From Central Office
From the President
This issue’s focus—coordinated by the ISBT Donors and Donations Working Party—highlights strategies and achievements to strengthen voluntary non-remunerated donation and more sustainable blood supplies in Africa, Latin America and South-East Asia. I would like to warmly thank all the contributors to this major topic.
Pierre Tiberghien, ISBT President
Recently, I had the honor to be invited to the 15th Pan-Arab Blood Transfusion (PABT) Conference in Kuwait, where I was asked to speak about ethical challenges and the controversies surrounding how sufficient safe blood and plasma is collected. This invitation was a wonderful opportunity to exchange with colleagues from the region, learn from their practices and innovations and to reflect on issues that are highly relevant to all of us.
At its core, the ethical framework of blood and plasma donation starts with a single overarching priority: ensuring that patients have equitable access to safe and effective therapies. Achieving this depends on the sustained availability of high-quality and safe blood components and plasma-derived medicinal products used appropriately. Ultimately, this can only be secured by safeguarding blood and plasma donor well-being and integrity, preventing exploitation, and preserving the conditions for long-term donor trust and engagement. Transfusion services must align these imperatives while facing growing clinical demand and rising societal expectations.
Among all ethical dimensions of donation, trust stands out as both essential and fragile. Donors trust that their health will be protected, that their donation will be used appropriately for patients, and that the system is governed fairly and transparently. Yet maintaining that trust now requires renewed attention. Our environment is shaped by increasing knowledge - including big data and linkage with large health databases - unprecedented transparency through open data and public reporting, instant amplification through social media, increased scrutiny of public institutions, and the growing impact of rapidly viral misinformation. In such a setting, donor trust cannot be assumed: it must be actively protected.
In this regard, donor health and non-exploitation are fundamental imperatives. Donation is safe, but not risk-free. Across donation types, risks must be recognized, prevented, and continuously monitored—for example fainting reactions, iron deficiency in whole blood donors, or protein and immunoglobulin depletion in frequent plasma donors. These concerns become even more sensitive in the context of high-frequency donation, especially when socio-economic vulnerability may blur the line between genuine voluntariness and undue inducement and coercion. This is precisely where robust safeguards are essential.
Voluntary non-remunerated donation (VNRD) plays her important role. VNRD is more than a guiding principle: it is a safeguard against undue inducement, coercion, and the gradual commodification of human substances. By keeping donation grounded in solidarity and informed choice, it supports donor dignity, sustains long-term engagement, and strengthens the social legitimacy of blood services.
ISBT has long been committed to VNRD through its Code of Ethics, which places donor protection, autonomy, and integrity at the forefront. This commitment aligns closely with the World Health Organization, which promotes VNRD as a foundation for sustainable national blood systems. It also resonates with the direction set in Europe by the new EU Substances of Human Origin (SoHO) Regulation, reinforcing voluntary unpaid donation, transparency, and donor protection across the European Union. Perhaps the most important message is this: loss of donor trust is a direct patient-safety issue. Maintaining trust is not merely a communication challenge; it is a core safety requirement and a shared responsibility of blood establishments, clinicians, regulators and policymakers. Protecting donor trust is protecting patients.
Ethical dilemmas in blood donation cannot be resolved by prioritizing supply alone. They require explicit policies that protect donors, uphold voluntary and non-exploitative donation, and preserve trust over time. Donor protection, recipient access to safe and efficient blood components and PDMPs, and sustainability of blood systems are not competing goals—they are inseparable ethical objectives. By safeguarding donor well-being and therefore trust, we secure patient access to essential therapeutics.
With ISBT Kuala Lumpur congress forthcoming, it will be a valuable opportunity to continue and enrich this discussion, and I am looking forward to meeting many of you there.
Pierre Tiberghien, ISBT President
