Blood in the Water

Illustration by Lily Xu

Illustration by Lily Xu

There is roughly a gallon of blood sloshing around in your veins right now. If you were to lose around 40% of it, the lack of oxygen being carried to organs and strain on your heart to keep blood pressure high would quickly result in death. This need for donated blood is common in car accidents or for cancer patients undergoing chemotherapy, and can require up to 100 pints of transfused blood. Without a way to artificially replicate human blood, the blood needed must come from donors. Since red blood cells remain viable for 42 days and platelets only 5 days, there is a constant need for blood donation [1, 11]. However, while whole blood donations are just that, donations, blood plasma is bought and sold.

Blood plasma is the liquid part of blood, consisting mostly of water, nutrients, and proteins without red blood cells or platelets. Blood from the donor is run through a plasmapheresis machine which separates its components and collects the plasma while returning the cellular components undamaged. Unlike with whole blood donations, donors can be paid between $20-50 per donation depending on volume of plasma they give (restricted based on weight classes determined by the FDA as 110-149 pounds, 150-174 pounds, 175-400 pounds) [6,7]. Donors can donate up to twice a week, more frequently than in any other country. However, many organizations such as the American Red Cross recommend only donating every 28 days [5].

Plasma donations are far less well-regulated than whole blood donations, primarily because they are easier to screen for transmittable diseases. In addition, plasma is rarely given directly to a patient but instead to large pharmaceutical companies that process them into treatments for those with coagulation disorders (such as hemophilia and von Willebrand disease) [11]. Many such treatments are so plasma-intensive that they collectively require millions of liters of plasma each year. Someone with hemophilia might annually require the yield of as many as 1,200 donations [10]. On top of that, global demand for donated plasma has steadily risen with an aging  population that requires plasma-based treatments. Pharmaceutical companies are frequently the ones that set up collecting centers necessary to obtain this plasma, and unlike most whole blood donation organizations, are for-profit [6]. Thus, they offer monetary reward for donations. Economic conditions have had a drastic effect on the spread of paid plasma donations. The number of centers in the United States ballooned during the 2008 recession, with 100 new centers opening and total donations rising from 12.5 million in 2006 to more than 23 million in 2011 [3,10]. The U.S continues to dominate the blood plasma market. Roughly 70% of worldwide collections comes from U.S. plasma donors, especially those from poor and rural areas [7].
There is some backlash about being paid for donating plasma, partly from ethical concerns about “selling” body parts and also from practical concerns such as the health and safety of the donor and recipients of the plasma. Having a monetary incentive gives donors motivation to lie on screening tests about any transmittable diseases they may have come into contact with, as well as if they are healthy enough to actually donate [3]. While donating plasma is not dangerous, it does come with side effects such as dizziness, faintness, vein damage (hardening and scarring), and bruising [8]. The sodium citrate given as an anticoagulant during the donation process can also cause adverse effects such as numbness and in rare (but severe) cases, irregular pulse, muscle twitches, seizures, and death. Since it binds to calcium, it may also have an adverse effect on bone density in the long term [12]. Plasma donation also removes serum immunoglobulins which weakens the immune system and elevates risk of infection, but long term effects of plasma donation have not been well investigated [12]. These risks are higher for the impoverished, the majority of donors, due to poor nutrition and lack of access to healthcare. There are also many anecdotal accounts of feeling physically weak and rundown after regular donations [4].

The devastating effects of underregulation of donation were seen during the AIDS/HIV epidemic in which hemophiliacs had a shockingly high infection rate. From 1960-1970, 50% of hemophiliacs contracted HIV from tainted pharmaceuticals derived from U.S. plasma, causing a widespread scandal and class-action lawsuits that exposed disturbing evidence of companies knowingly distributing tainted blood plasma treatments [7, 10]. The recipients of blood plasma are not the only ones who suffer from contamination either. In the 1990s, China attempted to compete with Western companies by offering money for plasma in its most impoverished province, Henan. Villagers could earn more money by selling plasma than by farming, but the facilities offered substandard sterilization techniques. By 1995, Henan had become a “blood farm” and thousands of Chinese donors became infected with AIDS and Hepatitis C [2]. While practices are much improved today (with a roughly 1 in 2 million chance of contracting HIV from a blood transfusion), there are still many problems with the system. U.S. companies pool donations for processing, often putting together hundred thousands of donations compared to Belgium’s  5,000 and Germany’s 60,000 [9]. The larger the pool, the cheaper it is to screen but the higher the chance that each batch is contaminated.

The question of whether parts of the human body can be bought and sold is a difficult one, and in this case, complicated further by the idea of it being voluntary. The Red Cross states that it, “…only accepts blood donations from volunteer donors,” and while no one is forced to donate blood plasma, offering a monetary reward for this muddles the waters [1]. Many plasma donors are Americans who need the money as a form of supplementary income, especially since more money is given to regular donors. The money provided by plasma donation also comes with the social stigma that only the truly desperate would be willing to sell bodily fluids in order to scrape by. However, it is increasingly becoming a norm among those in financial need, who donate as often as possible. The idea that people feel forced to monetize their body is disturbing to say the least, but for many households, donations represent a necessary income source. There have not been studies done on the extent to which donations are voluntary as opposed to their usage in the absence of an adequate social safety net.

However, there is no doubt that plasma donations are necessary and lifesaving. There is little to no risk for occasional donors, and while there are many improvements that need to be made to the current system, it is necessary to have such a system in place. Without plasma donations, many essential medical treatments would be unavailable to those who need them. Decreasing the frequency of donations and changing the practice of pooling hundreds of thousands of donations together would vastly improve the negative impact on both the donor and the recipient. Since these plasma donation programs are largely run by for-profit pharmaceutical companies, there is little incentive for them to make these changes which may require federal enforcement. In the end, no one should be donating parts of themselves out of anything but genuine altruism.

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