in this special issue, including analyses of routinely collected data (using statistical and machine-learning approaches), surveys (crosssectional and longitudinal), focus groups, individual interviews, laboratory experiments and intervention trials. These studies are introduced below, grouped by whether the aim is to understand, predict or influence blood donation.