Introduction

Blood donation constitutes one of the cornerstones of modern emergency medicine, surgery, haematology, and transplantation. Despite significant advances in medical science, no synthetic substitute for human blood has yet been developed; therefore, blood supply systems continue to rely on donations from healthy volunteers. According to the World Health Organization (WHO), more than 118 million blood donations are collected worldwide each year; however, the availability of blood remains highly uneven across countries with different levels of economic development. Despite variations in organisational structures, most national blood services are founded on the same fundamental principles: donor and recipient safety, voluntary donation, laboratory testing, and haemovigilance, defined as a comprehensive surveillance system covering the entire transfusion chain – from blood collection and processing to transfusion and the post-transfusion monitoring of recipients. WHO emphasises that regular voluntary non-remunerated donors from low-risk populations represent the safest source of blood [1].

Individual countries have developed distinct organisational, financial, and ethical approaches to blood and blood component donation. The most notable differences concern funding mechanisms, the permissibility of donor compensation, donation frequency, and the range of incentives offered to donors.

The aim of this review was to compare the organisation, financing, and functioning of blood donation systems in Poland and selected countries worldwide, with particular emphasis on donor recruitment models, principles of motivating blood donation, the level of plasma self-sufficiency, as well as current organisational and ethical challenges.

Methods

This study was designed as a narrative literature review aimed at comparing the organisation, financing, donor policies, and selected operational aspects of blood donation systems in Poland and five other countries (Germany, France, the United Kingdom, China, and the United States). The review was conducted to identify similarities and differences in national approaches to blood donation and to discuss their potential implications for transfusion safety and healthcare organisation.

A literature search was performed between April and June 2026 using the PubMed, Scopus, and Google Scholar databases. In addition, official publications and policy documents issued by the WHO, the National Blood Centre (Poland), NHS Blood and Transplant (United Kingdom), Établissement Français du Sang (France), the German Red Cross Blood Donation Service, the U.S. Department of Health and Human Services, and the National Health Commission of China were reviewed.

The search strategy included combinations of the following keywords: “blood donation”, “blood transfusion service”, “blood donation system”, “voluntary blood donation”, “plasma donation”, “blood donor incentives”, “hemovigilance”, “blood safety”, “blood donation legislation”, “blood donation compensation”, together with the names of the analysed countries.

Publications published in English between 2010 and 2026 were primarily included. Older studies were incorporated only when they were of significant historical or organisational relevance.

Publications describing the organisation of blood donation systems, funding mechanisms, donor eligibility criteria, donation frequency, donor incentives, plasma collection, blood safety, and haemovigilance were considered eligible for inclusion. Priority was given to peer-reviewed scientific articles, official governmental publications, and documents issued by recognised international organisations. Approximately 60 scientific publications and official reports meeting the inclusion criteria were included in the final review.

Publications unrelated to the organisation of blood donation systems, duplicate records, conference abstracts without full-text availability, and non-authoritative internet sources were excluded from the review.

The collected data were analysed descriptively and organised into thematic categories, including the organisation and financing of blood donation systems, donation frequency, donor benefits, ethical aspects of donor compensation, transfusion safety, and future challenges for national blood services.

Limitations

This review has several limitations. First, it represents a narrative literature review rather than a systematic review; therefore, no formal systematic review methodology or PRISMA framework was applied. Second, the analysis was based on scientific publications, official governmental documents, reports issued by national blood services, and institutional websites. As blood donation systems are subject to continuous legal, organisational, and administrative changes, some information may evolve over time. Furthermore, differences in reporting practices and data availability among countries limited direct comparison of certain organisational and operational indicators.

Global differences in blood donation

One of the most significant disparities in global blood donation is the unequal access to safe blood supplies. High-income countries, which account for approximately 16% of the world’s population, contribute nearly 40% of all blood donations worldwide. The average donation rate in these countries is 31.5 donations per 1,000 inhabitants, compared with only about 5 donations per 1,000 inhabitants in low-income countries [2].

Differences are also evident in the profiles of transfusion recipients. In developing countries, blood transfusions are most commonly administered to children under five years of age suffering from severe anaemia, malaria, or complications related to childbirth. In contrast, recipients in developed countries are predominantly patients over 60 years of age undergoing surgical, oncological, or haematological treatment [3].

In many regions of the world, inadequate laboratory infrastructure remains a major challenge. According to WHO, some countries continue to rely primarily on whole blood transfusions and are unable to screen every donation for human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis in accordance with recommended quality standards due to infrastructure limitations and shortages of testing reagents [3].

Organisation and financing of blood donation systems

Blood donation systems differ not only in their organisational structure but also in their financing mechanisms and the scope of responsibility of institutions involved in the process of blood collection and distribution. These factors influence both blood safety and the overall efficiency of the system’s functioning [1, 4].

Across the European Union, common legal frameworks, including Directive 2002/98/EC, regulate the safety, testing, storage, and distribution of blood and blood components. Consequently, the medical procedures related to blood donation – such as donor eligibility assessment, medical screening, and blood collection – are largely standardised across EU member states [4].

The financing of blood donation systems is one of the key factors determining their efficiency, accessibility, and compliance with ethical principles. Significant differences exist among the countries analysed in this review – Poland, Germany, France, the United Kingdom, China, and the United States – not only in terms of funding mechanisms but also in the organisation of the donation process itself [4, 5].

Poland

The Polish blood donation system is publicly funded and highly centralised. Overall supervision is exercised by the Ministry of Health, which coordinates activities related to blood collection, processing, and distribution. Many of these responsibilities are carried out through the National Blood Centre, an institution operating under the authority of the Ministry of Health. Blood collection is performed by Regional Blood Donation and Blood Treatment Centres, the Military Centre for Blood Donation and Blood Treatment, and the Blood Donation and Blood Treatment Centre of the Ministry of the Interior and Administration. Funding is provided primarily through the National Health Fund and the state budget. The system is based on voluntary non-remunerated blood donation [4].

The Institute of Haematology and Transfusion Medicine serves as Poland’s principal reference institution in the fields of haematology and transfusion medicine. Its responsibilities include:

• conducting inspections of blood donation and blood treatment centres;

• providing expert consultations regarding blood transfusion therapy and blood-derived products;

• participating in the investigation and analysis of serious adverse events and serious adverse reactions associated with blood donation and transfusion procedures.

The primary responsibilities of blood donation and blood treatment centres include:

• collection of blood and blood components;

• testing, processing, and storage of blood and its components;

• distribution of blood products to healthcare institutions.

The legal basis for the operation of the Polish blood service is the Act of 22 August 1997 on the Public Blood Service (Journal of Laws 2017, item 1371) [4].

Germany

Germany operates a mixed blood donation model in which whole-blood donation is predominantly voluntary and non-remunerated, whereas financial compensation is permitted for certain plasma donations. Blood collection is organised primarily by the German Red Cross Blood Donation Service and university-affiliated transfusion medicine centres. Funding is provided through statutory health insurance, private healthcare providers, and revenues generated from plasma-derived medicinal products [5, 6].

France

The French blood donation system is considered one of the most ethically restrictive models in Europe. It is centrally organised and managed by the Établissement Français du Sang (EFS), the national blood service. The French model places strong emphasis on state oversight and the principle of donor altruism. Blood donation is entirely voluntary, non-remunerated, and publicly administered, while any form of financial compensation for donors is prohibited [7].

Following the transfusion-related HIV crisis of the 1980s, France introduced comprehensive reforms that significantly strengthened donor selection, laboratory testing, and the national haemovigilance system [8].

For many years, France has opposed broader European initiatives aimed at permitting financial compensation for plasma donation, arguing that the altruistic nature of blood donation should remain a fundamental principle of transfusion medicine [7].

United Kingdom

In the United Kingdom, the blood service operated by NHS Blood and Transplant is widely regarded as one of the most community-oriented blood donation systems worldwide. The system is funded through general taxation and is based entirely on voluntary, non-remunerated donation. Financial compensation for blood donors is not permitted.

The British model is distinguished by extensive public awareness campaigns, regular educational initiatives, and a strong emphasis on social responsibility and civic engagement. Particular attention is devoted to recruiting donors with rare blood groups, especially among ethnic minority populations, in order to improve the availability of compatible blood products for diverse patient groups [9].

China

China’s blood donation system has undergone a profound transformation over the past several decades. During the 1990s, the country experienced serious challenges associated with paid blood donation, including outbreaks of HIV and viral hepatitis linked to inadequately regulated plasma collection practices among economically disadvantaged rural populations. This public health crisis prompted substantial legislative and organisational reforms. A major milestone was the enactment of the Blood Donation Law in 1997, which established a system based on voluntary and non-remunerated blood donation. As a result, the contemporary Chinese blood service is founded primarily on voluntary donations under strict governmental supervision [10].

Blood donation is actively promoted through public campaigns and is organised at the local level by public authorities. Modern information technologies, mobile applications, and digital donor registries play an increasingly important role in donor recruitment, retention, and management [11].

Despite considerable progress, China continues to face periodic blood shortages attributable to its large population, demographic ageing, and cultural beliefs related to blood loss. In traditional Chinese culture, blood has historically been regarded as a source of vital energy (“qi”), and its loss was often associated with physical weakness, which may still influence public attitudes toward blood donation [10].

According to data from the National Health Commission of China, the country currently maintains one of the highest levels of blood safety worldwide and operates an extensive network of blood collection centres. Nevertheless, historical experiences with transfusion-transmitted HIV infections continue to shape public perceptions of blood donation and transfusion safety [11].

United States

The United States combines altruistic whole-blood donation with compensated plasma donation. This model has ensured a stable plasma supply and positioned the country as the world’s leading producer of plasma-derived medicinal products. However, it continues to raise ethical concerns regarding financial incentives and the commercialisation of human biological materials [2, 12, 13].

The presented models of blood donation system organisation indicate that there is no single optimal solution applicable to all countries. The structure of a system is determined by historical, organisational, economic, and social conditions. Regardless of the adopted model, its effectiveness depends primarily on the ability to ensure blood safety, maintain an adequate number of active donors, and efficiently manage resources.

Types of donations

The countries analysed in this review perform similar types of blood donations, including:

• whole blood donation,

• plasma donation (plasmapheresis),

• platelet donation (plateletpheresis),

• granulocyte donation (leukapheresis).

The most advanced apheresis systems are found in Germany and the United States, where plasma donation is performed particularly frequently in response to the substantial demand from the pharmaceutical industry for plasma-derived medicinal products [12].

Volume and frequency of blood and blood component donations

One of the key factors differentiating national blood donation systems is the permitted frequency of donations and the volume of blood or blood components collected during each procedure.

In most European countries, men are allowed to donate blood more frequently than women. This difference is primarily attributable to physiological variations in iron metabolism and the increased risk of iron deficiency among menstruating women [2].

In Poland and Germany, approximately 450 ml of whole blood is collected during a standard donation, in accordance with European guidelines. Whole-blood donations may generally be performed every eight weeks by both men and women; however, men are permitted to donate up to six times annually, whereas women may donate up to four times per year [2, 4].

In the United Kingdom, a standard whole-blood donation consists of approximately 470 ml. Donation intervals are longer than those applied in most European countries, amounting to approximately 12 weeks for men and 16 weeks for women. This approach reflects a more conservative strategy aimed at maximizing donor safety [14].

France applies a more individualised approach, with donation volumes determined according to the donor’s body weight and height [7].

In the United States, the minimum interval between whole-blood donations is similar to that in Poland; however, the standard collection volume is higher, reaching approximately 500 ml per donation [12].

An interesting distinction can be observed in certain regions of China, where smaller-volume donations of approximately 200 ml are accepted. This approach is intended to increase donor eligibility among individuals with lower body weight. The minimum interval between two whole-blood donations is six months [15].

Even greater differences are observed in the collection of blood components, particularly plasma. In Germany and the United States, plasma donation is permitted at very frequent intervals, with some donors contributing several dozen times per year. In the United States, plasma may be donated up to twice weekly. The volume collected during a single plasmapheresis procedure generally ranges from 600 to 800 ml, depending on the donor’s body weight and other physiological characteristics [13, 16].

By contrast, plasma donation is less common and less extensively developed in Poland and the United Kingdom, contributing to a comparatively lower domestic plasma supply [13].

For platelet concentrates collected by apheresis, donation frequency in European countries typically ranges from 12 to 24 procedures per year, although specific limits vary according to national regulations and individual donor eligibility criteria [17] (Table 1).

Donation models and donor incentives: voluntary systems vs. financial compensation

A key distinction among global blood donation systems lies in the approach to donor remuneration and incentive structures. Most European countries, including Poland, France, and the United Kingdom, operate under the principle of voluntary non-remunerated blood donation, in line with WHO recommendations [1, 2]. Under this model, donors do not receive financial compensation, and donation is primarily based on altruism and civic responsibility.

Plasma collection represents one of the most significant challenges for transfusion medicine in Europe. A limited number of countries, including Germany, Austria, the Czech Republic, and Hungary, permit financial compensation for plasma donation [13]. These payments are generally framed as reimbursements for time and travel rather than wages for biological material, typically ranging from approximately €15 to €50 per donation. National legal frameworks are often sufficiently flexible to allow such compensation while maintaining formal adherence to voluntary donation principles. Countries allowing compensated plasma donation generally maintain domestic plasma fractionation capacity, which reduces dependence on imported plasma-derived medicinal products. Compensated donation has been associated with the development of repeat donor pools and contributes substantially to plasma supply stability, with estimates suggesting that such systems account for approximately 55% of plasma collected in Europe [13]. The remaining demand is largely met through imports, particularly from the United States [13]. Despite its advantages in increasing supply, compensated plasma donation continues to generate ethical debate regarding the commercialisation of the human body and the social implications of financial incentives in healthcare [1].

In contrast, the United States operates a predominantly market-based plasma donation system, in which financial compensation plays a central role. Donors may receive payments ranging from modest fees to several hundred US dollars per month, depending on donation frequency and promotional incentives [12]. This model has contributed to the United States becoming the global leader in plasma collection for fractionation. However, it also raises ethical concerns regarding the potential exploitation of economically vulnerable populations and the commodification of human biological materials [13].

Donation systems also differ significantly in the types of non-financial incentives offered to donors. While European countries primarily rely on symbolic recognition and social rewards, some systems incorporate broader benefit structures to support donor retention and recruitment [2].

In Poland, blood donation is strictly voluntary and non-remunerated; however, donors are entitled to several benefits, including two days of leave from work or education, a post-donation recovery meal, reimbursement of travel costs in selected centres, tax deductions, free basic laboratory testing, and honorary distinctions for regular donors [18]. Individuals with significant cumulative donations may receive the title of “Distinguished Voluntary Blood Donor,” which is associated with additional privileges such as priority access to selected healthcare services and transportation discounts in some municipalities [18]. Overall, the Polish system emphasises social recognition rather than financial reward.

Germany applies a mixed model in which benefits depend on the type of donation and institution. Whole blood and plasma donors may receive financial compensation (typically €20-30 for whole blood and €20-40 for plasma), along with refreshments, health assessments, and loyalty programs. Private plasma collection centres may also offer additional bonus payments for frequent donations or long-term participation [6].

France maintains a strictly voluntary and non-remunerated system, consistent with the principle of bénévolat. Donors receive no financial compensation but may benefit from paid leave arrangements (depending on employment conditions), refreshments after donation, reimbursement of transport costs, and symbolic recognition such as certificates and awards. French legislation strongly prohibits indirect financial incentives such as vouchers or gift cards, reinforcing the ethical principle of altruistic donation [19].

The United Kingdom similarly upholds a strictly altruistic model, with no financial compensation for donors. Incentives are limited to refreshments, commemorative certificates, medals, and recognition awards issued by NHS Blood and Transplant, typically granted after milestones such as 10, 25, 50, or 100 donations. The system focuses on fostering civic responsibility and long-term donor engagement through non-material recognition [14].

In China, blood donation is formally based on voluntary non-remunerated principles but supported by a range of non-financial incentives, including paid leave, small gifts, honorary certificates, and public recognition. Additional benefits may include preferential access to transfusion services for donors and their immediate family members. These measures aim to strengthen public participation while maintaining alignment with voluntary donation principles [10, 11].

The United States provides the most extensive system of donor incentives, particularly in plasma donation centres. In addition to direct financial compensation, donors may receive bonuses, loyalty points, gift cards, health screenings, and digital reward-based systems. Commercial plasma companies frequently use targeted promotional strategies to maintain donor retention and ensure stable plasma supply [12].

Overall, global blood donation systems demonstrate substantial variation in both ethical frameworks and incentive structures. While voluntary non-remunerated donation remains the dominant model in Europe, compensated plasma donation plays a critical role in global plasma supply chains. These differences reflect broader tensions between altruistic principles, public health needs, and the growing demand for plasma-derived medicinal products (Table 2).

Ethical considerations

Although the American model has proven highly effective in ensuring a stable plasma supply, it remains the subject of ongoing ethical debate. Critics argue that financial incentives may disproportionately attract individuals from lower socioeconomic groups and could potentially lead to the economic exploitation of vulnerable populations. Supporters, however, emphasise the system’s effectiveness in meeting the growing demand for plasma-derived medicinal products and maintaining national and international plasma supplies [1, 13].

Future challenges for blood donation systems

Contemporary blood donation systems face numerous interconnected challenges arising from demographic, epidemiological, environmental, and technological changes. Ensuring a safe and sustainable blood supply is becoming increasingly complex, particularly in high-income countries experiencing population ageing and declining donor recruitment rates.

One of the most significant demographic challenges is the ageing of the population. In many developed countries, older adults constitute the largest group of blood recipients due to the increasing prevalence of cancer, cardiovascular diseases, haematological disorders, and complex surgical procedures. At the same time, the proportion of young individuals eligible and willing to donate blood regularly continues to decline, potentially widening the gap between blood supply and clinical demand. These demographic trends require the implementation of long-term donor recruitment and retention strategies, particularly among younger generations [20, 21].

Epidemiological crises have also demonstrated the vulnerability of blood donation systems. The COVID-19 pandemic highlighted the importance of maintaining donor confidence, ensuring uninterrupted blood collection, and implementing flexible organisational solutions during public health emergencies. Future infectious disease outbreaks may similarly disrupt donor attendance, blood collection activities, and international supply chains, emphasising the need for comprehensive emergency preparedness plans [22, 23].

Climate change is increasingly recognised as an indirect factor affecting healthcare systems, including blood services. Extreme weather events, floods, heatwaves, wildfires, and other natural disasters may disrupt blood collection, transportation, and distribution while simultaneously increasing the demand for emergency transfusions. Consequently, national blood services should incorporate climate resilience into strategic planning and disaster preparedness [24].

Rapid technological development offers new opportunities for improving the efficiency of blood donation systems. Electronic donor registries, mobile applications, digital appointment systems, and real-time inventory management have already enhanced donor recruitment and operational efficiency in several countries. In the coming years, artificial intelligence and predictive analytics may support demand forecasting, optimisation of blood inventories, personalised donor recruitment, and early identification of potential shortages. These technologies may contribute substantially to improving both operational efficiency and transfusion safety while supporting evidence-based healthcare policy [25].

Future development of blood donation systems will therefore require close collaboration between governments, healthcare providers, blood establishments, researchers, and donors. Strengthening public trust, improving donor engagement, investing in digital technologies, and increasing resilience to demographic and epidemiological changes will be essential to maintaining a safe and sustainable blood supply worldwide.

In the coming years, the ability of blood donation systems to adapt to demographic, epidemiological, and technological changes will be one of the key factors determining the health security of populations. The development of modern management methods, while maintaining the highest ethical and quality standards, should be a priority for policymakers and institutions responsible for the organisation of public blood services.

Discussion

The present review demonstrates that, although all analysed countries pursue the common objective of ensuring a safe and sufficient blood supply, they differ considerably in the organisation, financing, and ethical foundations of their blood donation systems [1-4, 6-9]. These differences influence not only blood availability but also donor recruitment strategies, plasma self-sufficiency, and long-term healthcare policy [1, 13].

European countries, including Poland, France, and the United Kingdom, primarily follow the WHO recommendation promoting voluntary non-remunerated blood donation [1-3, 9, 14]. This approach aims to minimise the risk of transfusion-transmitted infections while maintaining public confidence in blood services [1, 3]. However, reliance solely on voluntary donation may contribute to insufficient plasma collection, increasing dependence on imported plasma-derived medicinal products [12, 13].

In contrast, the United States has adopted a mixed model in which compensated plasma donation plays an essential role in maintaining plasma availability [12, 13, 17]. Although this approach has enabled the country to become the world’s leading producer of plasma for fractionation, it continues to generate ethical debate regarding the potential exploitation of economically disadvantaged populations and the commercialisation of human biological materials [13, 17].

Germany represents an intermediate model, combining predominantly voluntary whole-blood donation with limited financial compensation for plasma donation [4, 6, 13]. This strategy appears to support higher plasma collection while remaining broadly compatible with European regulatory frameworks. Nevertheless, differences in national legislation continue to influence the level of plasma self-sufficiency achieved by individual countries [4, 13].

The comparison of the analysed systems also demonstrates that donor motivation extends beyond financial considerations. Public trust, social responsibility, accessibility of donation centres, educational campaigns, and efficient donor communication systems are equally important determinants of sustainable blood donation programmes [1, 10, 18, 20]. Consequently, countries with well-developed donor engagement strategies may achieve high donation rates despite the absence of financial incentives.

The findings presented in this review support the view that no single organisational model can be regarded as universally optimal. Instead, effective blood donation systems should be adapted to national demographic characteristics, healthcare organisation, cultural factors, and epidemiological conditions while maintaining high standards of donor and recipient safety [1, 4, 13].

Conclusions

The organisation of blood donation systems varies considerably among the countries analysed in this review.

European countries predominantly favour voluntary non-remunerated donation models, whereas the United States employs financial incentives to enhance plasma collection and maintain plasma self-sufficiency.

The increasing demand for plasma-derived medicinal products represents one of the major challenges facing contemporary transfusion medicine.

Digitalisation, technological innovation, and the further development of haemovigilance systems have the potential to improve both the safety and efficiency of blood donation services.

Regardless of organisational structure, regular and responsible blood donation remains the cornerstone of a safe and sustainable blood supply.

Disclosures

This research received no external funding.

Institutional review board statement: Not applicable.

The authors declare no conflict of interest.