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Who gives life? Understanding, explaining and predicting donor behaviour

Periodic Reporting for period 2 - DONORS (Who gives life? Understanding, explaining and predicting donor behaviour)

Reporting period: 2020-08-01 to 2022-01-31

Without prosocial individuals, no money would be donated to charity, no volunteer work would be performed and no informal caregiving provided to those in need. Without blood donors, there are no blood products to transfuse and no plasma donations for pharmaceutical drug production. Four million patients are annually treated with blood derived products in Europe, given by voluntary blood donors. However, as little as approximately 2-3% of the population in Europe is registered as blood donor and donor numbers are decreasing during the last decades. At the same time, the demand for blood products and other substances of human origin (e.g. donor organs) is increasing, in times of demographic change and longevity. Hence, it is crucial that a country’s donor pool is sufficient enough to ensure access to needed blood products and donor organs. Targeted recruitment and retention of donors is vital to meet these demands. Many countries cope with shortages of human donor substances. A thorough and inclusive investigation of motives to donate substances of human origin, as well as a dynamic approach to donor life courses is lacking. Yet, this information is fundamental to develop effective evidence-based donor management and understand why individuals are or are not willing to act prosocially and provide donations. Explaining (sustained) prosociality in humans requires innovative, multidisciplinary and dynamic approaches because we still do not fully understand why altruism and prosociality survive. DONORS will not only provides novel scientific results on determinants and dynamics of prosocial behavior but also identify clues to translation of the study results into evidence-based recruitment and retention strategies of blood and organ donors. Prosocial behavior often was and is studied in experimental settings and ample evidence about determinants of helping and giving behavior as well as mechanisms behind has been generated. Yet, the question whether and how these insights translate to real world prosocial behavior remains elusive. In this project, we study prosociality in real life, i.e. blood, plasma, and organ donation, as key examples of prosocial behavior, where a stranger (patient) is helped at a donor's personal costs. DONORS will produce important results for both science and society to enhance knowledge about donor behaviour, and ultimately the recruitment and retention of human substance donors, cornerstones of maintaining health care. Until now donor recruitment, retention and management is hardly, if at all evidence-based. Hence, besides scientific publications, results will be disseminated by professional publications in blood banking outlets, social media posts and blogs, and a final report that summarises key outcomes of DONORS that are relevant to policy making. Results from DONORS will not only give an impulse to research and theories on prosocial behaviour but can greatly improve the donor management of blood establishments and organ registries.

The main aim of the DONORS project is: To propose and test a life course model of prosociality, including (changes in) individual determinants, network characteristics and societal contexts to understand and predict motivations and behaviour of donors.

This main aim can be broken down in the following objectives:
• First, examine which (interplay among) individual factors and social network characteristics determine donor motivations and behaviour over the life course (WP1
• Second, study to what extent and which genes contribute to explaining variation in prosociality and donor behaviour (WP2)
• Third, explain variation in individual donor behaviour across societal contexts (WP3)
In the first months since the beginning of the project, I have further developed the theoretical model of prosocial behavior, based on literature from sociology, psychology, economics and biology. In the same period I recruited two PhD candidates to work on the subproject 'A life course model of donor behaviour' (WP1, PhD1) and 'Variation in blood donor behaviour across societal contexts' (WP3, PhD2). For WP3, a PhD candidate started her work in November 2019 and for WP1 in January 2020. Both have been successfully admitted to the Graduate School of Social Sciences of the VU faculty of Social Sciences. They have followed the compulsory research integrity course and have been involved in revising and improving the data management plan for the DONORS project and associated activities. In October 2020, we hired a postdoc with a background in genetics for WP2 'Genetic explanation to variation in prosocial behaviour'. Since then, the research team is complete and the work is and will be performed following the DoA. All WPs of the DONORS project proceed according to plan and several papers, preprints, popular outputs, publications and presentations have been realized. For a more detailed overview please refer to the Major Achievements and Dissemination and outputs sections in this report.

Since March, 2020 the Corona pandemic forces us, following the government measures, to work from home as much as possible and in two lockdown periods also to engage in homeschooling our children. During these lockdowns, less research output was generated than normally would have been the case. After schools were reopening in the Netherlands, the usual research activities had been taken up again. Travel and conference participation have been reduced or moved to online events, personal contacts with colleagues and team members has been brought back to a minimum. Now, at the end of the first half of the project, the situation is slowly improving but still keeping us from working at the office, traveling to conferences and meeting with and building up our network. This has asked a lot of flexibility from the research team and required additional commitment. As PI of the DONORS project I am incredibly happy and proud of my team that the project proceeds well, generates important results and research output, conform to the research plan.

Main results:
• Advanced theoretical models of prosocial behaviour. These models are described and outlined in more detail in the Major Achievement section and in the referred pre-registrations and preprints.
• Empirical tests of these models, also described and outlined in more detail in the Major Achievement section.
• Dissemination and translation of these models and results to the scientific community and other important stakeholders, including donors, policy makers, blood bank professionals, industry and the general public. For more details on the dissemination strategy and the concrete efforts, please refer to the Dissemination and outputs section.
Within the three main objectives several key achievements have been realized. Especially, WP3 could add some important new insights to both theory advancement but also to evidence-based development of targeted recruitment strategies for blood and plasma donors. As often described, incentives have surprisingly inconsistent effects on donor motivation, intention and behaviour. This persisting inconsistency of how incentives determine donor behaviour, as again indicated in our comparative paper (cf. Publication 10), is not new. However, a thorough and structured analysis of these effects has been lacking but can provide important evidence. Our own analysis across 28 countries with harmonized instruments (i.e. the Eurobarometer survey) finds effects that point into the direction that financial incentives do not generally encourage prosocial behaviour but the statistical effects are small. In addition, in order to explain the existing inconsistencies, we explored new theoretical directions, including, the role of social norms. We showed that adding social norms to the well-known and widely established model of intrinsic and extrinsic motivation can partly explain inconsistent effects of incentives on prosocial behaviour across different contexts, i.e. countries. Inclusion of social norms might have the potential to break new theoretical grounds and at the same time help collection organisations and charities to better target their recruitment and sollicitation efforts based on knowledge about prevailing social norms towards incentives across demographic groups and countries.

Until the end of the project, we intend to increase our output in terms of publications for WP1-3, following the DoA, initiate a genetics consortium on prosocial behaviour, consolidate existing collaborations and invest in building a professional network for the two PhD candidates and postdoc in order to stimulate their academic development and future career opportunities.
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