Should donors get paid for plasma?
Plasma is a light-yellow colored liquid that makes up about half the volume of our blood. Plasma acts like a courier in your body’s circulatory system. It’s an essential substance that helps so many of our bodies’ other functions to work properly.
Plasma is what carries nutrients from your digestive system to other parts of your body. When you get a cut, plasma carries clotting factors to the site of your injury, which helps you stop bleeding. It carries antibodies that fight infections throughout your body.
Plasma plays a large role in medications and treatments. Those who suffer fromhemophilia rely on plasma-based treatments to regulate their blood clotting. Plasma medications can treat immune deficiencies. They can also help with liver disease, severe burns, and other rare conditions.
There is only one place to get plasma for these treatments, and that is from living humans, who donate plasma. Every one of us has about four pints of plasma in our blood at any given moment. Our bodies replenish plasma easily after a donation. It takes just over an hour to donate.
But the world is facing a shortage of plasma. Patients who need plasma treatments often have to wait to receive the treatment they need. Hospitals ration the limited supplies of blood-based medication they do have available. And many poor countries simply can’t get plasma treatments at all, so patients there have fewer options for treatment.
But hang on a second: if almost all of us have lots of plasma, and if it’s safe for most people to donate, and if donors’ bodies replenish plasma in a couple of hours, then why is there a shortage?
It’s not easy to donate plasma. If you’ve ever donated blood, then you know what’s it’s like. It takes time and effort to go to a donation center. After giving, donors might feel fatigued for a little while. All in all, it’s hard to convince people to voluntarily donate plasma.
So if it’s hard to convince people to donate plasma out of the goodness of their hearts, what about sweetening the deal a little? Surely, offering a little bit of an incentive would help, right? Patients need life-saving treatment; people need money. Paying donors a little bit of money for their plasma would seem like a win-win.
It turns out that in most countries, it’s illegal to pay for plasma donations. The World Health Organization advises against paying for plasma, saying that voluntary contributions should meet the need for blood treatments. But this is easier said than done. Very few countries can collect in donations what they need for their own patients.
So where does most of the world get the plasma it needs to treat its patients? Most countries import it from the handful of other countries that allow paid donations. Those other countries are Austria, parts of Canada, the Czech Republic, Germany, Hungary, and the United States.
In the U.S., for example, twenty million people donate plasma annually—about eight percent of the nation’s adult population. But that eight percent of the U.S. population supplies 70 percent of the world’s plasma needs.
If paying for plasma has worked so well in the United States, then why don’t other countries allow it? There are two main arguments against this practice.
The first, and the strongest argument, is that paying people for their plasma exploits the poor. According to this argument, the most vulnerable people in society will open their veins time and again for a quick hit of cash. This seems inhumane. It sounds like something out of a dystopian novel. Capitalist drug companies want to literally suck the blood of the poor, all for their own profits.
Is this argument valid? Let’s consider the experience from the United States, by far the world’s biggest supplier of plasma.
Who are the people who donate plasma? In the United States, plasma donors are more likely to be poor, single parents, and ethnic minorities. Many people donate plasma to boost their incomes. Some donate proudly and go to the donation center with family and friends, but many people are ashamed that they donate, they’re ashamed that they need the money, so they don’t tell anyone.
The U.S. allows plasma donation twice in seven days. Each donation pays about $50 and lasts about 90 minutes. A lot of donors go to plasma centers when they need a quick infusion of cash. But some people donate frequently. If you go twice a week in the U.S., you can make $5,200 per year—that can make a big difference.
Some plasma centers gamify donations, awarding loyalty points and prizes for frequent visits. Billboards on the highway tout plasma donation as a “part-time job” or part of the “gig economy.”
So this would tend to support the argument that it’s mostly lower-income people who donate. But it doesn’t necessarily mean the poor are being exploited. People see it as another option to get a little extra money if they need it. A recent study showed that some people choose plasma donation instead of a high-interest loan when they have an unexpected expense.
It’s understandable if the commercialization makes you uncomfortable. But not every country that allows paid plasma donations is as freewheeling as the United States. Germany limits donations to sixty times per year, so it’s much less likely that you can make this a part-time, year-round gig in Germany. In some countries, it’s not permitted to advertise the payment on billboards, which makes it seem less commercial.
Besides, people of all income levels donate plasma for reasons other than the money, even if they do get paid a little for it. Many donors want to do something good for the world. They take time out of their day, they visit a clinic, they get a needle in their arm, and they may feel tired afterward. Sure, they get a little money for it, but they don’t consider it a part-time job, just a small incentive to compensate them for the effort and the hassle.
The second argument against paid plasma donations is about safety: people who have certain diseases cannot donate plasma. The concern is that some ineligible donors who need a quick fifty bucks may not be truthful on their screening questionnaires and donate anyway.
But there is a lot of testing done on donated plasma and the likelihood of disease transmission is extremely low. Many of today’s fears stem from high-profile outbreaks of HIV and hepatitis in donated blood in the 1970s and the 1980s, when testing wasn’t as advanced as it is today.
The argument about safety is less valid. The question comes down to this: where paid plasma donations are legal, the people who donate are disproportionately, though not exclusively, poor, and they often, but not always, do it because they need the money. This makes people uncomfortable and this is why people think it should not be allowed.
But this discomfort must be set against the global shortage of lifesaving medicine. Shouldn’t it also be uncomfortable that patients, especially in the poorest countries, don’t even have the option to receive plasma-based treatments? A single patient with an autoimmune disease needs hundreds of donations’ worth of plasma in a year. Where is all that plasma going to come from, if not from paid donors?
Jeff’s take
I don’t love it that people feel the need to get a needle in their arm when they need $50, and I don’t love the gamification and ads promoting plasma as a part-time job. But if the system is safe, sanitary, and regulated to prevent abuse, then I think it’s better than the alternative, which is shortages and rationing of medication for people who are suffering.
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