Is it ethical to compensate plasma donors in the US, one of the world's leading suppliers?
Key Takeaways
The United States allows for paid plasma donations.
The financial exchanges raise ethical concerns for patients and providers.
Tens of millions of patients in the United States profit from donating their plasma. These paid donations raise ethical concerns for medical systems—and health concerns for repeat donors—but may be essential for addressing a global blood shortage.[][]
Donated plasma is used to create plasma-derived medicinal products (PDMP), “which are needed to prevent and treat a variety of serious conditions that occur worldwide,” according to the World Health Organization (WHO). Currently, only a minority of countries produce their own PDMP, which limits PDMP supply and patient access in some places. A report by the WHO found that out of 171 reporting countries that produce PDMP, 56 had their own, 91 used imported PDMP, and 16 did not use any PDMP (at the time they were surveyed).[]
Kristen Fuller, MD, a physician and MDLinx Medical Advisory Board Member, says, "the US is one of the biggest plasma exporters in the world, and selling plasma is a multi-billion dollar industry.”
The US is among the highest contributors of paid plasma donations, accounting for about $25 billion of blood plasma products annually. About two-thirds of the world’s plasma supply comes from the US as of 2021, NPR reports.[][]
“Donating plasma has become a way for people to make a supplemental income to help them pay bills, get through college, or put food on the table,” says Dr. Fuller.
The WHO encourages the creation of more sustainable plasma donation programs globally. However, the organization advocates for voluntary donations over paid donations. In 2010, the agency released a global framework for shifting toward 100% voluntary blood donations and eliminating paid donations.
The controversy behind paying for plasma
Mixing money with medicine can be messy. When it comes to plasma donations, this combination yields ethical concerns for both the industry and patients.
“It is one of the few donation-based medical procedures that is paid, but because it is paid, it has become a multi-billion [dollar] process, and many individuals who are struggling for money donate plasma on a regular basis for cash,” Dr. Fuller says.
Paying for other types of medical donations, like organ or bone marrow donations, is illegal, Dr. Fuller adds. Along with plasma, two other commonly paid-for donations include egg and sperm donations.
Further, while the process may help create medicine for a patient in need, donating plasma can too often have negative health impacts on the donor, Dr. Fuller says. Donating plasma is also known as ‘plassing’ and “can put the donor’s health at risk by making them feel fatigued and [by] potentially weakening their immune systems, making them more susceptible to common infections,” she adds.[]
The FDA says that “[d]onors must not be plasmapheresed” or donate plasma more than once over the course of 2 days or more than twice over the course of a week. In contrast, people have to wait at least eight weeks, or 56 days, between whole blood donations. This is in order to give time for the body’s red blood cells to replenish.[][]
Buying blood
Several countries prohibit compensation for blood plasma donations, but a handful allow for it. Some countries that permit paid blood plasma donations include Austria, the Czech Republic, Germany, Hungary, and the US.[]
In the US, it is legal to compensate people for whole blood and blood plasma donations, but Dr. Fuller says that compensating people for whole blood donations is rare.
Whole blood donations are what people typically think of when they hear ‘blood donation,’ and is a process that collects all four components of the blood: red blood cells, white blood cells, platelets, and plasma. In a plasma donation, only blood plasma is collected, and the other three elements are returned to the donor.
The US Food and Drug Administration (FDA) requires that bought/sold blood donations of any type be marked with a paid donor classification statement in order to distinguish them from voluntary donations. Hospitals can then easily identify paid-for versus donated blood. While hospitals tend to readily accept paid-for plasma, they tend to opt out of paid-for blood, Dr. Fuller says.
The reason for this is largely due to safety concerns. Dr. Fuller explains that major health organizations like the FDA and WHO worry that people may lie about their eligibility to donate whole blood if they know they can make money.[]
People can be ineligible to donate whole blood for various reasons, including if they have blood-borne illnesses or chronic diseases that affect their blood,” Dr. Fuller says. Bloodborne pathogens can be transmitted through blood transfusions.[]
These same risks are less likely to arise via donated blood plasma, which, unlike whole blood, does not go directly into the receiving patient. Dr. Fuller says.
With so much reliance on plasma from the US, the world might not be able to ban paid plasma donations. Moving forward, Dr. Fuller says that she wants to see tighter regulations on the number of plasma donations individuals can give each year, with higher compensation for each draw, in order to protect the health of the donor.
“Since most patients are selling their plasma to make ends meet but are at risk of being fatigued and having a weakened immune system temporarily, it makes sense to limit their number of plasma donations, but [to] compensate them appropriately,” Dr. Fuller says.
She adds that while she personally disagrees with the paid donation model, “if the FDA is going to pay people, then [it] should compensate them appropriately.”
What this means for you
The US’s plasma donation system, which financially compensates donors, raises ethical concerns; however, it also supplies the world with a large proportion of medically needed plasma.