Health-related philanthropy: volunteers more likely to give of themselves, literally.

If you were to ask most nonprofit professionals a definition of philanthropy, the responses likely would cover the traditional triad of financial support, in-kind donations of goods and services and board and other volunteer involvement. One important facet of philanthropy, however, is less often included in the standard definition: actions such as blood donation, organ donation or the gift of one's entire body to science after death, collectively termed "health-related philanthropy."

These types of health-related contributions also are philanthropy. Research about them can reveal important insights not only about the vital connection between financial giving and volunteering, but about the volunteerism that is inherent in all types of giving.

Consider the following health-related philanthropy (HRP) facts:

* On July 21, 2006, there were more than 92,000 people in the United States on waiting lists to receive an organ transplant. According to the Organ Procurement Transplant Network, the vast majority were waiting for a kidney transplant (more than 67,000), followed by those awaiting liver (about 17,127), lung (about 3,000), heart (2,800), kidney/pancreas (2,500), pancreas (1,700) or intestine (200) transplants.

For some organs, the wait is measured in days or months. For other procedures, it could be much longer. For example, for those awaiting heart transplant in 2001-02 (the most recent data available), the wait was approximately seven months. But, receiving a kidney could take as long as five years.

These numbers do not tell the whole story, since wait times cain vary depending on ethnicity (African-Americans often wait longer than Caucasians, for example), blood type and other factors. But it is clear that there are not enough viable donated organs to save the lives of individuals who would benefit from them. While there are many more transplants being done than before, there are more people going on waiting lists--so the number (92,000) has stayed constant for many years.

* On this same day, the Web site of the Indiana Blood Center (IBC) in Indianapolis reported that it had low levels of O positive and negative blood types, that several area hospitals had backorders of blood and that many had insufficient inventory to fill them. The IBC noted that it "requires more than 550 units of blood daily to meet the needs of Indiana hospitals and the patients they serve." Shortage is common to the nation's blood centers, and in extreme cases, shortage leads to delayed or canceled surgery, and sub-optimal patient care.

Completing organ donor cards, giving blood at a blood bank and choosing to donate one's body to science are acts of altruism and benevolence to others of the highest order, yet philanthropy researchers know relatively little today about these acts of health-related philanthropy. The academic study of philanthropy has focused on private action for the public good, including the public good of improving health. But most of this work has focused on the philanthropic contributions of time and money to health institutions, such as hospitals and medical schools.

Similarly, the field of bioethics has long studied the ethical, legal and policy issues associated with blood, organ and body donation, whether for transplantation, treatment, research or education. But until recently, researchers have given little attention to how philanthropic scholarship and practice could inform the clinical and policy debates occurring in our hospitals, research centers and universities.

The Center on Philanthropy at Indiana University and the Indiana University Center for Bioethics have been collaborating to examine these issues in more depth. The overall goal is to bring together the methodology and approaches of philanthropy and bioethics to shed light on HRP in its many forms. The results offer some implications for philanthropy and volunteering more generally.

In 2004, with support from the Center on Philanthropy at Indiana University, the Indiana University Center for Bioethics convened a year-long study group of experts in philanthropy, bioethics, law, transplantation and economics to better understand the issues. Among the group's activities was the first-ever household survey on these issues.

The survey identified characteristics of people who are most likely to donate blood, organs or their bodies. But given the importance the study group placed on the incentives and barriers that may influence health-related philanthropy, it also looked at the correlation between measures of giving of money or time and measures of health-related philanthropy. Among the conclusions were:

* People who have given money to religious charities are no more or less likely to have given blood in the previous year than other people, but they are much less likely to be willing to donate organs or their whole body to science. Religious beliefs may have an impact on donating one's body to science;

* Conversely, those who gave money to non-religious organizations in the previous year are much more likely than average to have also given blood during that year or to be willing to donate their organs;

* Individuals who give money to any type of non-profit are more likely to donate blood, but are no more likely to donate their organs or body than those who don't give financially.

Just as an individual's giving of financial support sheds light on the likelihood that they will donate their blood or body parts, the health-related philanthropy study found that the relationship was reversed in interesting ways: participation in different kinds of health-related philanthropy increases or decreases a person's chances of giving different amounts of money to different types of organizations.

For example, organ donors are more likely overall to give money than non-organ donors, and are more likely to give to secular causes than religious ones. On the other hand, those who donate blood or agree to donate their body to science are no more likely to give money to nonprofits than those who do not. Blood donors who do give money to nonprofits tend to give more than non-blood donors, and are also more likely to give money for religious purposes than non-blood donors.

Perhaps the most important finding of the HRP study is that volunteer engagement appears to be an important predictor of whether a person will donate blood, organs, or body to science; so important that it may overshadow all other factors influencing a decision to give health-related philanthropy (such as nice, income and other variables).

These conclusions are qualified because this area of collaborative research between bioethics and philanthropy is still in its early days and there is much to learn about the robustness of the data. Still, there is reason to think that volunteerism plays a critical role in decisions about health-related philanthropy. For example, the General Social Surveys conducted by the National Opinion Research Center annually since 1972 have revealed that among the general population in the United States 11 percent of those who choose not to volunteer give blood, while 21 percent of volunteers are blood donors. This indicates a very strong correlation between volunteerism and blood donation.

What remains particularly intriguing in this ongoing area of study is the contribution that bioethics might make to philanthropy and philanthropy to bioethics. Concepts such as "volunteer" and "voluntary" (critical to the philanthropy world) are absolutely central to health care and bioethics: one speaks of informed and voluntary consent to treatment, a voluntary blood donation or a person volunteering to participate in a clinical trial.

Similarly, volunteerism is key to all types of philanthropic support--and nonprofit professionals should take this knowledge to heart in their development work. The Giving and Volunteering in the U.S. 2001 study conducted by Independent Sector found that among the households surveyed, those who both donate money and volunteer give larger average amounts to nonprofits than non-volunteers who give money. The Center on Philanthropy Panel Study (the largest study of charitable giving by U.S. households over time ever conducted, known as COPPS) found an even stronger correlation: volunteers are 31.4 percent more likely to give to nonprofits overall, and they donate higher amounts of money on average than non-volunteers. COPPS also reveals that volunteers are 17.5 percent more likely to give to health organizations than non-volunteers.

All nonprofit professionals who help structure their organizations for fundraising success have an obligation to help them engage volunteers. Doing so opens the door for potential new donors who are already committed to the nonprofit's mission, and ultimately may help increase funds raised. Similarly, all of the nation's organ procurement organizations, blood banks and medical school anatomy programs seek to structure their organizations to ensure that volunteers will come forward and give. In their case, giving involves the most personal act of donation--the literal gift of oneself. Health-related philanthropy may provide an additional route to building the foundation for all philanthropy.

What our collaborative work seems to indicate is that those of us who are working to develop financial support and voluntary action for worthy causes and those of us leading blood centers and organ procurement programs are dependent on each other for success. Each of us has an opportunity to enhance the success of the other. We should explore ways to be more explicit and deliberate in doing so.

Eugene R. Tempel, Ed.D., is executive director of the Center on Philanthropy at Indiana University. Eric M. Meslin, Ph.D., is director of the Indiana University Center for Bioethics and Assistant Dean for Bioethics, Indiana University School of Medicine.