6.7 Cultural differences and ethics: a great challenge ahead Voluntary, non-remunerated blood donation forms the ethical cornerstone for donor management worldwide and is reflected in written literature and ethical deliberations. However, discussions are ongoing and the DOMAINE survey indicated that the margin between compensation and remuneration in practice is not always clear. In addition, past, present and future migration throughout Europe has enormous effects on blood product supply and demand, due to its influences on both potential European blood donors and patient populations. Ideally, the donor population should reflect the general population. However, a common language on how to define and describe relevant (donor) population characteristics is lacking. It appears that migrants tend not to donate blood in their new country. As a consequence – on top of the effect of the general European demographic developments regarding age distribution – potential blood resources are not available for use, which further threatens the blood supply. Migration developments bring along imminent inequalities in health care quality between different population groups in EU member states. Migrant populations show different disease patterns and different infectious disease load. They also have specific needs for blood products. Therefore, population shifts entail certain consequences for the necessary availability of adequate blood products and the subsequent quality of health care offered. Especially in cases where specific tissue and blood group matching between patient and donor are life saving (as in stem cell therapies), shortages already occur, especially in minority populations. Communicative difficulties and complex logistics enhance these shortages in an indirect, but substantial way. The need for focussing on participation of (ethnic) minorities in the blood supply chain emerges. Proper attention towards cultural differences is crucial. Even an unchanged blood demand requires a vigorous change in donor recruitment and retention; otherwise the percentage of donors in the eligible non-minority population has to rise steeply to keep fulfilling the blood demand. Here specific ethical issues may arise. For example, the reciprocity issue: ‘you may get blood products transfused, if you are or have been willing to donate yourself’ immediately leads to strong debates. In analogous ways, nearly all ethical issues may have an impact on the cultural differences and vice versa. The challenge ahead of us is, using a transcultural language, to discuss this imminent problem of shortages related to differential participation within the population, while keeping in mind the more universal adopted ethical principles.
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European Blood Alliance