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Article

Can Incentives Ensure the Social Sustainability of Blood Donation? Insights from a Romanian Higher Education Institution

by
Iuliana-Raluca Gheorghe
1,
Consuela-Mădălina Gheorghe
1,*,
Alexandra Perju-Mitran
2 and
Ovidiu Popa-Velea
3
1
Department of Marketing and Medical Technology, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
2
Department of Management-Marketing, Romanian-American University, 012101 Bucharest, Romania
3
Department of Medical Psychology, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
*
Author to whom correspondence should be addressed.
Sustainability 2025, 17(8), 3637; https://doi.org/10.3390/su17083637
Submission received: 22 March 2025 / Revised: 8 April 2025 / Accepted: 11 April 2025 / Published: 17 April 2025
(This article belongs to the Special Issue Innovative Practices for Socially Sustainable Universities: Building Bridges within Communities)
Versions Notes

Abstract

:
Education plays an essential role in ensuring the social sustainability of blood donation. As altruism may be insufficient to support donor engagement, this study assesses the effectiveness of incentives on ensuring the social sustainability of blood donation. A self-administered questionnaire was used to collect data from 319 medical students about socio-demographic variables, donation frequency, altruism dimensions (impure, self-regarding, reluctant, egalitarian warm glow, and kinship), the perceived importance of monetary (travel compensation, meal vouchers) and non-monetary incentives (free blood screening, paid leave, refreshments, recognition gifts), and willingness to donate during a blood donation social marketing campaign in November 2021 and November 2022. Data were analyzed in SPSS 20 using chi-square, ANOVA tests, and multiple regression models. The key findings indicate no significant associations between donor categories and incentives, but meal vouchers, free medical testing, refreshments, and recognition gifts were linked to self-regarding altruism. Additionally, neither incentives, altruism dimensions, nor their interaction predicted willingness to donate blood. These findings highlight the need for education-driven approaches to ensure a long-term commitment of blood donors, by integrating educational, sustainable curricular or extracurricular activities. Integrating blood donation awareness into formal education may cultivate a culture of civic responsibility, expanding the donor pool and strengthening the social sustainability of blood donation.

1. Introduction

Education has an essential role in ensuring the sustainability of a society [1]. According to the 2030 Agenda for Sustainable Development, Goal 4 emphasizes that education fosters skills necessary for individuals to contribute actively to society and cultivate a sense of social responsibility and cooperation, which are essential components of social sustainability [2]. As transformative organizations [3], educational institutions significantly contribute to sustainability by building resilient, responsible, and ethical models [1,2,3,4].
Educational institutions should develop and implement inclusive, resilient, cohesive, and accountable activities [4]. However, this is not often the case, mainly because they lack strategies for transferring knowledge [5] and are poorly engaged in building partnerships [6].
In the particular case of higher education institutions (HEIs), a key strategy for providing sustainability is developing and disseminating prosocial behaviors [1,7], defined as “voluntary contributions to public good” [8]. Blood donation is an essential prosocial behavior, because it is a voluntary and civic act, which is based on trust, solidarity, and shared responsibility among citizens, which are the core components of socially sustainable communities [9].
While new donors must be continuously recruited to prevent blood shortages [10], the availability of blood often does not meet the actual demands of health care systems globally [11,12]. Generally, motivating people to donate blood seems complicated [13], leading to a large variability of behaviors and blood supplies worldwide [10]. A study in 195 countries identified a shortage of approximately 30 million blood donors annually [14]. Predictive models indicate that the higher percentage of aging individuals in the near future could further escalate transfusion needs and diminish the pool of eligible donors, contributing significantly to the blood shortage [15].
In 2021, in the European Union, Cyprus registered the highest rate of blood donations (6.46%), in contrast with Romania, which registered one of the lowest rates of blood donations (1.64%) [16]. In Romania, historical mistrust in health care institutions and a fear of medical interventions continue to be barriers in engaging in blood donation. Although research suggests that targeted ongoing awareness campaigns have improved the public knowledge and shifted attitudes toward blood donation by the Romanian individuals, this occurs in short periods of time [17].
The economic literature identified three potential motivations of blood donation [18]: (a) intrinsic motivation, which encompasses the desire to do good, generally referred to as altruism [19,20,21,22,23,24]; (b) extrinsic motivation, when individuals become motivated by different rewards, be they monetary and nonmonetary; and (c) social norms or self-image concerns of individuals [18].
Some scholars argue that altruism alone may not be enough to prevent blood shortages and that incentives could significantly increase blood donation rates [25,26,27,28]. Conversely, other researchers claim that incentives may undermine an individual’s intrinsic motivation and backfire [29,30], crowd out [28], or have no effect [31,32,33]. Therefore, the effectiveness of incentives in blood donation lies in the identification of the most appropriate types of incentives that can strengthen the willingness to donate blood in the short term or long term and, ultimately, to enhance civic engagement.
Despite its potential to become a sustainable strategy [34,35] and its extensive use to encourage blood donation [36,37], the effectiveness of incentives in blood donation remains unclear. Existing research in economics [8] and blood donation studies [35] has established that the impact of incentives on donation behavior is highly context-dependent [28]. While several factors contributing to this variability have been identified, including methodological differences in survey responses versus observed behavior [25], the types of incentives (monetary vs. non-monetary) [25,38,39], and cross-country variations in preference for incentives [10], there is no clear consensus on the motivations of these differences. Moreover, donor-specific preferences revealed that first-time donors may be more responsive to monetary incentives, whereas experienced donors are more likely to donate for intrinsic motivations [40]. Nonetheless, inconsistencies remain, particularly regarding whether younger donors prefer non-monetary incentives [40] or exhibit a preference for financial incentives [41].
Given the urgent need for a stable blood supply, a comprehensive understanding of how incentives function across different donor profiles and cultures is essential for developing evidence-based strategies that support donation behaviors. Thus, research must clarify whether incentives are an effective long-term strategy for increasing blood donation willingness or if they primarily serve as short-term motivators. This uncertainty emphasizes the necessity for research to identify the optimal strategies for fostering socially sustainable blood donation practices.
To address these gaps, this study aims to assess the effectiveness of incentives in ensuring socially sustainable blood donation. Specifically, this study seeks to (1) identify which incentives are associated with first-time donors and experienced donors, (2) examine if altruism is linked to incentive preferences, and (3) investigate whether the interaction between altruism and incentives influences the willingness to donate blood.
By acknowledging the role of incentives in a blood donation context, this research makes significant contributions to the literature in several ways. Firstly, this research connects the potential implementation of social sustainable strategies in HEIs with prosocial behaviors, especially with blood donation, which has been scarcely explored in the existing sustainable or education fields. This approach positions blood donation as a socially sustainable topic that can be integrated in the curriculum of the HEIs. Secondly, this study addresses the ongoing debate around the effectiveness of incentives for increasing blood donation. This refers not only to the evaluation of the impact of incentives on the willingness to donate blood but also explores it, depending on the types of incentives and on donor profiles. Thirdly, this study investigates the interaction between altruism and types of incentives, a relatively new perspective that may provide important information about the motivations why some incentives succeed in different contexts, as for instance, among students. Moreover, using Romania as a key country, this study emphasizes the cross-cultural dynamics, specifically in the case of blood donation, which is highly dependent on the legislative and policy regulations. Lastly, by defining blood donation on a broader level, this research can bring a new perspective to public health, education, and sustainability.
The following section provides the theoretical foundation of this study by thoroughly exploring the concepts of social sustainability, prosocial behavior within higher education institutions (HEIs), and the motivations of blood donation, with a particular focus on altruism and incentives. Consequently, the outline of the research design, participants, and instruments is presented, followed by an analysis of the results in relation to the proposed hypotheses. The Section 5 offers insights for HEIs, to strengthen students’ willingness to donate blood, and concludes with this study’s limitations and suggestions for future research directions.

2. Theoretical Framework and Literature Review

2.1. Social Sustainability in HEIs

Social sustainability has evolved as an essential yet underdeveloped pillar of sustainability, encompassing equity, social cohesion, participation, and justice [42]. The early sustainability literature often integrated social aspects within environmental and economic concerns, leaving the operationalization of social sustainability fragmented and inconsistent across fields [10,43].
HEIs are fundamental in addressing this inconsistency. They serve as knowledge hubs [1] and are uniquely positioned to promote social sustainability principles through education, research, and governance [3]. HEIs catalyze cultural and behavioral transformations, providing students with the knowledge and critical thinking skills required for long-term societal well-being.
HEIs that integrate social sustainability principles into their policies and curricula contribute to a more participatory society by the following:
  • Ensuring equitable access to learning, fostering long-term social mobility [44];
  • Promoting inclusivity and cultural awareness, essential for maintaining social cohesion and community resilience [20];
  • Encouraging active civic participation, empowering students to engage and potentially influence social policies and governance [41], especially in supporting prosocial behaviors [45].
This link between HEIs and social sustainability extends to prosocial behaviors, which are fundamental to building a cohesive and sustainable society. Therefore, understanding the role of HEIs in promoting these behaviors is essential in ensuring social sustainable strategies.

2.2. Prosocial Behaviors in HEIs

Prosocial behaviors are actions intended to benefit other individuals, where the perceived benefit is the gift received [46], which is also highly valued by society [47]. This may include acts of helping, caring, donating, and sharing [48], as well as altruism [49], empathy [50], and civic engagement [51].
While HEIs provide a favorable environment for prosocial behavior [52], students may actively engage in extracurricular activities [53], contributing to the HEIs’ sustainability [54,55].
The students’ prosocial behavior in HEIs may be reflected in the following:
  • Volunteerism and community engagement [56,57]: Many HEIs encourage students to engage in volunteer work and social programs to reinforce their sense of civic responsibility. Examples of these activities are mentoring disadvantaged student groups, charities, and promoting public health measures;
  • Collaborative learning and peer support [58]: Students participate in peer-to-peer learning in teams, by fostering cooperation and mutual assistance. Examples of these activities include study groups, tutoring programs, and teamwork;
  • Social responsibility refers to providing students with ethical and social education about health care prevention and promotion activities. Examples of these activities include promoting society’s well-being by engaging in health awareness campaigns, such as the need for blood donations [59,60].
Blood donation campaigns in HEIs are essential in maintaining a reliable blood supply, increasing awareness, and fostering prosocial values among students [61,62]. Given the persistent demand for blood and the decreasing number of regular donors in many countries, HEIs can support blood donation sustainability through the organization of on-campus donation campaigns [63]. However, understanding the motivations that stand behind the blood donor’s behavior is essential for designing tailored strategies for different target audiences, especially for students who have heterogenous characteristics.

2.3. Blood Donation Motivations

Blood donation has been considered a pure example of altruistic behavior [20,21,22,24]. Evans and Ferguson identified five altruistic motivations that differentiate donors from non-donors [21]:
  • Reluctant altruism—donating occurs because other individuals may not contribute enough;
  • Kinship altruism—prioritizing donations to benefit family members;
  • Impure altruism—driven by both self-benefit (e.g., warm-glow effect) and the intention to help others;
  • Self-regarding motives—donations influenced by personal benefits beyond altruism;
  • Egalitarian warm glow—deriving personal emotional rewards from helping others.
Some studies indicated that impure altruism and reluctant altruism are the dominant motivators for blood donors [21]. In contrast, other studies suggested that kinship, impure altruism, and egalitarian warm glow played significant roles [64], and other studies revealed that altruism alone may not be enough to meet the rising demands for blood [10].
Ideally, non-remunerated donations are considered the most ethical and sustainable approach to maintaining blood supplies [7,65]. Still, many researchers argue that offering rewards or incentives can increase blood donation rates [25]. More specifically, incentives can successfully nudge individuals toward donation if they do not influence the donor’s self-identity or decrease their altruism motivation [65]. In contrast, other studies suggest that incentives may undermine intrinsic motivation, potentially leading to having no effect [66].
While the debate surrounding the incentives and blood donation remains highly controversial [34,35,67,68], empirical findings about the effectiveness of different incentive types and their optimal value remain mixed [28,34,35]. A systematic review found that attitudes toward incentives vary significantly based on age, prior donation experience, and national policies on donor compensation [7]. The interpretation of extrinsic rewards also varies across cultural and social contexts, and not all incentives necessarily diminish an individual’s altruistic donor identity [65]. Some studies indicate that offering rewards does not negatively impact blood donation behavior [20].
The literature categorizes incentives into monetary (e.g., direct compensation, vouchers, tax relief) and non-monetary (e.g., health check-ups, small gifts, paid leave, honorary recognition) [69]. In addition, the impacts of the types of incentives on the individuals’ behaviors have different outcomes. Some studies revealed that supermarket vouchers successfully increased donation rates [70] and that transport vouchers were an effective recruitment tool of blood donors [27], while small gifts had no significant impact on future donation commitments [71], and monetary compensation reduced the donation likelihood among female donors [72]. Furthermore, the classification of “paid” and “altruistic” donors is not enough to capture the complexity of blood donor motivations, especially for first-time donors. Acknowledging the blood donor’s diverse perceptions of incentives is essential in designing effective policies [34].
Given these findings, the proposed hypotheses are as follows:
H1. 
First-time donors are motivated by monetary incentives.
H2. 
There are no associations between altruism and several types of incentives.
H3. 
There are statistically significant impacts of the interaction between altruism and nonmonetary incentives on the willingness to donate blood.

3. Materials and Methods

3.1. Design

This cross-sectional study was conducted during the biannual social marketing campaigns “Donate blood, be a hero!”, organized within “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania. This study was part of a larger research study, which aimed to investigate the motivations and willingness to donate blood of medical students.
The convenience sampling method was used for the recruitment of the participants, who were present at the two editions of the event, namely, November 2021 and November 2022. For the data collection, a self-administered questionnaire was used in a paper format. All participants were given an informed consent form and a detailed explanation of this study’s aim and objectives. Responses were anonymized, and each participant was assigned a unique numerical code, in order to ensure confidentiality and anonymity. No monetary incentives were provided for participation in this study.

3.2. Participants

The initial sample comprised 352 undergraduate medical students. From them, 6 students refused to participate, and 27 participants completed less than 30% of the questionnaire. The final sample consisted of 319 participants, which was in accordance with the minimal sample size requirements (f2 = 0.35, α = 0.05, power = 0.80) [73]. Depending on the frequency of blood donation, the sample was divided into novice donors (first-time donors), with less than or equal to two blood donations, and experienced donors, with more than two blood donations [74].
The sociodemographic profile of the medical student blood donors (Table 1) consisted of female participants (58%), single (98.1%). The participants had a mean age of 20.86 (±2.42), and most respondents were novices, with less than or equal to two blood donations (70.5%).

3.3. Instruments

The instruments were selected, according to the objectives of this study, and were adapted from the previous literature, containing items for sociodemographic data collection, altruism measurement with the Mechanism of Altruism Index (MOA) [21], the importance of monetary and nonmonetary incentives [22,67,69], and the measurement of willingness to donate blood [75]. The Romanian versions of the MOA and the willingness to donate blood were validated in a previous research study [76].
To assess altruism, the Mechanism of Altruism (MOA) Index was used, which provided a comprehensive measure based on the following altruistic dimensions: self-regarding altruism (SR), reluctant altruism (RA), kinship altruism (K), egalitarian warm-glow altruism (EWG), and impure altruism (IA) [24,77]. The participants’ answers were measured on a 5-point Likert scale, 1 representing strongly disagree and 5 strongly agree. The Cronbach’s alpha coefficients revealed satisfactory internal consistencies in its original format and in the Romanian version of the scale, meaning that all dimensions had values above the threshold 0.70 [21,76].
In addition to altruism, this study also aimed to evaluate the perceived importance of different types of incentives in motivating blood donation. Following the classification of incentives into monetary and nonmonetary types [22,67,68], participants rated the importance of each type of incentive on a scale from 1 (low importance) to 3 (high importance). Monetary incentives referred to travel compensation and meal vouchers, while nonmonetary incentives encompassed free blood screening, free days, refreshments, and recognition rewards.
Participants’ willingness to donate blood in the next 6 months was measured with items adapted from the previous literature, using a 5-point Likert scale [75]. The Cronbach’s alpha coefficient for the Romanian version of the instrument showed a satisfactory internal consistency, suggesting a value above the threshold 0.70 [76].

3.4. Statistical Analysis

The data were collected and analyzed in SPSS 20® and the Macro Process for SPSS®. The descriptive measures for the qualitative variables (sociodemographic, types of incentives and categories of donors) were frequency and percentage, while, for the quantitative variables (the scores of the dimensions of altruism and the willingness to donate blood), the mean and standard deviation were used. According to the Shapiro–Wilk tests, the distributions of the quantitative variables were normally distributed (p > 0.05). The associations between the type of incentives and the categories of donors were assessed with the chi-square test (χ2). Several one-way analyses of variance (ANOVA) were performed to measure the effect sizes of types of incentives on altruism (η2p). According to Cohen, there is a small effect if the value is below 0.2, a medium effect if the values are below 0.5, and a significant effect if the values are below 0.8 [78]. To investigate the relationships between different dimensions of altruism and willingness to donate blood, as well as whether these relationships were influenced (moderated) by the types of incentives, multiple regression models were conducted using Macro PROCESS for SPSS (Table A1 in Appendix A) [79]. The threshold for statistical significance was considered at p < 0.05.

4. Results

There were no statistically significant differences between the types of incentives and blood donors (Table 2).
Despite the comparisons between novice and experienced donors not revealing significant differences, other specific data provide valuable insights:
  • Free blood screening had medium importance for both novice and experienced blood donors [89 (27.89%) and 38 (11.91%)], and the same finding was met for meal vouchers [98 (30.72%) and 42 (13.16%)];
  • Free days had high importance for both novice donors [100 (31.34%)] and experienced donors [(41 (12.87%)];
  • Travel compensation had high importance for both novice and experienced donors [98 (30.72%) and 52 (16.32%)];
  • Refreshment incentives had low importance for both novice and experienced donors [152 (47.64%) and 69 (31.63%)];
  • Recognition incentives had low importance for both novice and experienced donors [163 (51.09%) and 68 (21.31%)].
Table 3 illustrates the assessment of the associations between the dimensions of altruism and the types of incentives.
Students who found free medical screening important were likelier to have high SR scores (F = 25.46, p = 0.001, η2p = 0.13). The stronger the importance that students attributed to free medical screening, the higher their scores tended to be, especially for SR. Although moderate and minor effects were registered for K (F = 9.97, p = 0.001, η2p = 0.05) and EWG (F = 4.71, p = 0.01, η2p = 0.02), they were still statistically significant.
Students who valued meal vouchers more reported higher scores for SR (F = 21.78, p= 0.001, η2p = 0.12) and moderate scores for K (F = 11.35, p = 0.001, η2p = 0.06) and EWG (F = 13.99, p = 0.001, η2p = 0.08). Although smaller, IA still registered a meaningful effect size (F = 5.91, p = 0.003, η2p = 0.03).
The incentive-free day seemed to enhance all components of altruism, but moderate effects were registered in the scores for IA (F = 8.70, p = 0.001, η2p = 0.05) and EWG (F = 8.93, p = 0.001, η2p = 0.05).
Travel compensation may help, but, on its own, it is likely not enough to significantly impact IA (F = 2.76, p = 0.06, η2p = 0.01) and RA (F = 2.84, p = 0.06, η2p = 0.01).
Refreshments strongly and significantly affected SR (F = 66,29, p = 0.001, η2p = 0.29). Students may feel a greater sense of responsibility when receiving refreshments. The effect of refreshments on K was significant but small (F = 3.78, p = 0.02, η2p = 0.02).
Recognition incentives substantially affected SR (F = 70.07, p = 0.001, η2p = 0.30) and had a significantly small effect on K (F = 5.21, p = 0.006, η2p = 0.01).
Although some incentives were associated with the dimensions of altruism, none of them and their interactions with the dimensions of altruism were statistically significant predictors for the willingness to donate blood (Appendix A Table A1). Specifically, the predictors’ altruism dimensions (IA, K, SR, RA, EWG), the incentives (free blood screening, meal vouchers, free days, travel compensation, refreshments, and recognition incentives), and their interactions (predictor x incentive) have high p values (p > 0.05), indicating non-significant effects on willingness to donate blood.

5. Discussion

The aim of this study was to ascertain the incentives’ effectiveness in ensuring socially sustainable blood donation.
Regarding the first hypothesis, our findings indicate that no specific incentives were linked to first-time (novice) or experienced blood donors among medical students. These results only partially align with the existing literature. Although several studies found that monetary compensation, paid leave, and blood screening tests were preferred incentives [41] or that younger donors are more interested in receiving incentives [40], other studies suggest that offering rewards does not significantly impact student donation behavior [20]. At the same time, other studies highlight that many medical students perceive blood donation as a civic duty [80].
Although no associations were found between the types of incentives and donor categories, the second hypothesis was partially confirmed because self-regarding altruism was linked to a series of incentives. Specifically, meal vouchers, free medical testing, refreshments, and recognition were more strongly associated with self-regarding altruism. This is consistent with studies stating that students may engage in altruistic behaviors not purely out of selflessness but due to underlying self-interest [81]. These actions may provide indirect or intrinsic benefits, such as enhancing self-image or gaining social recognition [10,34,82]. Still, this finding was partially inconsistent with other studies, indicating that self-regarding altruism was not a significant motivator for non-student donors [64]. One possible explanation for this contradiction is that attitudes toward incentives in blood donation vary with age, gender, cultural background, and donor experience [28,32,35,70,83].
Concerning the third hypothesis, our findings indicate that neither the types of incentives, the dimensions of altruism, nor their interaction effects predicted the willingness to donate blood. These findings were in accordance with the previous literature, which revealed similar conclusions, highlighting the weak or no impact of the incentives’ effectiveness [32,33,35]. Other studies found that altruism did not significantly influence the willingness to donate blood or the necessity to investigate every altruism dimension’s impact on the willingness to donate blood in different populations [76,84]. However, several marginal statistically significant positive associations were registered between reluctant altruism and free blood screening (t = 1.81, p = 0.07), impure altruism and travel compensation (t = 1.81, p = 0.07), and marginal statistically significant negative associations between self-regarding altruism and free day (t = −1.76, p = 0.07) and kinship altruism and recognition incentives (t = −1.80, p = 0.07) [85]. Reluctant altruistic individuals consider blood donation a social duty, requiring a minimal encouragement to act, especially if this action is useful or beneficial in other ways, apart from moral obligation [21]. Given their higher levels of health literacy compared to the general population, medical students may view free blood screening as beneficial both personally and professionally, rather than as a social responsibility [86]. Additionally, this motivation may indicate a form of cognitive negotiation, in which free blood screening is accepted not as a compromise of altruism but as a practical, nonmonetary health benefit that does not conflict with the donor’s altruistic identity [87].
Impure altruism refers to the motivation that blends self-interest with the intention to help others [88]. Research on non-student populations found that impure altruism was the primary motivation for blood donation [64]. In the case of medical students, given their demanding schedules and academic pressures, travel compensation may be considered a facilitator that blends self-interest with the intention to help others [84].
Self-regarding altruism refers to prosocial behavior motivated by internalized personal standards, self-image, or emotional satisfaction than external rewards [84]. This aligns with the crowding-out theory, which states that external rewards may reduce intrinsic motivation, especially among medical students who engage in blood donation activities as part of their moral and professional identity [86]. Receiving a free day may undermine their internal justification for blood donation [89]. Similar to self-regarding altruism, kinship altruism is a prosocial behavior motivated by the desire to help family members and peers [84]. Medical students, with increased kinship altruistic levels, are more likely to donate blood because they have a sense of increased responsibility for their peers and social group, rather than receive recognition incentives. Also, medical students may perceive recognition incentives inappropriate, or even sense dissonance [30]. These findings may suggest that neither incentives nor altruism are enough to ensure the social sustainability of blood donation.
In this sense, education may remain the key to ensuring the social sustainability of blood donation by raising awareness, encouraging civic responsibility, and shaping long-term donor behavior [84].
HEIs may provide a potentially stimulating environment for shaping health behaviors, particularly among students [90], within the broader context of civic engagement [91]. Introducing blood donation education early helps students familiarize themselves with the practice, bridging psychological distance and embedding it as a regular civic responsibility [92]. While students may not be immediately willing to become blood donors, their education should support long-term attitudinal shifts by applying the principles of citizenship education [93] and service-learning education [94].
Citizenship education in HEIs may present blood donation as a life-sustaining act [91] based on voluntary behavior [7] across several disciplines. For instance, in medicine, a comprehensive transfusion medicine curriculum can be developed, consisting of scientific and clinical aspects of transfusion practices, based on structured and experiential learning [95]. Recognizing the clinical and social aspects of blood donation can empower medical students to encourage their peers to participate as a civic responsibility [96].
Service-learning education is particularly an effective pedagogical strategy in HEIs, as a combination of experiential learning, academic study, and community service [97]. It aims to promote educational activities with social impact, facilitating students’ community engagement [98]. In the context of blood donation, this approach may be used in blending experiential learning with civic engagement, with the aim of encouraging students to participate in awareness campaigns and donate blood actively. In addition, research indicates that service-learning enhances students’ knowledge, lowers perceived barriers, and cultivates positive attitudes toward blood donation [94].

6. Conclusions

While blood donation is a civic and altruistic act, low engagement challenges its sustainability. This study revealed that incentives and altruism do not predict willingness to donate blood. However, integrating blood donation education into higher education curricula and using service-learning approaches can foster long-term positive attitudes and behavior changes. By promoting civic responsibility and awareness, higher education institutions play an important role in ensuring the social sustainability of blood donation.
This study’s cross-sectional design limits the extent to which the findings can be generalized to broader populations. The convenience sample of medical students and its homogeneity adds to the limitation of generalizability. Future research can strengthen or extend the reliability of the findings by conducting longitudinal studies or multicentric studies, allowing for a more in-depth exploration of changes in donor willingness or behaviors over time, especially in relation to different types of incentives and educational interventions. The limitation also emphasizes the need for future research to use more diverse and representative sampling methods, such as stratified or random sampling in order to gain a more comprehensive understanding of the blood donation perspectives.
Potential social desirability bias was likely to have influenced the responses of participants’ true intentions regarding blood donation. Engaging with a sensitive topic, participants might have overreported socially approved behaviors, that is, willingness to donate blood and altruism, and underreported the undesired behaviors (receiving incentives), impacting the validity and reliability of the research findings. In this study, the social desirability bias was reduced by ensuring anonymity and confidentiality during the data collection and processing stages, as well as using validated instruments. To gain deeper understanding of the motivations behind blood donation, future studies can examine the impacts of altruism and incentives (both monetary and nonmonetary) through qualitative research methods, such as focus groups and interviews. Moreover, the impact of storytelling of the blood donors may be analyzed by conducting discourse or narrative analysis. This may provide insights into the emotional perspectives and considerations of the blood donors. The ethnographic methods, referring to the observation of individuals in real-life donation settings, may reveal differences between the declared willingness and the actual behaviors of donors. Using virtual reality and artificial intelligence to explore the emotional and psychological aspects of blood donation can capture new perspectives.
Some limitations may also refer to the classification of blood donors into novice (first-time donors) and experienced donors. This classification may simplify the complexities of blood donation behavior, as, for instance, individuals who rarely donate blood or have donated only once may not fit into either category, and this may reveal other motivations for blood donations. Further research can benefit more from a more accurate and narrower classification, as, for instance, first-time donors, occasional donors, regular donors, and lapsed donors.
From a practical perspective, the following research directions can be explored to increase or foster social sustainable practices of blood donation within HEIs:
  • Enhance students’ knowledge and their positive attitudes regarding blood donation by addressing specific topics through educational programs, be they curricular or extracurricular, workshops, and presentations. During these educational programs, several methods for raising awareness may be used, but it is preferable to have a practical approach, based on visual and interactive materials;
  • Understand how peer behavior and group dynamics within HEI settings impact individual decisions to participate in blood donation campaigns;
  • Organize on a continuous basis, in the HEI campus, social marketing campaigns for blood donation;
  • Investigate how students’ willingness to donate blood evolves over time and the long-term effects of altruism and incentives on donation behavior within HEIs;
  • Conduct research to differentiate the motivations and behaviors of first-time donors, repeat donors, and lapsed donors within HEIs, and how these groups respond to various incentive types;
  • Examine the role of HEI policies, support systems, and partnerships with blood donation organizations in fostering sustainable blood donation practices on campus.

Author Contributions

Conceptualization—I.-R.G. and O.P.-V., methodology—I.-R.G., C.-M.G. and A.P.-M., software—I.-R.G. and C.-M.G., validation—I.-R.G. and A.P.-M., formal analysis—I.-R.G. and C.-M.G., writing—original draft preparation—I.-R.G. and O.P.-V., writing—review and editing—I.-R.G. and O.P.-V., visualization—I.-R.G. and A.P.-M. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The Ethics Committee of “Carol Davila” University of Medicine and Pharmacy approved this study, with the number CH5/07.09.2020.

Informed Consent Statement

Informed consent was obtained from all involved participants.

Data Availability Statement

The data presented in this study are available upon reasonable request from the corresponding author.

Conflicts of Interest

The authors declare no conflicts of interest.

Appendix A

Table A1. The results of the multiple regression analyses.
Table A1. The results of the multiple regression analyses.
ModelPredictorBtp
1Constant2.502.150.03
IA0.090.360.71
Free blood screening0.040.080.93
Interaction (IA × Free blood screening)0.0020.020.98
2Constant3.086.990.001
SR−0.16−0.670.50
Free blood screening0.110.580.55
Interaction (SR × Free blood screening)0.0090.090.92
3Constant3.446.470.001
K−0.13−0.940.34
Free blood screening−0.36−1.320.18
Interaction (K × Free blood screening)0.101.550.12
4Constant1.953.100.001
RA0.261.590.11
Free blood screening0.541.810.07
Interaction (RA × Free blood screening)−0.12−1.660.09
5Constant3.054.970.001
EWG−0.02−0.170.85
Free blood screening−0.14−0.470.63
Interaction (EWG × Free blood screening)0.050.670.50
1Constant2.632.280.02
IA0.040.160.86
Meal vouchers0.0030.0060.99
Interaction (IA × Meal vouchers)0.020.170.86
2Constant2.916.750.001
SR−0.12−0.560.57
Meal vouchers0.221.080.27
Interaction (SR × Meal vouchers)−0.01−0.110.90
3Constant3.015.470.001
K−0.04−0.310.75
Meal vouchers−0.12−0.410.67
Interaction (K × Meal vouchers)0.050.790.42
4Constant2.303.530.005
RA0.130.790.42
Meal vouchers0.371.180.23
Interaction (RA × Meal vouchers)−0.06−0.810.41
5Constant2.985.130.001
EWG−0.03−0.230.81
Meal vouchers−0.09−0.320.74
Interaction (EWG × Meal vouchers)0.050.680.49
1Constant2.802.370.01
IA0.020.080.92
Free day−0.09−0.160.86
Interaction (IA × Free day)0.030.270.78
2Constant3.597.630.001
SR−0.42−1.760.07
Free day−0.13−0.700.48
Interaction (SR × Free day)0.131.350.17
3Constant3.005.140.001
K−0.03−0.200.83
Free day−0.10−0.400.68
Interaction (K × Free day)0.040.690.48
4Constant2.062.890.004
RA0.221.160.24
Free day0.451.410.15
Interaction (RA × Free day)−0.10−1.220.22
5Constant2.664.050.001
EWG0.070.380.69
Free day0.050.190.84
Interaction (EWG × Free day)−0.0002−0.0020.99
1Constant0.340.260.79
IA0.561.910.054
Travel compensation1.011.810.07
Interaction (IA × Travel compensation)−0.20−1.660.09
2Constant3.106.510.001
SR−0.15−0.680.49
Travel compensation0.060.330.74
Interaction (SR × Travel compensation)0.020.240.81
3Constant2.744.150.001
K0.020.110.90
Travel compensation0.010.040.96
Interaction (K × Travel compensation)0.020.330.73
4Constant2.183.130.001
RA0.170.930.34
Travel compensation0.371.270.20
Interaction (RA × Travel compensation)−0.07−0.970.32
5Constant2.703.850.001
EWG0.030.180.85
Travel compensation0.030.110.90
Interaction (EWG × Travel compensation)0.010.200.83
1Constant3.022.130.03
IA0.0070.020.98
Refreshments−0.19−0.330.73
Interaction (IA × Refreshments)0.040.330.73
2Constant3.016.760.001
SR0.010.060.94
Refreshments0.100.540.58
Interaction (SR × Refreshments)−0.05−0.540.58
3Constant2.414.100.001
K0.171.150.24
Refreshments0.160.650.51
Interaction (K × Refreshments)−0.04−0.700.48
4Constant4.015.980.001
RA−0.25−1.480.13
Refreshments−0.48−1.600.10
Interaction (RA × Refreshments)0.121.650.09
5Constant3.144.710.001
EWG−0.02−0.150.87
Refreshments−0.17−0.610.53
Interaction (EWG × Refreshments)0.040.640.52
1Constant3.603.460.006
IA−0.07−0.300.76
Recognition incentives−0.68−1.080.28
Interaction (IA × Recognition incentives)0.110.800.42
2Constant3.318.520.001
SR−0.04−0.220.81
Recognition incentives−0.11−0.430.66
Interaction (SR × Recognition incentives)−0.009−0.100.91
3Constant3.596.950.001
K−0.05−0.450.64
Recognition incentives−0.68−1.800.07
Interaction (K × Recognition incentives)0.111.280.19
4Constant3.335.910.001
RA−0.008−0.050.95
Recognition incentives−0.24−0.640.51
Interaction (RA × Recognition incentives)0.010.150.87
5Constant3.405.770.001
EWG−0.01−0.100.91
Recognition incentives−0.51−1.200.22
Interaction (EWG × Recognition incentives)0.080.750.45
Note: IA = impure altruism; K = kinship altruism; EWG = egalitarian warm-glow altruism; RA = reluctant altruism; SR = self-regarding altruism; t-test value = Student test value; p = statistically significant value; and B = unstandardized beta. Source: Authors’ calculations with SPSS.

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Table 1. The sociodemographic profile of the participants.
Table 1. The sociodemographic profile of the participants.
Nominal VariablesStatistics
NumberPercent (%)
GenderMale13442
Female18558
Marital statusSingle31398.1
Other61.9
Type of donorFirst-time (≤2) donations (“novice”)22570.5
Repeated (>2) donations (“experienced”)9429.5
Numerical variablesMeanSD
Age20.862.42
Source: Authors’ calculations with SPSS.
Table 2. The associations between types of incentives and different categories of blood donors.
Table 2. The associations between types of incentives and different categories of blood donors.
Type of IncentiveCategory of Blood Donorχ2p
NoviceExperienced
Free blood screeningLow importance63 (19.74%)30 (9.40%)0.850.654
Medium importance89 (27.89%)38 (11.91%)
High importance73 (22.88%)26 (8.18%)
Meal vouchersLow importance70 (21.94%)29 (9.09%)0.040.980
Medium importance98 (30.72%)42 (13.16%)
High importance57 (17.86%)23 (7.23%)
Free dayLow importance41 (12.85%)21 (6.58%)0.780.675
Medium importance84 (26.33%)32 (10.03%)
High importance100 (31.34%)41 (12.87%)
Travel compensationLow importance42 (13.16%)15 (4.70%)3.770.152
Medium importance85 (26.64%)27 (8.46%)
High importance98 (30.72%)52 (16.32%)
RefreshmentsLow importance152 (47.64%)69 (21.63%)1.270.530
Medium importance56 (17.55%)18 (5.64%)
High importance17 (5.32%)7 (2.22%)
Recognition incentivesLow importance163 (51.09%)68 (21.31%)0.9700.616
Medium importance49 (15.36%)18 (5.64%)
High importance13 (4.07%)8 (2.53%)
Note: χ2 = chi-square test; p = level of statistical significance. Source: Authors’ calculations with SPSS.
Table 3. The effects of types of incentives on altruism dimensions.
Table 3. The effects of types of incentives on altruism dimensions.
Type of IncentivesDependent VariableFpη2p
Free blood screeningSR25.460.0010.13
K9.970.0010.05
EWG4.710.010.02
Meal vouchersSR21.780.0010.12
K11.350.0010.06
EWG13.990.0010.08
IA5.910.0030.03
Free daySR4.270.010.02
K3.980.020.02
EWG8.930.0010.05
IA8.700.0010.05
RA6.850.0010.04
Travel compensationIA2.760.060.01
RA2.840.060.01
RefreshmentsSR66.290.0010.29
K3.780.020.02
Recognition incentivesSR70.070.0010.30
K5.210.0060.03
Note: IA = impure altruism; K = kinship altruism; EWG = egalitarian warm-glow altruism; RA = reluctant altruism; SR = self-regarding altruism; F = Fisher test; p = statistically significant value; and η2p = effect size. Source: Authors’ calculations with SPSS.
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Gheorghe, I.-R.; Gheorghe, C.-M.; Perju-Mitran, A.; Popa-Velea, O. Can Incentives Ensure the Social Sustainability of Blood Donation? Insights from a Romanian Higher Education Institution. Sustainability 2025, 17, 3637. https://doi.org/10.3390/su17083637

AMA Style

Gheorghe I-R, Gheorghe C-M, Perju-Mitran A, Popa-Velea O. Can Incentives Ensure the Social Sustainability of Blood Donation? Insights from a Romanian Higher Education Institution. Sustainability. 2025; 17(8):3637. https://doi.org/10.3390/su17083637

Chicago/Turabian Style

Gheorghe, Iuliana-Raluca, Consuela-Mădălina Gheorghe, Alexandra Perju-Mitran, and Ovidiu Popa-Velea. 2025. "Can Incentives Ensure the Social Sustainability of Blood Donation? Insights from a Romanian Higher Education Institution" Sustainability 17, no. 8: 3637. https://doi.org/10.3390/su17083637

APA Style

Gheorghe, I.-R., Gheorghe, C.-M., Perju-Mitran, A., & Popa-Velea, O. (2025). Can Incentives Ensure the Social Sustainability of Blood Donation? Insights from a Romanian Higher Education Institution. Sustainability, 17(8), 3637. https://doi.org/10.3390/su17083637

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