Background: While providing adequate and healthy blood, governments should ensure that measures are taken to respect the right of blood donors to privacy and confidentiality of information and their right to informed consent, as well as to protect them from stigma and discrimination. Therefore, the present study aims to explore the ethical challenges in blood donation from the perspective of policy makers, experts and stakeholders of blood transfusion.

  Materials and Methods: This qualitative content analysis study was conducted in the second half of 2019 (before the Covid-19 pandemic). The participants consisted of policy makers and experts from the Blood Transfusion Organization and the Deputy of Public Health, Ministry of Health and Medical Education and also blood donors. Purposeful sampling and focus group discussion were used to collect data. Data analysis was performed by Graneheim and Lundman inductive content analysis.

  Results: In this study, four main themes emerged in relation to ethical challenges in blood donation: First, the relativity of confidentiality, which itself includes three sub-themes: donor privacy and mutual trust, public health preference, and low awareness about examples of confidentiality and disclosure of information; Second, the occasional conflict between donation motivation and organizational policies; Third,  ambiguous informed consent; And Fourth, the fear of social stigma and lack of alternatives to increase confidentiality.  Conclusion: The findings indicate the need to evaluate the executive processes of registration and reporting, and devise alternative strategies to secure these processes, in order to ensure the confidentiality of information, while informing and building trust.