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In this paper, we use register data on all blood donors (n = 259,172) and changes in geographical locations of blood donation centers in the Netherlands over the past decade, to examine the strength of altruistic motivations in blood donation by testing how blood donor behavior changes after the cost of donating in the form of time and inconvenience increases. We examined whether closing donation centers influences blood donor lapse, and whether the risk for lapse varies between donors with different blood groups. A lower lapsing risk for donors with universal, O-negative blood as costs increase is considered as evidence of altruism: continued efforts in making a societal impact despite the increased time commitment would indicate altruism in donor behavior. In the total sample, 137,172 (52.9%) donors lapsed at least once. We found a very strong effect of changes in the distance to the nearest collection point on donor lapse. Donors whose nearest donation center closed were 53% more likely to lapse than donors whose donation center remained open, with the risk for donor lapse increasing with each extra kilometer distance to the new nearest donation center. While O-negative donors were 10.5% less likely to lapse after closing a donation center compared to donors with other blood groups, the effect of closing was similar across blood groups. Based on these results, we conclude that blood donors are clearly sensitive to cost changes imposed by blood banks and that they are not particularly motivated by altruistic concerns. Future studies are recommended to further examine the role of contextual factors in motivational change across the blood donor career. Blood banks are advised to strategically place donation centers throughout the country to promote blood donations, and design interventions to reduce donation barriers after changing their donation centers' locations.
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