[Column] Blood donation crisis: in 20 years, 2 people will have to share 1 supply

"Future Blood Debt" is the title of a paper I co-authored last year with demographer Kim Oh-seok Kim of Korea University. It is almost a cliché to say that an aging population will reshape our society. However, because these changes are not immediately visible, discussions on reforming the national system to prepare for the mid- to long-term future struggle to gain traction.

However, even those who view the future complacently may reconsider when confronted with something as concrete and tangible as blood. As we age, we inevitably develop various diseases, many of which require blood transfusions, including those related to surgery. This is why the demand for blood and blood products is highest among people in their 70s, much like how older adults account for the largest share of national healthcare spending.

However, blood donation is primarily carried out by young, healthy individuals. Korea’s blood supply relies entirely on voluntary donations. Yet, this is changing as the number of eligible young donors has sharply declined due to the falling birth rate.

According to Korean Red Cross statistics, annual blood donations dropped from approximately 2.7 million in 2017 to 2.4 million in 2022—a decline of about 10 percent in five years. This trend highlights the growing reality of a donor shortage as the population continues to shrink and age.

Currently, the upper age limit for blood donation is set at 70. Given this, it is not difficult to foresee the severity of the national blood shortage if recent age-specific blood supply and demand data are analyzed alongside future demographic trends. If the upper age limit remains unchanged, blood supply is projected to decline by 35.5 percent over the next 20 years, while demand will rise by 29.5 percent. By 2045, only about one in two people who need blood will be able to receive it compared to 2025.

No artificial blood has been developed to replace human blood, nor is it possible to import blood from other countries.

What would happen then? We can envision a dystopian future—a bleak scenario where younger generations face increasing social pressure to donate blood, potentially to the point of coercion. There could be heated debates about raising the donation age limit, or even discussions about implementing a mandatory six-donation system for those under a certain age. Incentives and penalties based on donation frequency might also emerge as policy considerations. These are my thoughts as I donated blood for the 82nd time at a blood donation center.

No matter how authoritarian a government may become, it would be difficult to force young people to donate blood. However, the blood supply crisis could serve as a probe—or a metaphor—for a much larger societal issue.

Let’s consider another issue with a similar dynamic. Recently, the National Assembly, with bipartisan support, passed the first national pension reform bill in 18 years. The reform gradually raises the contribution rate from 9 percent to 13 percent over the next eight years while increasing the income replacement rate from 40 percent to 43 percent. This is a meaningful step toward addressing a pension system that has remained largely unchanged for decades.

However, according to the government's fiscal estimates, these reforms will only delay the depletion of the national pension fund by nine years, from 2055 to 2064. Structurally, younger generations will face nearly 50 percent higher premiums by the time they retire, while older individuals nearing retirement will only experience a few years of increased contributions before collecting their pensions.

Younger people are even worse off. After a lifetime of paying high insurance premiums, they will still face the depletion of the national pension fund, forcing the tax burden to be shifted onto the next generation to sustain it.

Structural reforms—such as gradually raising the retirement age or introducing automatic adjustment mechanisms that account for societal changes and the actual degree of frailty—are difficult to implement. I can’t help but think of the movie “Don’t Look Up,” where bureaucrats and experts hesitate to confront an obvious crisis, even when an asteroid is in plain sight.

Where politicians and technical bureaucrats should be focusing on the big picture, the fragility of representative democracy becomes evident. When policies prioritize the interests of the current voting generation, the needs of future generations inevitably fall by the wayside. Time and again, decisions are made to serve the largest segment of the population pyramid rather than to ensure long-term sustainability. Instead of bold, forward-thinking policies, we see the same old band-aid solutions—measures that ease immediate political pressure while postponing real problem-solving. This is precisely the case with the recent pension reform, which some lawmakers have criticized as merely delaying financial exhaustion while ultimately shifting the burden onto younger generations.

The problem is that this kind of burden shifting is not limited to pensions—it is happening across all areas of society. The population pyramid, once shaped like a Goryeo Cheongja (Korean celadon), is gradually evolving into an extreme thumbtack-like form.

In healthcare, nursing, labor, transportation, and every other sector involving intergenerational economic transfers, if the system’s operational logic does not evolve, a shrinking society will struggle to sustain fiscal deficits, and younger generations will face an increasingly unbearable tax burden. It’s akin to one person being forced to share their blood with many.

Demographic change is inevitable. However, the gap between the system’s perception and the rapidly evolving reality is widening. The failure to bridge this gap for the benefit of the current generation is akin to a fisherman depleting all the fish for immediate profit, disregarding the little fish needed for future catches. If we continue prioritizing short-term convenience, the true victims will be our children born into debt. Conversely, if we ask the current generation to share some of the burden out of consideration for future generations, we may achieve a softer landing in response to demographic shifts. If the constraints of representative democracy prevent future generations from having a direct voice, the responsibility falls on the present generation’s insight and conscience. While we cannot reverse the effects of demographic change, we can decide how to distribute its burdens.

Jung Hee-won, a geriatric physician at Asan Medical Center, graduated from Seoul National University College of Medicine and trained at Seoul National University Hospital. During his med-school days, while practicing the horn, he realized the importance of muscle maintenance and became interested in sarcopenia. His main research interests include frailty, sarcopenia and establishing age-friendly health systems for acute hospitals. This column was originally published in Chosun Ilbo in Korean on April 2, 2025. -- Ed.