This book, as Chapter 1 explained, is fundamentally about human values and their relationship to those institutions and services in society with which social policy is concerned. At this point, however, some readers may have begun to wonder whether it was turning into a technical exposition of blood transfusion services.

This is not so. It was, however, essential to examine in depth and on a comparative basis the issues of freedom of choice, uncertainty and unpredictability, quality, safety, efficiency and effectiveness, and to relate such issues to the supply and distribution of human blood.

The choice of blood as an illustration and case study was no idle academic thought; it was deliberate. Short of examining humankind itself and the institution of slavery – of men and women as market commodities – blood as a living tissue may now constitute in Western societies one of the ultimate tests of where the ‘social’ begins and the ‘economic’ ends. If blood is considered in theory, in law and is treated in practice as a trading commodity, then ultimately human hearts, kidneys, eyes and other organs of the body may also come to be treated as commodities to be bought and sold in the marketplace.

Profitable competition for blood ‘is a healthy thing’, it is argued by some in the United States. It improves services, increases supplies of blood and is the answer to a ‘shiftless, socialistic approach’. If competition for blood were eliminated, it is warned, it would ‘be the entering wedge for the destruction of our entire anti-monopoly structure’, and would threaten the interests of ‘great pharmaceutical companies’.

The payment of donors and competition for blood should be introduced in Britain, urged two economists in a publication of the Institute of Economic Affairs in London in 1968. Productivity would rise; supplies of blood would increase; ‘a movement towards more efficiency in the blood market is a movement towards more efficiency in the economy as a whole’. The editor, Arthur Seldon, in a preface said that the authors ‘have made an unanswerable case for a trial period in which the voluntary donor is supplemented by the fee-paid donor so that the results can be judged in practice, and not prejudged by doctrinaire obfuscation’.