Paths to improve voluntary blood donation in mixed public/private blood donation systems such as in Lebanon?

• Approximately two-thirds of donors in Lebanon have adequate knowledge of blood donation; nevertheless, they exhibit reluctance to donate owing to apathy. • Merely 22.2% of donors are voluntary non-remunerated donors (VNRDs), with the remaining 77.8% being replacement donors. • The fragmented blood transfusion system, compounded by the continuous financial and socioeconomic turmoil, political inertia, and geopolitical disruptions, collectively impede the achievement of the World Health Organization's goal of achieving 100% VNRDs. • The active engagement of public authorities combined with the implementation of strategies gleaned from successful experiences in culturally akin neighboring countries, such as Morocco, are crucial for enhancing blood donation rates in Lebanon. The World Health Organization advocates for the achievement of 100% voluntary non-remunerated blood donation (VNRD) globally by the year 2020. However, until today, little was known in Lebanon regarding its actual rate or influencing factors, particularly donor motivations and behaviors. Therefore, the aim of this study was to assess the knowledge, attitudes, and practices of blood donors in Lebanon. The ultimate goals were to retain first-time donors, encourage them to become regular ones, and facilitate the transition from replacement donation to VNRD. A multi-centric cross-sectional study was carried across the five governorates in Lebanon. A self-administered and structured questionnaire was used in this survey. Results were presented in terms of odds ratios, with statistical significance defined at a P value of 0.05 and a 95% confidence interval. Additionally, a benchmarking analysis of the situation of blood donation in Lebanon was also conducted, identifying several areas for improvement. A total of 620 blood donors participated in this study, with 21.3% being first-time donors and 78.7% repeat donors. While the latter were primarily motivated by self-esteem, solidarity or returning a favor (89%, 77.9% and 78.1%), the main obstacle for becoming regular donors was a lack of initiative (34.6%). Female donors (9.9% of the total) exhibited better knowledge (OR = 2.20, p = 0.011) and were more inclined to donate voluntarily (OR = 1.52, p = 0.048). Conversely, male donors were more likely to be repeat donors, often through replacement donation (OR = 2.95, p = 0.001). There is a significant disparity between the low rate of voluntary donation in Lebanon (22.2%) and the relatively high proportion of donors with adequate knowledge of the donation process (60.5%). Therefore, urgent action by public authorities, based on the evidence based strategies outlined in this article, is crucial to enhancing the voluntary donation rate in Lebanon. [ABSTRACT FROM AUTHOR]