C O M M E N T A R Y : D O N O R R E C R U I T M E N T A N D M O T I V A T I O N

Giving the donor his (or her) due

John Armitage

This special themed issue of TRANSFUSION hasa focus on donor recruitment and motivation,the sine qua non of blood banking and transfu-sion medicine. Without the people who gener-

ously provide collectors with blood, little to none ofthe downstream work on phlebotomy practices, hema-pheresis, component manufacturing, storage conditions,infectious disease screening, immunohematology, qualitymanagement, blood management, transfusion complica-tions, and a host of other subjects that consume ourindustry’s time, attention, and treasure would be possible.Of course, without these giving souls, this particularjournal would disappear or at least be reimagined as apublication devoted to hematopoietic transplantation,cellular engineering, and regenerative medicine.

While the essential role of the donor may seem anobvious truth about our profession, it is far from apparentjudging from the way we in the United States deploy ourintellectual, operational, and financial resources. Forexample, the AABB discontinued the donor recruitmenttrack within its Annual Meeting several years ago, andconsequently our premier industry gathering has onlylimited substantive interchange in this arena, apart fromsales pitches made in the exhibition space. At regionalconferences and general trade meetings the story is notmuch different. The recruitment, communications, andpublic relations content is typically minimal and atten-dance by subject matter experts is sparse. The leaders onwhom we rely to maintain adequate blood flow to millionsof patients meet across organizational boundaries atevents organized by the Association of Donor RecruitmentProfessionals and, to a lesser degree, America’s BloodCenters or individual vendors. By and large, they convene

on their own, with few physicians, scientists, technolo-gists, nurses, administrators, or colleagues from other dis-ciplines making the collaborative effort to attend, interact,contribute, and learn.

Since 2009, the declining demand for blood has alsoserved to reinforce this inattention to donor recruitmentand retention. At least in the United States, this usage drophas largely been the result of changes in health careaccess, treatment delivery, blood conservation, and hos-pital cost cutting (typically under a rubric of patient bloodmanagement). Newly faced with excess production capac-ity, most blood collectors have had little impetus towrestle with long-term supply problems that only recentlyseemed so pressing. This retreat is unfortunate becausethe chronic problems in the field remain unsolved. Rela-tive O– RBC deficits, seasonal shortfalls, minority donordisengagement, overreliance on high school drives, andaging out of the “greatest generation” of apheresis donorsare but a few of the difficulties that persist, even in thistime of plenty. Long-term supply-and-demand projec-tions suggest that these problems will rebound and inten-sify. For context, contemplate the self-actualizing babyboomers reaching their prime years of blood consump-tion while insisting upon the same escalating treatmentintensity and expanding therapeutic options their geriat-ric forbearers enjoyed for over a century.

If we are neglectful of our recruiter colleagues andtheir agendas, our outlook with donors, blood drive coor-dinators, and sponsors is even more dismissive. Thesefolks may make cameo appearances as award winners or,rarely, as seminar presenters when we, the paid cadre,gather for conferences, webinars, FDA workshops, and thelike. In the American setting, we leave the long-term cul-tivation of this invaluable resource to the individual bloodcollectors and their disparate web sites, blast e-mails,newsletters, social media, and mass mailings. There is pre-cious little unified print or electronic communication toinvolve these constituents on an ongoing basis in the sig-nificant national issues affecting their charity of choice.

What if we educated these good folks about the criti-cal innovation gap our country is experiencing in patho-gen reduction? Could we explain to them how lack offinancial resources prevents meaningful implementationof hemovigilance, adequate staffing of medical technolo-gists (let alone specialists in blood bank technology),

From the Oklahoma Blood Institute (WBBB), Oklahoma City,

Oklahoma.

Address reprint requests to: John Armitage, Oklahoma

Blood Institute (WBBB), 1001 North Lincoln Boulevard,

Oklahoma City, OK 73104; e-mail: jarmitage@obi.org.

Received for publication December 11, 2013; accepted

December 11, 2013.

doi: 10.1111/trf.12560

© 2014 AABB

TRANSFUSION 2014;54:750-752.

750 TRANSFUSION Volume 54, March 2014

timely development of blood establishment computersystem capabilities, and so forth. Considering that thisaudience numbers in the tens of millions stateside andhundreds of millions globally (if one counts lapseddonors), it surely would wield influence on public policy ifawakened to threats affecting its chosen altruistic outlet.Dauntingly, though, to embrace this opportunity, theleaders in our field must envision themselves at the headof a broad-based, people-oriented mass movement,rather than as captains of a modest, nonprofit pharma-ceutical and medicoscientific enterprise.

Happily, given these many background impediments,the editors of TRANSFUSION have made a concertedeffort to broaden the coverage of donor recruitment andmotivation. In 2013 they published more than a dozenarticles on this subject. Social scientists, marketers,system engineers, and others from outside the traditionalconfines of blood banking have joined the effort to betterdescribe and analyze our efforts to enlist and retain bloodgivers. This widening interest makes sense given thetreasure trove of readily available, quantifiable informa-tion compiled on donation behaviors due to our rigorousrecordkeeping requirements. Using enormous nationalparticipant pools, investigators can explore a widevariety of demographic, geographic, experiential attri-butes that have bearing on a distinctive, well-demarcatedactivity.

Readers of this themed issue get to sample severalimpressive new contributions to the literature. Several ofthese address direct recruitment tactics. Van Dongen andcolleagues1 use a questionnaire to investigate the factorsaffecting the return rates of Dutch whole blood donorsduring the second year after their initial collections. Whilethe negative and positive predictors vary for the subsetsthat gave once, twice, or more than twice, across all threecohorts the self-perceived difficulty in executing priorplans to donate correlates negatively with the likelihood ofmaking additional donation visits. Bagot and coworkers2

provide insights into the successful conversion of Austra-lian donors from whole blood to plasmapheresis collec-tions. Donor-initiated and donor-focused conversationsheld in person between collection staff and less habitu-ated donors yielded the best outcomes. Asenso-Mensahand his team3 offer the results from Ghana of a survey ofunpaid donors who, in the role of family members andfriends, had given at the request of a patient or his medicalteam. The authors conclude that, based on their similarsafety profile to first-time, volunteer donors and their will-ingness to donate again, this group should be activelyrecruited as means to avoid both acute shortages and theneed to pay donors.

Other articles add indirectly to understanding thetask of sourcing blood from the public. France and herco-authors4 statistically define a brief set of questions tomeasure the three common constructs (attitudes, subjec-

tive norms, and perceived behavioral control), whichdrive the intention to donate, as modeled using the theoryof planned behavior. This US-originated work can serveresearchers as a basis for standardizing future psychomet-ric evaluations of donor motivation. Wevers and her col-laborators5 construct an expanded assessment tool for anindividual’s motivation that adds variables of self-identity(the sense of being a donor) and organizational variables(select customer satisfaction drivers) to better establishedmeasures derived from the theory of planned behavior.For the Dutch study population, a subjective pressureto donate, albeit poorly characterized and unlinked tospecific recruitment behaviors, negatively impactedthe return donation tendency for both occasional andmultigallon givers.

While these new articles are insightful and thought-provoking, they are at risk of being underutilized unlessconscious efforts are made to translate them into knowl-edge, systems, and programs deployable by front-linerecruitment staff. The pursuit and publication of freshunderstandings should not exist in a space divorced frompractice and utility. Those responsible for converting thispotential benefit into actual progress for collection agen-cies are the very executives and managers responsible forproviding an adequate blood supply. Ideally, they willfacilitate senior-level, cross-functional discussions con-cerning the local implications and applications of thisresearch. Additionally, recruitment departments will allottime to summarize the findings at staff meetings and indi-vidual recruiters will read and digest the papers for them-selves. In such ways, these novel concepts can reshapeour efforts, improve our organizations, and elevate ourprofession.

Unfortunately, this translational effort is currentlybeing honored mostly in the breach. In my blood center,for example, a recent spot poll revealed that only one of 16field recruiters had read or heard a reference to a TRANS-FUSION article in the past 24 months. Among the moresenior department supervisors, managers, and directors,the figure was zero for nine. While our institution enjoysoutstanding recruitment results, it has shaped this successwithout much reference to recent literature. Far frombeing an outlier, my center appears representative judgedby the comments of recruitment leaders from other quar-ters. If your organization has a better track record at apply-ing recruitment science to the business of meetingeveryday production goals, you are certainly to be com-mended.

If you share the educational opportunity confrontingmy center, I encourage you to dive into discussions ofthe ideas brought to you this month. Perhaps blood centermanagement could commit to developing journal clubsfor recruitment professionals, similar to an educationalprocess often used successfully for scientific, technical,and medical education. For starters, can the Ghanaian

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Volume 54, March 2014 TRANSFUSION 751

experience with family donors extrapolate to the manage-ment of directed donors in the United States? Are vanDongen’s suggestions for improving donors’ commitmentto collection appointments practicable? Pursuant toBagot’s observation, how does one spark a donor to initi-ate a conversation about the best use of his or her blood?There are many additional questions to consider. Thereare also multiple right answers to most of them, so be freewith your responses and share widely and often withothers. You and your coworkers in recruitment will bebetter for doing so.

ACKNOWLEDGMENT

The author thanks Catherine Elliott Armitage for editorial

guidance.

CONFLICT OF INTEREST

The author reports no conflicts of interest or funding sources.

REFERENCES

1. Van Dongen A, Ruiter R, Abraham C, et al. Predicting blood

donation maintenance: the importance of planning future

donations. Transfusion 2014;54:821-7.

2. Bagot K, Bove L, Masser B, et al. Asking for something dif-

ferent from our donors: factors influencing persuasion

success. Transfusion 2014;54:848-55.

3. Asenso-Mensah K, Achina G, Appiah R, et al. Can family or

replacement blood donors become regular volunteer

donors? Transfusion 2014;54:797-804.

4. France J, Kowalsky J, France C, et al. Development of

common metrics for donation attitude, subjective norm,

perceived behavioral control, and intention for the blood

donation context. Transfusion 2014;54:839-47.

5. Wevers A, Wigboldus DH, van Baaren R, et al. Return behav-

ior of occasional and multigallon blood donors: the role of

theory of planned behavior, self-identity, and organizational

variables. Transfusion 2014;54:805-13.

ARMITAGE

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