This story was originally published by North Carolina Health News on Dec 19. Story by Michelle Crouch. Co-published with Charlotte Ledger

Last month, my daughter Rosie got an urgent email from The Blood Connection, one of three organizations that collect blood in Charlotte.

“BONUS $50!!! BLOOD DRIVE URGENT NEED!!” screamed the subject line.

For a 16-year-old who is often short on cash, it was an enticing offer.

A few hours later, we were lounging in recliners in a mobile bus, IVs in our arms, as we each donated a pint.

While we were glad to be saving lives, what drew us there that day was the $50 e-gift card we could use at retailers including Target, Amazon and Walmart. 

“We lost a lot of blood donors during the pandemic, and we haven’t gained as many back,” said The Blood Connection spokeswoman Katie Smithson. “Sometimes we get into hard situations where we are low on inventory, and if we add things like that [the $50 bonus], we’ll see people come in.”

Traditionally, blood centers have steered away from paying for donations, in part because of Food and Drug Administration rules. But with the number of donors dwindling, blood centers across North Carolina –- and across the country – are trying new strategies to get people to open their veins. Those strategies include generous “thank you gifts” and the chance to win big prizes. 


The advertisement in red and white shows a santa figure in shorts relaxing on a beach chair under several palm trees. The text reads: Lifesavers deserve a vacation! The ad is pitched at encouraging blood donation.
The Facebook advertisement from Charlotte-based The Blood Connection offering entry into a raffle for a beach vacation.
  • The Blood Connection, which services 120 hospitals in the Carolinas and Georgia, offered the $50 e-gift card bonus – on top of its standard $10 thank you gift – twice in December. December donors also have a chance to win a 5-night stay at a South Carolina beach condo (“A $2,300 value!”) or one of three $500 Airbnb gift cards.
  • OneBlood, which provides blood to Atrium Health and other local hospitals, is offering December donors a $20 e-gift card and a plush blanket. Or, if you give through a special promotion drive, you could earn prizes such as two free movie tickets, a ticket to see a local light show or a burger at Red Robin (with the purchase of a beverage).
  • The American Red Cross, which supplies 40 percent of the country’s blood, distributed $10 Amazon gift cards through its “Give a gift. Get a gift” campaign from Nov. 15 to Dec.15. In January, donors have a chance to win a trip for two to the Super Bowl that includes pre-game activities, roundtrip airfare, three nights in a hotel and $500 for expenses.

“Silver Tsunami”

Even before the pandemic, blood centers faced a shrinking donor pool, largely because many regular donors are aging out.

“Those who lived through World War II and had experience with the Red Cross, they are passing away, and they were very dedicated to blood donations,” said Angela Powley, regional executive for blood services over the greater Carolinas region for the American Red Cross.

shows a smiling woman looking at the camera who has an IV in her arm that's draining blood from her.
The author, Michelle Crouch, received $50 for donating a pint of blood.

About 60 percent of donations come from those older than 40, according to the Association for the Advancement of Blood & Biotherapies. Of those, about 75 percent come from people over age 50, said Smithson.

“I call it the silver tsunami,” Smithson said.

The pandemic exacerbated the problem. Staffing shortages and canceled blood drives in 2020 and 2021 created a severe blood shortage, forcing hospitals to make difficult decisions. In January 2022, the American Red Cross announced its first-ever “blood crisis.”

To help boost supply, the FDA in 2020 loosened some restrictions, such as the one on men who have had sex with men which had been in place since the 1980s. Earlier this year, the agency lifted its longtime ban on donations from Americans who spent time in certain European countries between 1980 and 2001 amid outbreaks of mad cow disease.[MC1] 

Smithson said COVID-19 especially impacted high school and college student participation. At The Blood Connection, donations from people under age 29 plunged by 43 percent between 2019 and 2021.

Strategies to attract young donors

Jerry Holmberg, a blood and biotherapies consultant in Denver, N.C., was the senior advisor for blood policy at the U.S. Department of Health & Human Services from 2003 to 2011. He said the blood industry has invested in a lot of research on how to appeal to younger donors.

Millennials “expect information – how the blood is processed and where it is going and how it is going to help,” he said. “They also have to know the reason and purpose for doing it.”

To that end, blood centers have developed robust social media accounts filled with stories of people who have benefited from receiving blood. Sophisticated mobile apps offer rewards and badges for frequent giving, allowing people to track their donations and get reminders when it’s time to donate again.

Those who donate through OneBlood may even get a personal message from the recipient of their blood through its “message my donor” program.

“Imagine in the middle of your day receiving a message from someone whose life you saved,” said OneBlood spokeswoman Susan Forbes. “That has been a huge inspiration for our donors.”

Partnering with HOAs, workout groups

With more people working remotely, fewer are participating in corporate blood drives. That has spurred blood centers to find new partners such as homeowner’s associations, churches, sororities and sports teams like the Charlotte Knights.

In one of the more creative partnerships, the Red Cross partnered with a Charlotte-based network of men’s workout groups called F3. The group has hosted hundreds of drives nationwide since 2020, Powley said. 

“They make it fun,” she said. “The different groups challenge each other and talk a lot of smack.”

To reach high school students, the Red Cross gives student blood drive organizers gift cards ranging from $50 to $200, depending on how many pints are collected.  Organizers are also eligible to win a $2,500 college scholarship.

The Blood Connection has a similar program for student organizers. And it is rolling out a high school curriculum called Vein to Vein about the science of blood donation that can be paired with a blood drive.

“We want to reach the younger age group and turn them into regular donors,” Smithson said.

Is it legal to pay donors?

Another thing that works to attract young donors? Financial incentives.  After all, that’s what caught my daughter’s attention.

“Your daughter responded to the monetary aspect,” Holmberg said. “That is one thing millennials look for – are they going to get paid for it, especially if it is an inconvenience. How much does it cost them to drive to the blood facility? Is it keeping them from their paid employment?”

One study published in Science found that a $10 gift card increased blood donations by 50 percent with no negative effect on blood safety.

There’s no law against paying for blood. But the Food & Drug Administration (FDA) requires blood donations to be labeled as either “paid” or “volunteer.”

The requirement was put in place in the 1970s after research found that blood from paid donors was more likely to be contaminated. It essentially eliminated paid donor programs in the U.S,. Holmberg said, because hospitals stopped buying blood from paid donors.

Shows a red and white truck with the name and logo "The Blood Connection" parked in a lot outside an office building.
The Blood Connection’s mobile donation van parked outside of Microsoft offices in Charlotte.

(Plasma, which is easier to sterilize, is not subject to the same rule, which is why plasma centers pay donors.)

FDA guidelines on gifts

FDA guidelines say gifts for unpaid blood donors are ok as long as they can’t easily be turned into cash. That means gifts shouldn’t be easily transferable to others or redeemable for cash.  Tickets to professional sporting events, for example, would not be acceptable if they could be easily sold, the guidelines say. (Raffles for such prizes are specifically allowed.)

These days, with donor gifts increasing in value, the line between paying cash for donations and offering incentives can be slim.  “It can be hard to see a difference,” Holmberg said. 

Blood centers say they’re careful to follow FDA regulations. Smithson noted that most people contribute because they truly want to help others, but incentives can be the thing that gets them to donate on a particular day.

“We do want to incentivize people and thank them in a way that might get them to come in when our supplies are low,” Smithson said.

The strategy worked to spur Rosie into action. She bought holiday presents for her friends with her gift card and says she’s already looking forward to making her next donation.

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