We don’t pay donors for blood plasma. But is that the right approach?

Most if not all societies accept, or demand, that people receive fair remuneration for their time and effort in many activities; from white-collar jobs like bureaucrats and bond traders, to risky ones such as high-rise window cleaners, miners and soldiers, to jobs with a more direct, “prosocial” impact like nurses and teachers.

For other services with similar requisites (effort, time, even physical discomfort), however, payments are highly contested, and societies and jurisdictions vary considerably in how they regulate them.

One such case is the supply of blood plasma, the liquid part of blood that remains after removing platelets and red and white cells. It contains salts, enzymes, antibodies and other proteins that contribute to blood clotting and fighting infections. Patients can receive plasma via direct transfusion, but plasma is also a key ingredient in therapies to treat chronic diseases and disorders such as primary immunodeficiency, hemophilia and genetic lung disease, as well as for trauma and burns. Producing these therapies requires a lot of plasma. For example, the annual treatment of hemophilia requires 1,200 plasma donations per patient.

To obtain plasma, a “donor” would have their blood drawn, a centrifuge would separate the liquid and the solid parts, and the solid parts would be transferred back to the donor – a procedure that can last up to an hour and produces some physical discomfort. Yet, most societies would not consider this activity worthy of remuneration.

The stated reasons are several. Paying plasma donors may be exploitative of people in more precarious economic conditions; it may attract donors with diseases or life habits that may compromise the quality of their plasma; adding money to this transaction would reduce the “intrinsic,” altruistic motivation of potential donors; more broadly, profit motives (of donors and companies collecting plasma) should not concern exchanges that include the human bodies or its parts, and this commodification would deteriorate some deep-rooted values that hold a society together.

It is for a combination of these reasons that, in Canada, remuneration to plasma donors, as well as the establishment of private plasma collection centres, has not been allowed. And despite some openings in this direction, Toronto recently reinstated its opposition. The city is not alone; the European Union also recently deliberated for tighter restrictions as well.

Concluding that this is irrational because remuneration would attract more donors and guarantee a greater domestic supply of plasma would be a mistake. The aversion to payments appeals to beliefs, norms and values that are important for societies as they serve as connections between different people: sharing (and promoting) certain values enhances cooperation and peaceful cohabitation, for example.

But it would also be a mistake to assume that those values are so strong and widespread that they are impermeable to considerations of a number of facts about the collection and allocation of blood plasma, in Canada and worldwide. So maybe it is worth going through some of these facts – five, to be precise.

First, the vast majority of plasma used in the production of therapies in Canada comes from the United States, where donors are compensated (typically between $30 and $50 per donation). For example, about 80 per cent of immunoglobulin used in Canada is made from American paid plasma donors (immunoglobulin therapy treats primary immunodeficiency, Kawasaki disease, certain cases of HIV/AIDS, measles and Guillain-Barré syndrome, among other conditions).

Second, the only countries with a domestic supply of plasma for pharmaceutical use that exceeds the needs of resident patients are those where remuneration is legal. In addition to the U.S., these include Austria, Germany and the Czech Republic, for example. Simply put, economic incentives increase the willingness to provide plasma.

Third, the dangers about the quality of collected plasma from compensated donors, which led to the transfusion of plasma contaminated with Hepatitis C and HIV in the 1980s in Canada as documented by the Krever Inquiry, are, thankfully, no longer present. Studies and reviews over the past 40 years, based on evidence from large, representative samples, show that properly devised rewards increase supply without compromising the quality and safety of blood and its components. Current regulatory measures, scientific advances in testing and donor selection and rigid inspections of facilities guarantee the absence or removal of known and unknown infective agents.

Fourth, plasma supply shortages are particularly severe in low-income countries. The causes range from the lack of resources to guarantee “state of the art” safety measures, to the high price of importing plasma because only a few firms – all from the few countries that allow these firms to operate – dominate the market.

Fifth, allowing for payments does not necessarily imply permitting for-profit collection companies to operate in a territory. Perhaps because of the influence of the U.S. model, an argument against remuneration is that the collection and allocation of plasma should be shielded from profit motives. This conflation makes it difficult to understand what exactly is morally unacceptable to people. Nothing prevents publicly owned or non-profit collection agencies from offering economic incentives, with the achievement of social welfare as opposed to private economic returns as the main objective.

Any debate about whether to enhance the domestic supply of blood plasma by allowing payments to donors should consider these five items and ensure that citizens are aware of them. Because of the moral charge of the activity in question, no one should claim that there is only one right policy to adopt. But everyone should first have full awareness of the context before concluding that compromises between moral concerns and the benefits of allowing for payments (under a variety of regulatory and organizational arrangements) are not possible.