Blood is supposed to be given, not sold. That is the organizing ideal behind the World Health Organization’s push for “100% voluntary, nonremunerated” blood donation.
But real-world blood systems are much messier.
In a new Substack post, I draw on a recent essay co-authored with Al Roth to look at donor benefits in whole-blood systems around the world, drawing on examples from thirteen countries: Super Bowl sweepstakes in the United States, K-pop photo cards in South Korea, cash “expense allowances” in Germany, exam points for donors’ children in China, priority-service rights in Brazil, and replacement-donation systems that can generate informal cash markets.
The question is not simply whether blood donors are “paid.” It is how donor benefits are structured, funded, routed, and legally classified — and why some transfers are treated as gratitude while others become morally and legally suspect.