title: Family donors are critical and legitimate in developing countries.
abstract: BACKGROUND
  For many years, family blood donors have been considered less safe than volunteer non-remunerated blood donors and actively discouraged by international organisations and affluent countries support agencies for developing countries. In addition to safety, pressure and coercion was considered unethical. However these assumptions were not supported by evidence.
  
  
  OBJECTIVE
  To assemble recently collected evidence to reopen the assessment whether or not the ban of family blood donors is justified.
  
  
  METHODS
  Review of old and recent literature through Pubmed and references from identified articles.
  
  
  CONCLUSIONS
  Viral marker data comparing confirmed seroprevalence in 1(st) time volunteer non-remunerated donors (VNRD) and family/replacement donors (FRD) corrected for gender and age, show no significant difference between the two groups. Evidence has been provided that for both VNRD and FAD benevolence is more appropriate than altruism. The two groups merge for psychological attitude to donation for which knowing someone needing transfusion is a powerful incentive to give blood. Excluding a life or death situation found in areas where severe blood shortage justifies replacement donation, pressures are exerted on both VNRD and FRD. There is no evidence of coercion of FRD. FRDs therefore meet all criteria for VNRD and are willing to become VNRD and to repeat donation. Ostracising FRD is illegitimate and damaging to the blood supply in resource poor areas. In some countries no difference is made between the two groups of donors representing similar populations asked to give blood in different circumstances.
  
  
  CONCLUSIONS
  FRDs remain a critical source of volunteer, non-remunerated, blood meeting all classical criteria of VNRD that should be considered legitimate and indispensable at this point in time instead of discouraged.
authors.affiliation: Department of Haematology, University of Cambridge, Cambridge, UK.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Allain
authors.affiliation: IQM Consulting for International Development of Quality Management in Transfusion Medicine, Groningen, The Netherlands.
authors.forename: Cees Th Smit
authors.initials: CT
authors.lastname: Sibinga
keywords: Altruism; benevolence; blood donation; blood donors; blood supply; coercion; ethics; pressure