Giving from the heart: Simple and complex blood and plasma ethics

Background: Blood and plasma (b&p) are crucial but scarce resources for medical therapies. Collecting b&p poses technical and ethical challenges, as can be observed when it comes to regulation.

Objective: To provide ethical orientation for organizing and regulating the donation and collection of b&p.

Method: Analysis of ethical theories in regard to their potentials to reach the objective.

Results: The ongoing ethical debate between paid vs. unpaid b&p donation is shaped by a ‘simple b&p ethics’ approach that focuses on the individual donor and the existence or non-existence of one motivation: altruism. Utilitarian and deontological ethics come to different conclusions but basically apply the same simple approach. In contrast, forms of ‘complex b&p ethics’ acknowledge the ambiguity of altruism, try to find a common framework for the plurality of motives to give b&p (contractualism), or point out that giving b&p is part of a good life (virtue ethics). Complex b&p ethics furthermore widens the perspective from the individual donor to the collecting organization and the donation/collection regime and critically assesses them.

Conclusion: Neither ‘gift fetishism’ nor total commodification seem to be ethically sound ways of enabling people to live good lives. Those engaged in b&p collection will be well advised to acknowledge the complex plurality of motives while simultaneously upholding the caring nature of b&p donation, collection, and distribution.