Commentary: Healthpoint rewards for blood donations are a right step forward
Properly regulated incentives can address Singapore’s blood shortage without compromising the safety of donors or recipients, says Julian Savulescu of Centre for Biomedical Ethics.
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SINGAPORE: When it comes to blood donations, Singapore has long relied on the generosity of strangers. Since 1946, blood for transfusion has been collected from voluntary, non-remunerated donors – a model endorsed by the World Health Organization and operated locally today by the Health Sciences Authority and Singapore Red Cross.
In 2025 the programme collected roughly 128,000 whole blood and 8,000 blood product donations, distributed across five blood banks. It is, by any reasonable measure, one of the world’s better-functioning altruistic systems.
It is also running out of time. The HSA now warns that demand for blood could outstrip supply in seven years. Youth donations have fallen by more than half over the past decade, from 20,000 to under 9,600.
It is estimated that 119,720 units of blood will be required in 2026 – a figure projected to climb 1 to 1.3 per cent annually as the population ages and cancer incidence rises. Periodic shortages already happen: In early 2024, Group O stocks dipped to less than six days’ supply and were declared critical.
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The consequences of running short are not abstract. When blood banks empty, doctors are left with no acceptable options: Transfusions are delayed or withheld, elective surgery is cancelled, cancer chemotherapy is interrupted, and trauma patients face worse outcomes. There is a saying: Time is money. In medicine, time is lives.
DEBATE ABOUT COMPENSATING BLOOD DONORS
Singapore’s response, announced this April, is to award donors Healthpoints. These points can be redeemed on the Healthy 365 app for MediShield Life premium discounts, e-vouchers for goods and services, or charity donations.
This is a thoughtful, distinctively Singaporean compromise which focuses on promoting health and preserves altruism. But members of the public have raised concerns that rewards may pressure financially disadvantaged individuals into donating.
Compensating blood donors is a contentious topic, with the key objection being that paid donors are more likely to conceal infections or health conditions. It is therefore rare for countries to pay whole blood donors – but the case of plasma donation is instructive.
In the United States, donors can get paid at plasma donation centres run by biopharmaceutical companies. As a result, the country collects nearly two-thirds of the world’s plasma. Most European countries prohibit payment, yet imported American plasma make up roughly 40 per cent of their needs.
However, recent reports show that middle-income Americans are selling their plasma to stay afloat as costs rise and jobs dwindle. “I’m angry that I’m working this much, that I’m educated, articulate, and have marketable skills, and am reduced to selling my plasma,” said an interviewee.
This presents a dilemma: Incentives may create a steady supply of life-saving blood products but may leverage background injustice or inequality. In such cases, they may be exploitative.
To prevent exploitation, a society needs a safety net. Singapore has this net in the form of universal health coverage and other social protections for its citizens.
RIGHT STEP FORWARD
In contrast to purely paid donations, Singapore’s approach of offering non-monetary incentives strikes a balance. It nudges more donors to come forward, while preserving the spirit of goodwill as altruists can redirect their compensation to charity.
Safety is not compromised either. Blood and plasma donation is highly regulated in Singapore; risks are minimised by medical screening, deferral intervals and volume limits.
The risk of incentivised donors hiding their medical background is addressed by universal nucleic-acid testing, behavioural questionnaires and donor deferral registries. Modern screening does not care whether a donor was rewarded; it cares whether the blood is safe.
Then there is the worry that compensating blood donors, especially vulnerable individuals, may involve coercion or exploitation. But coercion, properly understood, involves pressuring someone to do something against their interests.
Donating blood under medical supervision is not against a healthy adult’s interests. It is a low-risk act that helps strangers, and now, modestly, helps the donor. Small incentives do not cloud judgement in a manner that constitutes undue influence. And donors are not exploited when the risks to them are properly controlled.
Singapore is right to incentivise blood donation – at home, transparently, and under its own ethical control – rather than risk importing moral compromise from abroad. Properly regulated incentives can save lives without compromising the safety of donors or recipients.
Professor Julian Savulescu is Head, Centre for Biomedical Ethics (CBmE) at the Yong Loo Lin School of Medicine, National University of Singapore.
Source: CNA/el
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