Do You Want Your Plasma to Come From a Voluntary Donor, or a Paid Donor?

Need a couple of extra bucks this week? How about selling your plasma? Might be a better option than a payday loan. Put the money in your pocket and walk away. Plasma selling centers are popping up all over the U.S.

Is it ethical? Maybe. Maybe not. Read on to find out about the burgeoning plasma business.

Plasma accounts for about 60% of a person's total blood volume. The average adult has about 5 liters of blood. Women have slightly less. Blood is valuable, and whole blood is hard to come by. Plasma, on the other hand, is not so hard to find. A plasma-buying center is opening up near you (if you live in the U.S). I just looked at Google Maps. I plugged in different communities across the country (including my own) and the bright red plasma donation symbol popped up everywhere.

While blood donation is limited (legally) to once every 56 days, plasma can be donated twice a week (in the U. S.). Donors receive between $50 and $100 per donation. The amount varies by state.

Here's a link to a list of states and what a donor might expect to receive in each state.

The economic incentive for donating plasma can be quite strong. At $100 a session, twice a week, such donations could amount to a tidy little second income. Indeed, in the U. S. the number of plasma donation centers has increased recently, and this is regarded by some as an indication of the rising cost of living. One study, described in the Independent, reports that plasma donations have increased by 30% since 2022.

Not every country believes paying for plasma is ethical. Some countries banned it and only allow non-monetary donations. Among these are: Australia, New Zealand, the UK, the Netherlands, Zimbabwe, South Africa and France. Commercial collection (pay for donations) is allowed in Austria, the Czech Republic, Germany, China and the US (among other countries).

Most African countries do not allow payment for plasma donations. This statement from Namibia reflects the attitude of some toward paid plasma donation:

Blood is a human tissue. Paying a substantial sum for blood, such as “even a N$200”, as cited in one post, would be tantamount to the commodification of human tissue.
Paying N$200 to potential donors would border on coercion in our country, where a large number of the population might donate because they live below the poverty line.
Offering monetary compensation for blood might increase the percentage of donations that have HIV beyond what is sustainable for NamBTS.

The World Health Organization encourages voluntary donation over paid donation. The WHO explains that voluntary donors:

are also the safest group of donors as the prevalence of bloodborne infections is lowest among this group.

The organization also offers caution about accepting donations from low-income countries, where disease prevalence is higher. The chart published on their site shows, for example, that transmission of syphilis, HIV and HBV in blood from high-income countries is found to range from 0.01% (HIV) to 0.12% (HBV and Syphilis). Low-income country donations transmission of these same diseases ranges from 1.60% (for HIV) to 6% (for HBV).

WHO attributes the difference in disease transmission to the prevalence of the disease in the respective donor pools.

I was talking to my son about plasma donation and he said, "Oh yea, the homeless and addicts have always gone there."

So how safe is the blood derived from paid donors? I found an article published by the "International Journal of Transfusion Medicine". The article found that frequent donors experience a decline in immunoglobulin G levels. The authors conclude, " Because commercial plasma donation centres are located in areas of greater poverty, vulnerable populations are made even more vulnerable concerning their health safety..."

But, does monetary remuneration affect the safety of the blood collected? Apparently it does. The report states:

A study examining this unique within-country (Lithuania) natural experiment showed higher prevalence of transfusion-transmitted infectious (TTI) disease markers for remunerated donations compared to donations based on VNRD (Voluntary Non Remunerated Donations) from 2013 to 2017. This is consistent with previous research that found lower TTI disease markers for voluntary compared to paid donors in the Democratic Republic of Congo and Nigeria.

Plasmapheresis Machine

_{Image Credit: RexxS. Used under Creative Commons Attribution-Share Alike 4.0 International license.. Caption reads: Plasma donation uses two lines - the machine takes whole blood through one line and centrifugally separates the plasma (about 100 ml per cycle), returning the red cells via the second line. The target is usually 560 ml, which requires several cycles.}

Why Plasma?
Many of us have received, or know someone who has received a whole blood transfusion. In 1989 I had emergency surgery and received 2 1/2 pints of blood. By that time, testing for HIV had become routine. Still I felt a level of discomfort because I had received blood donation from potentially three anonymous donors. Whole blood is a more difficult resource to collect and store than plasma. Yet, plasma is life saving.

PDMP: Plasma Derived Medicinal Products are widely used. Three of the most commonly used PDMPs are listed below:

Clotting Factor
In hemophilia, for example, one patient may require plasma-derived clotting factor from as many as 1200 donors over a period of a year. While there are clotting factors that can be produced in a lab, for many hemophiliacs these are rejected by the body and a plasma-derived factor is used.

Immunoglobulin
Many of us may have heard about the use of immunoglobulin to treat recalcitrant COVID19 infections. However, this compound is a life saver for other conditions. Made from immune cells in plasma, immunoglobulin treats just about any disease in which the immune system needs a boost. The Cleveland Clinic lists the following, which is not exhasutive:

HIV.
COVID-19.
Kawasaki disease.
Lupus.
Adult-onset Still’s disease.
Myositis and polymyositis.
Vasculitis.
Sjögren’s syndrome.
Diabetes.

I am personally familiar with immunoglobulin in the treatment of autoimmune diseases. Some years ago my brother suddenly experienced seizures, personality change and mental confusion. After several misdiagnoses (including senile dementia) it was discovered that he had voltage-gated autoimmune encephalitis. Once the correct diagnosis was given, appropriate treatment was offered. This was a combination of corticosteroids, plasmapheresis (removes harmful elements from plasma), and immunoglobulin. My brother recovered, though because of the delay in diagnosis he did experience some long-term effects.

Albumin
According to the Mayo Clinic, albumin has a number of vital uses. It increases blood volume. It's apparently important in the treatment of malnutrition, major burns and severe injury. It helps in the treatment of pancreatitis, infections and cardiopulmonary bypass surgery.

Apparently, albumin is an essential product of plasma collection.

To Pay or Not to Pay for Plasma
There is a lot of money to be made off plasma. The U.S. supplies 70% of the plasma used worldwide. In 2023, that was $37 billion worth of exported plasma. The exported plasma was worth more, according to the Cornell SC Johnson College of Business, than exported coal and gold.

Is harvesting plasma from paid donors ethical? Is it safe? Is it a case of the well-healed living off the poor? What about a kidney? Why not sell that? Or, what about paid organ donation at death?

There are certainly ethical and safety considerations in the plasma-for-sale industry. It's new to me, so I thought I'd mull the issue over in a blog and share those thoughts with my readers.

Thank you for reading my blog. Hive on!
Peace and health to all. May calm, and kindness prevail in my country.