Out of the blue, a dear friend finds herself in the hospital. The diagnosis: leukemia. She has a fighting chance of beating it, but she's pretty sick and word goes out: She needs blood donors.
I'm O-positive. So is she. It's been a while since I've done this, I'm ashamed to say, and I don't quite remember the ground rules.
Does my friend literally get my blood? Is there a system of credits, where she's entitled to one pint for every pint that somebody donates in her name? Come to think of it, she's desperately ill. Shouldn't she just get the blood she needs? And, more basically, how should society collect and distribute blood, so that there are fewer shortages?
When I arrive at the hospital, I see signs everywhere. Blood shortage: Please donate. Evidently, there are cases more urgent than my friend's -- trauma and emergency surgery, other medical patients in life or death situations. For my friend, not getting enough transfusions merely makes her feel awful and delays her remission.
So, off I go to the blood bank. It turns out that there's no system of credits. It is possible to enlist as a "dedicated donor," where Iexplicitly give my blood to a particular patient. But the hospital's blood bank really wants me to donate blood in my friend's honor, and then the blood can be used for whoever needs it.
I do some hard thinking. For starters, is it even ethical for individual donors to earmark blood, when the hospital often needs it for even sicker people? I think it is, just barely. After all, none of the people giving blood for my friend would have donated at all, if she hadn't put out the call.
But this immediately leads to a more obvious thought. There should never, ever be shortages of blood for anyone, because we all have a huge spare supply coursing through our veins. All of us should donate blood, as often as possible (about every eight weeks). Then the hospital would not have to make hard rationing decisions.
This leads to a third thought. Today, it is fashionable to claim that the society would work more efficiently if everything were for sale, even including human products like babies and organs whose sale is now off limits. Good idea?
As it happens, blood is one of those human products that is for sale. Until the 1970s, there was a whole separate system of commercial blood banks that bought pints of blood on skid row. Not surprisingly, that blood was much more likely to spread disease than blood given voluntarily. Almost by definition, blood obtained from someone desperate enough to sell it is blood that you probably don't want.
This reality was documented in a classic book called The Gift Relationship, written by Richard Titmuss in 1970. Titmuss compared the American blood-donation system with the British system, where blood could not be sold, but where the society expended effort cultivating the compassionate ethic that everyone should give blood. In this natural experiment, Britain had cleaner blood and fewer shortages. Compassion breeds compassion.
The United States meanwhile, had a dual system. One part, run by hospitals and the Red Cross, promoted volunteer donations. The other part, run by commercial blood banks, bought blood that was more likely to be contaminated by disease. And there wasn't enough blood. Selfishness breeds selfishness.
The government eventually issued regulations requiring that any blood obtained from paid donors had to be labeled as such. That and other measures by the Food and Drug Administration mostly put the skid-row blood banks out of business.
Blood products, like plasma, are still collected from paid donors. These are used to produce clotting factors desperately needed by hemophiliacs, and a spokesman for the FDA explains that if these paid donations were prohibited, there just wouldn't be enough plasma.
But that just shows that we as a society haven't taken Professor Titmuss' paradox to heart. According to the American Association of Blood Banks, only about eight million Americans, about five percent of the people eligible, donate blood regularly. But the last thing we need is a commercial market in blood or organs. What we need is broad education about, and practice of, the value of compassion for strangers.
Moral: Nobody should be so poor that they have to sell their blood. Nobody who needs blood should have to send out urgent personal calls. And everyone should give -- not sell -- blood.
Robert Kuttner is co-editor of the Prospect.
A version of this column originally appeared in Wednesday's Boston Globe.
