Donor Behaviour

Research lines

Without blood donors there would be no blood to transfuse and no blood products to use for pharmaceutical drug production. Hence, it is crucial that our donor pool is sufficient, healthy and diverse enough to ensure access to every blood type that is needed. Targeted recruitment of donors with specific characteristics is therefore crucial to meet the demands. In addition, research shows that the risk of viral infections is much lower in repeat than in first-time donors. Therefore retention of donors guarantees a sufficient and healthy blood supply. In our recruitment and retention research we use theories and evidence from social and behavioural sciences to study, explain and influence donor behaviour. Several projects contribute to gaining more insights into facilitators, experiences and barriers related to blood donation.


DISTRESS aims to measure blood donation related stressors, induced stress reactions, and their effect on donor anxiety and the donated blood product. It investigates the effects of blood donation related stress for the donor, by combining physiological (heart rate, heart rate variability, blood pressure), hormonal (cortisol), and psychological measurements (stress, anxiety) in immediate conjunction with the bloodletting procedure. The possible effects of donation stress experienced by donors on the quality of the blood product will be examined by measuring coagulation and platelet activity.  Read more


To examine whether, when and why donors start donating blood and drop out at certain moments, it is necessary to examine donor careers, following potential and first time donors turning into returning and loyal regular donors. Motivational change across time and crucial decision moments, when donors face barriers and are at risk for lapsing, will be identified. The aim of the project is a dynamic investigation of (potential) donor behavior in order to examine donors during different time points in their donor career. This projects provides important input for the Blood Bank department Donor Relations and its recruitment and retention activities. Read more


Selection and retention of plasma donors of anti-RhD immunoglobulin (hereafter referred to as anti-D) is important to keep up the national prevention program, aiming to prevent RhD-immunisation and subsequent haemolytic disease of the fetus and newborn (HDFN) in RhD-negative pregnant women. The current Dutch prevention programme is very successful in reducing these severe complications in pregnancies of RhD-negative women. Anti-D is produced by Sanquin from the plasma of a small group of donors, mostly women who have been RhD-immunised during or after pregnancy. More insight in facilitators and barriers for these RhD-immunised women to donate plasma for anti-D production is of utmost importance to retain existing and recruit new anti-D donors in order to guarantee the production of anti-D from Dutch voluntary donors.


This project plays a role in the prediction of negative donor experiences, such as fainting, through for example measuring stress, anxiety, and emotional state with psychophysiological techniques, such as muscle activity (EMG), electromyography (EEG) and functional magnetic resonance imaging (fMRI). Also, it will map how more trait like aspects such as personality, coping and attachment influence donor experience and motivation. Furthermore, this will eventually result in the development of a bio/neurofeedback intervention to facilitate positive experiences and relaxation during donation. Additionally, the postdoc project will assess how cultural aspects play a role in the recruitment and retention of donors on a national and international level, through for example assessing how we can motivate certain minorities in the Netherlands to donate, but also by examining how the influences of cultural aspects and motivational barriers in certain subgroups, and their effect on donor behavior, vary between (European) countries.    


Donor deferral, especially on-site deferral, is highly undesirable for several reasons. First, deferrals are disappointing and costly for both donors and the blood bank. Second, high deferral rates may jeopardize a stable and sufficient blood supply, because temporarily deferred are at risk of lapsing. Third, the likelihood of being deferred is rather high at the beginning of the donor career. Unfortunately, deferrals at the donor’s first or second donation attempt are most strongly associated with donor lapse. It is unclear which mechanism drives the association between deferral and donor lapse. In order to fill this knowledge gap and develop effective interventions to prevent lapsing after deferral, a thorough investigation of reasons behind and consequences of donor deferral is of utmost importance. Hence, this project focuses on managing the deferral process in a cost-effective way that deferred donors are more likely to return.

Research projects donorstudies

Research projects on donor behavior are often linked to projects on donor health.

Browse our projects.

Key publications

  • Klinkenberg, L.F., Romeijn, B., De Kort, W.L.A.M., & Merz, E.-M. (2017). Reasons to end the donor career; a quantitative study among stopped blood donors in the Netherlands. Transfusion Medicine 2017 Jul 5.
  • Slootweg, Y., Koelewijn, J., De Kort, W., De Haas, M., & Merz, E.-M. (2018, accepted). Facilitators and barriers for RhD-immunized women to become and remain anti-D donors. Transfusion 2018 Apr;58(4).
  • Piersma, T.W., Bekkers, R., Klinkenberg, E.F., De Kort, W.L.A.M., & Merz, E.-M. (2017). Individual, contextual and network characteristics of donors and non-donors: a systematic review of recent literature. Blood Transfusion, 2017 Sep;15(5):382-397
  • Hoogerwerf, M.D., Van Dongen, A., Middelburg, R.A., Merz, E.-M., De Kort, W.L.A.M., Frings-Dresen, M.H.W., Sluiter, J.K., & Veldhuizen, I.J.T. Negative experiences and pre-donation blood pressure: the role of attitude and anxiety. Transfus Med. 2017 Apr;27(2):105-113.
  • Merz, E.-M., Zijlstra, B.J.H., & De Kort, W.L.A.M. (2015). Perceived blood transfusion safety. A cross-European comparison. Vox Sang. 2016 Apr;110(3):258-65.