Gift Giving
Gift-giving and receiving is a commonly practiced activity that is embedded in many cultures and societies. French sociologist Marcel Mauss argued that the term ‘gift’ is polysemous, therefore, it can mean several different things - according to his essay "The Gift: Forms and Functions of Exchange in Archaic Societies." (1925). He also firmly believed that gifts and donations shouldn’t be confused due to gifts not being truly free, leading to the gift recipient entering an unspoken deal where they become the gift giver. He stated that gifts are not material but are a fundamental part of societal relationships and create reciprocity which helps growth within communities. Furthermore, "there is no inherent nature within an object that makes it a gift or a commodity. Rather, this is defined at the moment of exchange by the types of relationships that are being built by the transaction” (Sanchez, 2022). So, to brand blood transfusions as a gift, it can certainly be argued that there would need to be some form of social relationship or association between the recipient and the donor - which in many cases, is not possible. Yet, the reality is, in many countries, individuals will donate their blood and not expect anything in return, whilst being fully aware that they will most likely not be forming a relationship with the person that their blood will go to. The Pan American Health Association, in collaboration with the World Health Organisation, published testimonies from a selection of blood donors in 2013, and the results were uplifting - with individuals stating how donating can be rewarding, even with no monetary benefit, indicating that "knowing that you helped someone with your blood is priceless'' (Urioste, 2013). "What motivates me to donate blood is to know that through this simple act, I can save a life, I can bring happiness to an entire family, or I can contribute to a mother’s ability to enjoy the benefit of seeing her children grow” (Vasquez, 2013). There is certainly no harm in being reminded of the altruistic among us, and it is reassuring to know that there are individuals who genuinely and legitimately want to donate out of the pure kindness of their hearts, and despite Mauss’s notion of gift-givers subconsciously expecting something in return, in these cases, it is clear that the satisfaction is enough.
In 1970, Welfare State philosopher Richard Titmuss published a study entitled ‘The Gift Relationship’, predominantly detailing a comparison between the largely privatised blood donation system in the USA and the non-profit system in the UK. This study prompted lots of discussion around the topic, as he ‘showed that making money out of blood was both economically inefficient and health-damaging; sold blood is more likely to transmit disease, and he argued that a system of blood donation which does not rely on economic motives and values allows people to make a morally healthy contribution to society’ (Oakley, 2011). The desire to privatise blood, and to destroy the relationship between donor and recipient is selfish and needless, and I believe it takes away from the initial selfless motivations that individuals have to donate. The comparison between the systems in the UK and the USA is very relevant, as it provides two stark contrasts between policies, and allows examination of each to present conclusions as to whether one is better than the other. The model in the USA, as mentioned, is very reliant on the privatisation of blood, and is certainly seen as a commodity by the majority of people - and unsurprisingly this has had some rather ugly consequences.
Economics and Exploitation
The inevitable rise of the blood and plasma economy and industry saw its value rise to $33.5 billion in 2016 (BCC, 2017), highlighting the real worth of the sale and procurement of blood, which on its own, would certainly be able to be used to argue that blood is undoubtedly a commodity. One of the largest implications of such a reality is the inevitable exploitation that comes with any commodified product. One of the most salient examples of this exploitation came in the 1960s when a Blood and Plasma Centre began operations in Cummins Prison, Arkansas. The inmates, who naturally had no method of income, were told that they could earn $7 for every pint of blood that they agreed to donate, which to a population that has little to no other choice or option, was a no-brainer. However, shockingly and unfortunately unsurprisingly, it was then discovered that the prison was selling each pint on for $100 each, profiting off of and exploiting those who did not feel they had a choice (Belek, 2022). To make matters worse, this blood was unsafe for use, and hepatitis began to spread throughout the supply, even one contaminated unit would go on to infect all of the other samples. Obtaining blood in ways like this, based on keeping costs low and profits high, is exactly why making blood a commodity is so dangerous - similar methods prompted HIV to make its way into blood supplies in the early 1980s, and it was found that the transfusions were causing an AIDS outbreak among hemophilia patients (Belek, 2022). This proves Richard Titmuss’s theory right, as he hypothesised ‘that paying blood donors would reduce the quality of the blood donated and would be economically inefficient’ (Niza et al, 2013), and in this case, putting a price tag on our blood only prompted biological exploitation resulting in the spread of disease. Situations such as these aren’t only occurring in America, with China recently experiencing a ‘blood famine’, as hospitals are running out of supplies of blood.
This has forced the creation of a black market for blood, as this famine is ‘an unintended consequence of China’s attempts to restore faith in the nation’s scandal-stained blood supply and encourage people to donate’ (Harney, 2015). Because of the low supply, ‘desperate patients are turning to agents known as "blood heads”, who sell certificates that give patients access to state blood banks, creating a black market at the heart of the system’ (Harney, 2015), and an unfortunate process such as this is without doubt an indication that blood is definitely viewed as a commodity and no longer a gift in China, and by having this exchange of money for these certificates, and by following Mauss’s theory that "something becomes a commodity when it is exchanged in a market transaction for something else that has a different use value’ (Sanchez, 2022), we can clearly see the commodification of blood in action, and some of the nasty consequences it is capable of having.
Religious beliefs
One could argue that the practice of blood transfusions don’t fit into either the gift or commodity categories. When assessing how global perceptions of blood transfusions are formed it is vital to take into account religious beliefs and the significance of the influence that such a large proportion of the international population undertakes. "The Pew Research Center’s Forum on Religion & Public Life estimates that there are 5.8 billion religiously affiliated adults and children around the globe, representing 84% of the 2010 world population of 6.9 billion” (Pew Research Centre, 2012). Jehovah’s witness’, a Christian denomination that has large followings in the USA and areas of Western Europe are notoriously opposed to the practice of blood transfusions. "Jehovah's Witnesses believe that a human must not sustain his life with another creature's blood, and they recognize no distinction between taking blood into the mouth and taking it into the blood vessels. It is their deep-seated religious conviction that Jehovah will turn his back on anyone who receives blood transfusions” (Thompson, 1989). This attitude towards blood transfusions could classify the exchange of blood not as a gift nor a commodity but as a sin.
There have been various cases in the media over recent years of Jehovah’s Witnesses refusing blood transfusions for their young children which ultimately ended up with the child dying. An article in the Sydney Morning Herald described "A pregnant Jehovah's Witness and her baby [died] after the woman refused a blood transfusion in a Sydney hospital” (Corderoy, 2015). This came after the 7 month pregnant woman came into hospital and discovered she had acute promyelocytic leukemia but refused any form of life saving blood transfusion as it went against her religious beliefs which resulted in her and her unborn baby dying. These attitudes surrounding the topic of blood transfusions and other medical practices are dangerous and do inevitably result in the loss of life. However, other Christian denominations don’t refuse blood transfusions and believe that the discovery and use of them is their God answering their prayers to heal the ill. Therefore, one could argue that a blood transfusion is not a gift or commodity but an act of God or the Devil.
Review
To try and label blood transfusions as either gift, commodity, or something else, is evidently a precarious and multi-facteted task - and one could argue that it is not entirely possible to do so. I would argue that it falls under all of the above, due to different contexts in different countries with different kinds of people dictating processes. In the mind of the selfless individual who donates with the sole intention of helping others, which despite many anthropologists pessimistic view of humanity, is still a reality, it is without doubt that they would believe they are giving a gift.
And they certainly are, as donors really do not get anything in return apart from that warm feeling that one receives after doing a good deed. While it can be argued that there is no such thing as a gift, and that donors will inevitably subconsciously feel like they are owed something in return, more often than not, they do not even know who their blood is going to, and physically cannot receive anything in return, rendering the process as entirely one sided - which I still feel makes it a gift. Yet, regrettably, the darker side of humanity has unsurprisingly put price tags on blood, which by definition has made it a commodity in lots of parts of the world. While anthropologist Gretchen Herrmann’s ethnography argued that objects can’t be assigned as either a commodity or as a gift but can only have characteristics of one or both associated with said object (Hermann, 1997), putting a price on something is a clear indication that it has been commodified. Whether it be to make a profit, or to try and create a more lucrative market that could potentially see more donation with the addition of monetary incentive, either way, there is no doubt that blood is a commodity in the eyes of millions.
And aside from this, it is also critical to note that in the eyes of another enormous portion of the global population, blood is neither a gift or commodity, it is either a process supported by either God or the Devil. The religious perspective must not be overlooked when assessing this due to the large influence that religious populations have, in terms of their large numbers, yet it still provides little clarity in terms of trying to assign the act of transfusion to either gift or commodity. However, in terms of where we go from here, while it is clear that ‘blood systems are complex and morally fraught’ (Belek, 2022) and that deliberating over how to categorise the transfusion of it is consuming and important, it is also easy to forget that ultimately, this process saves lives. While we should continue to ask questions regarding the ethical and moral nature of procurement and donation, whether it be a gift, commodity, hell or heaven sent, it is clear that all the arguments for each categorisation are valid in the minds of those who are involved in each separate context.
While transfusions currently fall under all of the above, it is also evident that by putting a price tag on blood has proved very harmful in the past, and without better regulation and enforcement in this field, work needs to be done in order to ensure that the process remains safe, and if the best way to do this is to remove all forms of monetary exchange, then I believe this would be worth looking into in the future to maintain what is essentially one of the best scientific advancements that humanity has seen in the past 200 years.
Bibliography
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