Introduction: The family voucher program (FVP) for living kidney donors was first introduced in the United States (US) in 2014, prompting ethical concerns as well as scepticism about its efficacy in expanding opportunities for transplantation. The program has since demonstrated modest success and avoided ethical controversies, prompting consideration of FVPs in other countries. Given current experience of FVP for kidney donation is limited to the US, engaging with knowledge of similar voucher programs used for blood donors may be helpful in informing the design and implementation of new programs. A variety of FVPs have been used in China, under policies permitting family replacement /mutual blood donation.
Methods: A scoping review of the literature was conducted to identify, describe and evaluate key models of FVP for blood donation used in China. A comparative analysis of selected models with the US FVP and variations proposed for living kidney donation was performed using a structured framework to evaluate objectives, ethical design elements, and outcomes of implementation including impact on donation rates, access to transfusion or transplantation for voucher beneficiaries, and ethical hazards. 
Results: Despite national legislation governing blood donation in China, considerable diversity is evident in models of FVP. Common features mirror those proposed or included in FVPs for kidney donors such as rules regarding eligibility of potential beneficiaries, degree of priority in allocation, and mechanisms to prevent fraud or commercial sale. Evidence suggests that use of FVPs may increase donation rates for blood and kidneys and aligns with public preferences regarding incentives for donation. However, case reports of trafficking in blood and system failures preventing access to blood transfusion for voucher beneficiaries in China demonstrate the validity of concerns about ethical implementation of FVPs.
Conclusion: As more countries consider the introduction of FVPs for living kidney donation, evaluating experiences with FVPs for blood donation may provide valuable insights regarding the risks and potential benefits of these programs. Use of FVPs may be effective in incentivising and reducing barriers to living donation of blood and kidneys but requires careful design and oversight of implementation to ensure ethical values and principles including solidarity, financial neutrality in donation, equity in access to transfusion and transplantation, and respect for donor autonomy are upheld.