Ethical issues in donation-based prosocial interventions for health: a scoping review

BACKGROUND: Donation-based prosocial interventions for health, such as monetary donations for diagnostic tests, aim to encourage voluntary actions that benefit others while fostering public participation to promote health. These interventions are increasingly used in public health, but the associated ethical issues have not been comprehensively described. METHODS: We conducted a scoping review using the Arksey and O'Malley framework to synthesize bioethics and public health literature on the ethical issues encountered with donation-based prosocial interventions for health. We searched PubMed, PsycINFO, SCOPUS, NIH Reporter, and ClinicalTrials.gov for empirical qualitative, quantitative, and mixed-methods studies. Two independent reviewers extracted data and coded data from each study according to a codebook. Categories of similar codes were analyzed to name cross-cutting issues across the included studies. RESULTS: The search identified 2,585 citations; 34 publications were included in our review. The publications described studies involving donations of blood, organs, biospecimens, data, and money. Most studies (32/34) were conducted in high-income countries and used observational designs (31/34). We identified three broad categories of benefits associated with donation-based interventions: health (physical and psychological), social (generosity, kindness, and community cohesion), and economic (improving welfare). We also identified several problematic ethical concerns at different levels (donor, recipient, provider, and system), such as undue pressure, privacy concerns, and inaccurate information. To mitigate these concerns, the literature discussed strengthening informed consent, ensuring confidentiality, building public trust, and ensuring appropriate stewardship of donations. We found that most studies did not empirically measure adverse consequences associated with donation-based prosocial interventions. CONCLUSIONS: Donation-based prosocial interventions offer several health, social, and economic benefits. However, it is essential to consider the potential ethical concerns that may arise in their design and dissemination. Further research is needed to evaluate the success of mitigation strategies for addressing these concerns and thereby enhance the overall benefits of prosocial interventions.