Improving the Supply of Blood in Europe

Currently, blood donations remain entirely voluntary across the EU, and the Union quietly relies on the US for over 30% of its plasma. Imbalanced supply amongst member states, failure to integrate blood supply systems, and political and economic factors all contribute to this imperfect system. This article argues for an integrated European blood policy which would significantly reduce supply inefficiencies whilst ensuring adequate supply in the face of unexpected tragedy.

It seems redundant to state the importance of blood in the world; it powers the life of every human  on the planet regardless of nation, creed or any other identifier. We are bound and made man by blood. Crucially, this ‘Gift of Life’ facilitates a broad spectrum of essential, life-saving treatments in the medical field (Titmuss, 2019). Blood, and its components such as plasma, are crucial to dealing with trauma and major surgery and are frequently needed in cancer management or to treat chronic blood diseases like Thalassaemia (European Blood Alliance, 2026).

Supranational institutions such as the European Union have their own policies and protocols regarding blood policy on collection, distribution and administration in matters of medical practice with deep and comprehensive legal frameworks to ensure transfusion safety. But, observations demonstrate poor intra-organisational cooperation and efficiency regarding more logistical matters (Baggio et al., 2023). Presently the European Union’s approach to blood policy is positive from a medical and pharmacological standpoint, but the naturalised issues of blood supply chains persist due to poor integration and inter-member state harmony which causes imbalances and absence of equity in supply and demand, donation and reception levels and the overall efficiency of EU blood systems.

Global blood and plasma donations are a critical pillar of modern healthcare systems. Each year, nearly 120 million units of blood are donated worldwide, with around 22 million units transfused across Europe (European Commission, 2023). Donated plasma is also essential for the manufacture of plasma-derived medicinal products (PDMPs), which are vital treatments for patients living with chronic and often life-threatening conditions such as primary immunodeficiencies, haemophilia and other coagulation disorders, as well as autoimmune neuropathies (Petrini, 2014; WHO, 2025).

This speaks to the significance of having a standardised and regulated blood market to ensure safety for patients and efficiency for providers to make optimised use of such a crucial substance. There is a naturalised absence of market prices and, subsequently, shadow values for blood collections in areas where donations are primarily voluntary, which is the case for the European Union (Baggio et al., 2023). Due to this variation and in-built nebulousness, supply and demand issues in blood both domestically and internationally are unsurprising (Slonim et al., 2014; Meneses et al., 2023).

Demand is relatively consistent but may experience spikes rather than significant gluts, i.e. in the case of tragedy or natural disaster where blood supplies are needed in much higher quantities on extremely short notice, in which case preparedness and maintenance of suitable supply become a requirement. Currently, EU policy fails to do this satisfactorily.

The status of Europe’s blood supply is imperfect, but not without merit. The commitment to blood safety at all stages of collection, distribution and administration has been largely successful, but this has come at the direct cost of self-sufficiency, cooperation and versatility (Watson, 2003). Blood donations remain entirely voluntary across the EU so as not to entice potentially substandard donors with incentives as this could lead to contamination, and the international supply of safe plasma is centralised in the US with the EU quietly relying on it for over 30% of its plasma and PDMPs (Baggio et al., 2023; Pijuan, 2025).

This volunteer-based system has a knock-on effect on the overall EU blood supply in terms of volume of blood collected; there are large imbalances in donation and reception levels between larger and smaller EU members.

(Note: UK data is present as an additional point of reference as a non-EU member and its data is not used in any following analysis or conclusions)

As the chart above demonstrates, voluntary blood donation rates are higher in smaller nations, but aggregate blood supplies are lower than if population-based percentage donations were standardised requirements. Most nations are clustered around the high donation/low volume collection end of the chart. The suggestion is that donation isn’t so much the problem in smaller nations but the limitations on collection due to population sizes inhibit their ability to produce more meaningful blood volumes compared to larger countries like Italy and Germany.

The issues stemming from this can be noted relatively plainly; imbalanced supply leads to poor efficiency in distribution and less effective product utilisation which is negative for both patients and trade prices (Slonim et al., 2014). Political and economic factors create barriers to integrating blood supply systems, as negative impacts on trade prices and pricing pressures limit the ability of member states to obtain blood supplies domestically and across borders. Although 22 million units were donated in 2023 this is a flat amount and not representative of a standardised, EU-wide target volume to prevent shortages (European Commission, 2023).

These inefficiencies and weaknesses become issues when anticipating tragedy; globally there are frequent problems, with shortages during tragedies arrive unanticipated or surpluses stemming from donations arriving after the event already took place. This is an inherent problem of the blood supply chain owing to the product’s limited shelf-life, but a more optimised and balanced system of trade between nations could ease this issue if not wholly resolve it.

A policy addressing this need for balance as a core tenet could additionally solve integration issues alongside lasting problems in supply chains and collection imbalances. This begins with an EU-wide, ‘domestic-supply-plus’ system. A more integrated European blood policy could significantly reduce supply inefficiencies by introducing a harmonised ‘domestic-supply-plus’ system of rotating reserve collection targets across the Union.

Under this model, each country would maintain a base donation rate sufficient specifically for domestic demand, while selected states would periodically increase collection above that baseline to create a shared strategic reserve for disasters, public health emergencies, or sudden shortages. For example, if the standard target to achieve comfort were 4% donor participation, rotating countries could temporarily increase this to 5%.

This system would address a major structural weakness in the current blood provision: uneven collection capacity and fragmented integration. Smaller states often achieve relatively high donation rates but cannot generate meaningful reserve volumes due to population constraints, while larger countries possess the infrastructure to produce significant surplus capacity. WHO data shows blood donation rates are substantially higher in wealthier countries, averaging 31.5 donations per 1,000 people in high-income states compared to 16.4 in upper-middle-income countries and 5.0 in low-income countries (2025). Collection obligations should therefore be calibrated according to population size, national wealth, and healthcare infrastructure rather than imposed uniformly across all member states.

Although maintaining reserve capacity may create limited short-term wastage during periods without major emergencies, improved coordination, shared storage planning, and more predictable supply management would likely reduce overall inefficiency. More importantly, the policy addresses the far greater risk of insufficient supply during crises.

Research also suggests donation rates can be increased through carefully designed incentives without compromising blood safety. Richard Titmuss’ work argued that commodifying blood donation could reduce blood quality and weaken altruistic motivations (2019). However, later evidence has challenged this concern, showing that modest incentives such as vouchers, medals, lottery entries, or symbolic rewards can increase participation without negatively affecting safety outcomes (Lacetera et al., 2012; Lacetera et al., 2013). Such approaches may be particularly effective when combined with civic recognition and appeals to solidarity in higher-income European states.

Any reform must also preserve strict ethical safeguards, particularly informed consent and transparency regarding the use of donated blood. Framing blood donation as both a civic contribution and a shared European public good would strengthen solidarity while improving resilience, preparedness, and long-term strategic autonomy in healthcare supply. Over time, a policy like this would buttress the European blood supply chain and deepen European integration too.

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