The Gift Relationship
by Richard M. Titmuss
Pantheon, 339 pp., $6.95
In The Gift Relationship, the distinguished Professor of Social Administration at the University of London, Richard M. Titmuss, examines and discusses a quite unfamiliar but most revealing index of social values. His book, subtitled “From Human Blood to Social Policy,” is a study in depth of the contrast between the British and American systems for providing human blood for transfusions, complemented by glimpses of comparable practices in the Soviet Union, South Africa, Japan, and Sweden. More accurately, one might say that Professor Titmuss contrasts the British system for supplying needed blood with the American chaos that fails to provide it, or provides instead a dubious and often fatally deficient or infectious fluid.
In both countries, the demand for blood transfusions has increased at a far more rapid rate than population, with the elaboration of techniques like open-heart surgery artificial kidneys, and organ transplants. In England, where the collection and supply of blood has been organized and controlled by the National Blood Transfusion Service since 1948, there are no paid donors, though there are some, like prison inmates and servicemen, whose participation in the program can hardly be regarded as wholly voluntary. The amount of blood available is, on the whole, adequate for the nation’s surgical needs—though this is in part merely a way of saying that the British, being less freaked out on technology than Americans, more often eschew the bloodier forms of surgical and political enterprise.
English blood is obtained under circumstances that permit careful and accurate records to be maintained of the medical histories of donors. Donors are not permitted to give blood more than twice a year. The incidence of serum hepatitis following transfusions—the most serious risk involved—is less than 1 percent, as compared with between 3 and 4 percent in the United States, causing some 10,000 deaths per year. The US rate is rising; while in Germany and Japan, hepatitis now occurs in about 15 percent of patients after transfusion.
In these high-risk countries the truly voluntary donor contributes very little to the blood supply. Half the blood collected in the United States from 1965-67 was bought outright as a commercial transaction between the donor and, usually, a commercial blood bank. Forty percent more was obtained under a contractual arrangement whereby the donor established a credit for himself and his family in anticipation of need, or discharged a debt incurred. An unknown number of these transactions were covered by commercial donors hired to substitute for the blood debtor. Only 7 percent were true volunteers. Using data from a variety of sources that, admittedly, are not fully comparable, Titmuss considers 98 percent of blood “donations” in Japan to be, in fact, purchases; estimates in Germany run up to 85 percent purchases—with the proportion being higher in East Germany than in the Federal Republic, except for West Berlin where, as in Sweden and the United Arab Republic, all “donors” are reported to be paid.
Reliance on paid donors, especially through the agency …