Selling Blood Plasma Is Not Unethical

Several Canadian provinces are currently considering proposals to ban payments for blood plasma. Ontario, Quebec, and Alberta have already adopted such bans.

It’s a bad idea. Canadian patients need more plasma, and such bans will only get in the way.

Blood plasma is a pale yellow fluid of whole blood that includes water and its medically valuable dissolved constituents, including albumin, clotting factors, and immune globulins. A company called Canadian Plasma Resources wants to open commercial plasma centers, where it would pay sellers between $25 and $50 per session. Obtaining plasma takes considerably longer than regular blood donations—between an hour and 90 minutes more—and paying for it makes people more likely to offer it. (It is not illegal in the U.S. to pay for whole blood, but it must be labeled as such and hospitals generally choose not to use products that are labeled from a paid donor for liability reasons. Let us set aside why that is the case for another time.)

In an op-ed in The Toronto Star, Canadian Doctors for Medicare chief Danyaal Raza claims that “Paying Canadians for plasma donations carries too many risks and should be stopped.” Similarly, the nonprofit Canadian Blood Services (CBS), which is in charge of obtaining and distributing fresh blood donations, is against commercial plasma collection.

Yet CBS issued a statement two years ago that acknowledged two important facts:

• Drugs made from plasma donated by paid donors are just as safe as those made from plasma from volunteer donors.

• Access to the commercial paid plasma market is essential in ensuring enough supply so that Canadian patients continue to receive the lifesaving therapies they need.

CBS also noted that unpaid Canadian plasma donations are not enough to supply Canadian patients with vital plasma protein products such as immune globulins. “We only collect enough plasma to meet about 25 per cent of the demand for immune globulins,” the group notes. “The remaining plasma needed to make these drugs comes from paid donors in the United States. It is safe and is acceptable to patient groups who use these products and recognize this practice ensures security of supply.”

Given this shortage, why are some Canadian ethicists, physicians, and legislators opposed to paying for plasma from sellers? Many of them argue that the folks who sell plasma are more likely to be poor and to harbor diseases that could taint plasma supplies. Earlier this month a group of ethicists and economists organized by the Georgetown philosopher Peter Jaworski countered these arguments in an open letter that concluded these concerns are unwarranted.

The Jaworski letter begins by pointing out that “Canada is almost entirely dependent on the United States for its supply of plasma-derived medicinal products, like immune globulin, albumin, and clotting factor.” (More than 90 percent of the world’s plasma comes from the U.S.)

“The fact that we’re buying plasma products from south of the border rather undermines our rationale for not paying donors here, because it suggests we don’t actually believe that payment is unsafe, commodifying, or exploitative, and shows just how badly these products are needed,” says Vida Panitch, an ethicist at Carleton University and a signatory to the letter.

Other opponents of plasma sales argue that they exploit low-income sellers. The open letter notes that plasmapheresis—the process in which the liquid part of the blood is separated from the blood cells—is non-invasive, and that the level of compensation is not so high as to unduly induce someone to sell. They further observe that there is no evidence that compensation to sellers of blood plasma donations has “promoted the view that donors or their blood plasma are regarded as mere commodities.”

The group also rebuts the worry that paying people for plasma will necessarily reduce the incentives for altruistic donations. Over 600 paid plasma collection centers operate in the U.S., yet the country has an approximately 50 percent higher rate of voluntary, unpaid blood donations than Canada does.

Finally, the signatories argue that banning compensation for plasma is itself unethical because it is likely to harm patients by reducing the supply of vital medicines. They correctly conclude that “none of the moral objections to the compensatory model are persuasive.” If anything, they think there’s a “strong moral presumption” against any law that would reduce the supply of plasma-derived medical products.