Do I Really Need to Give Blood?

The Short Version

Donating blood may not be the most effective use of our time, so don’t fret if it’s not your thing. It’s still a good thing to do, though, and I am going to keep at it.

The Long Version

My wife introduced me to blood donation early in our relationship. I was nervous about it, but I was also happy to contribute and eager to impress Mary. After the donation, I sat up, remarked on how I still felt awesome, and (literally) strutted over to the snack table to enjoy my well-earned juice and cookies.

Mary and I started chatting. About 30 seconds into that, I was zoning out staring down at my juice, and Mary asked, “Are you okay? You look a little pale.” The next thing I knew, the juice was spilled all over the table, and I was being leaned back and checked out after passing out.

That and subsequent experiences (thankfully, no others involved passing out) taught me my limits for donating, and I go into my appointments telling the workers to start me lying down and asking for a pre-emptive juice. I take my time getting up and about afterwards, too.

I don’t have a regular donation routine going — it’s really sporadic and based on when it pops up in my mind, or my work has a drive on site. Lately, I’ve also started wondering whether it is worth it.

Some Analysis

Just focusing on the cons, now: I get poked and prodded, it takes a long time to answer a bunch of strange personal questions (between the years 1982 and 1999, were you abducted and experimented upon by, and/or shared needles with, alien beings? okay, that’s not a real one), it takes that time from my day where I could be doing something else productive for myself or society, and I worry about whether I’m going to pass out.

According to the blood donation organizations, my blood donation might save up to 3 lives. Whether it goes to helping cancer patients and ER patients, or if it is used in scheduled surgeries, I can probably assume that this is helping to make a substantial difference in someone’s quality of life. Undoubtedly, then, donating blood is a good thing to do.

I’ve been finding effective altruism as a helpful lense, though, to use. For that, I would ask: “is this the best and most effective use of my time / resources for the greatest gain?”

Effective altruism uses Quality Adjusted Life Years (QALY’s) as a measure of effectiveness — basically, how much do we extend a life or measurably improve the quality of life. I did some rough math and thought experiments to understand the cost per QALY of blood donation and how effective that is compared to other alternatives.

First, I took the case of a car accident victim. According to the Red Cross, a car accident victim may need up to 100 units of blood. Based on that, my single unit donation saves 0.01 lives. Car accident victims skew younger, so I feel fairly comfortable in estimating that this life saved is worth 40 QALY’s or so. Now my donation is worth 0.4 QALY’s. Let’s say that we value our time at $25/hr and it takes an hour for everything involved with donating blood. At around $63 per QALY, that would be competitive with third world interventions like malaria nets and deworming.

However, this is maybe looking at some of the most impactful uses of the blood donation. These uses are covered already whether or not most of us donate blood. What we really have to look at is the marginal benefit and cost per QALY (i.e., how much is my extra unit of blood likely to do).

I found an interesting discussion of this on the Internet, here. I repeated the rough analysis process and validated some of the numbers for myself in USD. The analysis goes something like this:

  1. The cost of a unit of blood within the medical system is about $250 / unit
  2. If there were greater demand for it to be used with sufficient benefit, the price would be bid up higher
  3. Our medical system assigns (whether explicitly or not) a cost-effectiveness threshold (somewhere between $10K and $150K per QALY — let’s say $50K)
  4. Therefore, the marginal benefit of another unit of blood is $250 / $50K / QALY = 0.005 QALY

I can imagine some hypothetical treatment right at that margin, where 200 units of blood extends a person’s life for 1 year at good quality. If I stop donating blood, maybe that treatment no longer occurs, but all of the car accident victims are fine, as are all the people that have treatments that only require 199 units of blood to extend for 1 year.

At $25/hr, this means that blood donation costs me $5,000 for 1 QALY. That’s about 50 times more expensive (less effective) than donating to efficient third world causes (although, probably not bad for Western standards).

There are definitely a lot of caveats to this analysis. Validity of QALY’s aside, there are some assumptions about the “market” for blood and how it functions. Since blood donations are used potentially in multiple ways, this analysis may neglect other benefits. It’s not always possible, too, for someone to convert their time into money to donate.

Conclusion

After my research, I feel that I would be justified in forgoing the uncomfortable experience of donating blood, as long as I use my time and efforts to advance some other altruistic cause with a higher return.

However, at the same time, I think I’m going to keep donating (but not stress out if it’s not as often as I’m eligible). The cost effectiveness isn’t that bad by Western standards, and while I think the effective altruism lense is helpful, I’m not ready to commit to it exclusively.

I would not want to contribute to a world where so few people donated blood that the cost of a unit was driven up to something like $10K / unit and was only used for the most extreme emergency cases (and then I’d be worried about economic fairness and whether hospitals in low-income areas could afford the blood that they needed).

I also like the connection that I feel from literally giving of my blood to help others.

I’m going to focus on making the experience as smooth as possible for me. I will keep experimenting with the best snacks to have before donating. And, I tried out Red Cross’s fast pass the last time I donated, and that made the appointment itself go a lot faster.

Mary and I are also talking about having “donation dates” where we both go to donate together and then have a meal out. In that case, the donation is part of an experience that builds our relationship (and be damned the cost per QALY’s!).

Last week, the Red Cross sent me an e-mail letting me know that my most recent donation was sent to Jewish Hospital in Louisville, Kentucky, “to help a patient in need.” Cool! I wish wellness to whoever that patient is in Louisville might be — I send them my love, and my blood.

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