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Donor compensation and remuneration – is there really a difference?

Opposing voluntary non‐remunerated donations (VNRD) to compensated or paid donations is still a matter of debate, particularly for donors supplying plasma collected for plasma‐derived products. In this context, the aim of this review, based on a search of the literature and discussions with all involved stakeholders in Europe and North America, was to present and discuss the (i) definitions for non‐remuneration, compensation and remuneration of blood and blood component (BC) donors; (ii) ethical principles which should guide transactions regarding donated human blood and BC; and (iii) an analysis of the ethical acceptability of the different modes of donations, including compensation. According to the Nuffield Council on Bioethics (NCB), recompense means payment to a person in recognition of losses they have incurred. This may take the form of either reimbursement of direct financial expenses incurred in donating or compensation for non‐financial losses (e.g. inconvenience, time). To protect donors’ and patients’ safety, transactions of human bodily materials should comply with well‐acknowledged principles of biomedical ethics: autonomy, beneficence, non‐maleficence and justice. Dignity also applies to donors in the sense of prohibition of making the human body as a source of financial gain. The NCB intervention ladder has been recognised as a useful tool for analysing the ethical acceptability of different forms of encouragement for donating bodily material. Awareness of ethical principles for blood and BC donations and the NCB intervention ladder appears as indispensable means to help to identify the non‐altruist‐focused forms of compensation of blood and BC donors and to replace them by altruist‐focused forms of compensation.