China's blood-borne HIV catastrophe in the 1990s prompted the government to adopt a blood-collection system that combines voluntary donations with the state's monopoly on blood services. Juxtaposing fieldwork and survey data, this study examines how the intricate interplay between government manoeuvres and citizen reactions has led to blood shortages that are serious yet manageable. This article reveals that even though voluntary blood donations are adversely affected by a public distrust of state-run collection agencies, owing to political concerns healthcare officials shirk from engaging with citizens to overcome the distrust. It also finds that the blood shortages are nevertheless largely manageable because the authorities have the capacity to recruit captive donors through work units, with the caveat that such captive practices are used sparingly. Overall, this study argues that the lack of state–society synergy in voluntary donations, while exacerbated by government involvement, is also partially remedied by the government's mobilization of captive donors.
