Feature

Paying Blood Donors: Ignoring the Past and Endangering the Future

It saddens and angers me that we are having a serious debate about abandoning the principle of unpaid donations, and risking the safety of the blood supply, so that a private company can profit from this public resource.

By David Harvey
Published April 16, 2013

A private company is seeking to open paid blood donor clinics in Canada. They have two sites in downtown Toronto, and one in Hamilton. They want to pay people $20 to donate plasma, which can be done once a week. They are awaiting licensing decisions from Health Canada and Ontario's Ministry of Health.

To this point, Canada has relied on volunteers to donate blood. Donors who are motivated by altruism, not money: those who give to help, not to profit. And we rely on their honesty in truthfully answering screening questions before being qualified to donate.

In this system, both the donors and the collectors of blood share a single motivation - the collection of blood free from infection, that will be safe, and often life saving, for the recipient. No one has any incentive to be less than fully truthful, as there is nothing to be gained or lost.

But a paid donor system fundamentally changes that equation. Admitting you had the flu recently could disqualify you, costing you your $20. "I'm feeling fine now, nothing to worry about, I don't need to tell them".

Canada's Blood System Scandal

For 20 years, I was involved in examining what went wrong in the 1980's in Canada's blood system. I watched an entire generation of hemophiliacs get sick and die. I went to too many funerals, for friends who were taken far too young.

One of the fundamental causes of such a tragedy was scientific and bureaucratic arrogance - a belief that we knew all the risks and had conquered them. Even as the death toll rose from AIDS, those running the system repeated the erroneous risk figure of "one in a million".

By the time the actual risk was accepted and action taken, it was too late for far too many people.

So it is with disbelief and frustration that I see the same justifications being offered for accepting a system of paid donations, the same assertions being made that current testing and processing eliminates the risk of blood borne pathogens.

HIV was transmitted to blood recipients before anyone knew it existed. Hepatitis C was transmitted before it was appreciated how serious a disease it was. We have significantly reduced, but not eliminated, the risk of transmission of these diseases.

It would be foolish to assume that no new pathogen will appear. Lowering our guard, and accepting practices that are known to increase risk, could have deadly consequences.

Krever Inquiry

After an exhaustive, multi-million dollar, multi-year public inquiry into the blood system in Canada, Justice Horace Krever made dozens of recommendations to preserve and enhance the safety of the blood system in Canada.

The inquiry report set out several fundamental principles which should govern our blood supply, including:

  1. Blood is a public resource.

  2. Donors of blood and plasma should not be paid for their donations, except in rare circumstances.

  3. Safety of the blood supply system is paramount.

It saddens and angers me that we are now having a serious debate about abandoning the principle of unpaid donations, and risking the safety of the blood supply, so that a private company can profit from this public resource.

My friends James Kreppner and John Plater devoted the last years of their lives, often while suffering from debilitating illness, to advocating for a safer blood system for everyone. They're no longer here to do that, but I am, and I will. For them.

David Harvey is a retired lawyer living in Burlington. For 20 years, he represented people who had become infected with HIV and hepatitis C through blood and blood products in Canada. He represented patient groups at the Commission of Inquiry into the Blood System in Canada (the Krever Commission). He won damages for people infected with HIV, including precedent setting cases at the Supreme Court of Canada, and negotiated a $1 billion compensation package from the federal government for people infected with hepatitis C. Follow him on Twitter @davidharvey.

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By ScreamingViking (registered) | Posted April 16, 2013 at 21:19:34

As a regular blood donor, I too am troubled by this. The potential safety risks are of grave concern, but there are other things that are hopefully going to be carefully considered and discussed by Health Canada, provincial health ministries, Canadian Blood Services, health professionals, and the Canadian public (donors, recipients, and others).

I believe it's better to have one agency running the system. Will this company operate under the direct supervision of Canadian Blood Services? Or will they become a "competitor"? Plasma is just one component of whole blood, but will the new company eventually want to collect whole blood and platelets?

What will this do to the existing pool of donors? Will it cause a portion of them to decide it's not worth donating their blood unless they're paid to do so? Will many of them switch to donating plasma for money instead?

Are there better ways to encourage people to donate?

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By hipgnosis (anonymous) | Posted April 17, 2013 at 03:33:41

David,

I am unsure how the potential of paid donors of plasma puts the blood system at risk as a paid donor can lie as easy as someone who donates for free. I would also direct you and anyone reading this to a commentary written by Dr. Graham Sher from Canadian Blood Services here: http://www.thestar.com/opinion/commentary/2013/03/13/prohibiting_payforplasma_would_harm_patients.html

I would also direct you to the following Opinion article as well:

http://www.thestar.com/opinion/commentary/2013/03/18/thousands_of_canadians_depend_on_plasma_from_paid_donors.html

That last article is by the Canadian Hemophilia Society Blood Safety and Supply Committee. From what I read they are not concerned about any possible contamination from this and Hemophiliacs certainly have a reason to be concerned due to the tragedy of tainted blood from 20 years ago.

I don't agree with everything that has happened since the recommendations of the Krever Inquiry came out but I think that the Blood System and the techniques, fail-safes and redundancies used to protect it are strong. There is nothing wrong with wanting to make sure we don't forget what has happened in the past but I think condemning potential changes without providing all the information is wrong and a bit too agenda driven.

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By Ave (anonymous) | Posted April 19, 2013 at 16:57:36 in reply to Comment 87880

Thank you Hipgnosis for posting this articles. It helped me understand and view this paid plasma donation differently. I do believe, this private company will follow the tight regulation of Health Canada. Considering the fact that we need a lot of Plasma to make one medicine to save life, I believe that compensating the time of the donors will be a good idea.

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By Conrad664 (registered) | Posted April 17, 2013 at 15:22:05

I juste whould like to know what is the plasma thing all about .

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By Shawn Selway (anonymous) | Posted April 17, 2013 at 15:36:08

Good piece about a bad idea.

The Star covers this here :
http://www.thestar.com/life/2013/04/12/should_federal_and_provincial_regulators_allow_plasmaforprofit_clinics_to_operate_in_canada.html

The background to this story, which lies in the HIV epidemic ( and its hepatitis C shadow) is provided by Jacques Pepin in The Origin of Aids (Cambridge 2011). This is among the best works of history I have ever read. Pepin is professor in the Department of Microbiology and Infectious Diseases at Sherbrooke. He recruits and considers many kinds of evidence to produce plausible hypotheses of the emergence of the viral agent of the disease, its amplification in its human hosts and its eventual worldwide transmission. Many of Pepin's conclusions are probabilities only, though well supported. This is not the case with most of his chapter on the Blood Trade, in which he explains that the infection of haemophiliacs was only a portion of the problem. Also infected were the donors whose plasma had been processed to supply them.

Stated with maximum simplicity, this situation arose because of the development of a process called plasmapheresis, by which plasma - valuable for its many proteins - is separated from whole blood. The blood cells are returned to the donor along with fluids. This enables the donor to give plasma again within a few days or a week. However, this also meant that infectious agents could be transferred not only to the recipient of some part of the plasma, but also between donors if there was any lapse in equipment cleaning procedures. Accordingly, Pepin reports

"The first well-documented epidemic of HIV-1 among paid plasma donors occurred in a poor suburb of Mexico City where, in 1986, 281 donors were found to be HIV-infected, especially those that sold plasma ten or more times each month. Re-utilisation of blood collecting material was blamed. At the time there were thirteen plasmapheresis centres in the country, mainly in Mexico City and in states near the Texan border. Most donors were young men living in the per-urban shanty towns. They could sell their blood as often as every two to three days. By the time that the sale of plasma was prohibited nationwide in 1987, 7% of 9,100 paid donors were HIV-infected. In one of the plasmapheresis centres, HIV prevalence increased form 6% in June to 54% in November 1986. Other outbreaks among paid plasma donors were reported in Valencia, Spain and Pune, India...These outbreaks...were dwarfed by what happened in China in the early 1990s...There were several hundred plasma collection stations set up by blood product companies. In the most heavily affected provinces...approximately 250,000 paid donors acquired HIV. "

Yes, you read that right. 250,000.

Meanwhile, back in Haiti, a plasmapheresis centre operated by American investors and Luckner Cambronne, the head of the Tontons Macoutes, Duvaliers private militia, was exporting a maximum of 6000 litres a month to the U.S. from May 1971 to October 1972. When Cambronne was forced into exile by intrigues in Baby Doc's court, some of the shortfall in the supply was taken up by an outfit owned by Nicaraguan dictator Anastasio Somoza, which became the largest plasma collection facility in the world, processing up to 1,000 donors a day.

According to Pepin, "During the heyday of the plasma trade in the early 1970s, plasma was bought in at least twenty-five developing countries to be exported to pharmaceutical companies in the industrialized world. Apart from [Mexico, Haiti, and Nicaragua] the list included Belize, Brazil, Colombia, Costa Rica, the Dominican Republic, El Salvador, Guatemala, Puerto Rico, Taiwan, Thailand and even African counties such as Lesotho."

This is the crux, I think. Reportedly, Canada gets some portion of its current plasma needs from the States. What can this mean? Since living conditions are very similar in both countries, presumably the U.S. has the same per capita plasma needs as Canada, so how can there be a U.S. surplus for export? Because payment allows it to be tapped? But who is being tapped, and what happens to them if something goes wrong? What if plasma demand in the States goes up, and increased payments are not enough to maintain the exportable surplus? (This is pretty much a sure bet. Better option your plasma futures today. The income stream will allow you to purchase your health care services in the future. Ain't capitalism wonderful?) Suppliers will of course be seeking approvals to collect from wherever there are probable sellers.

Apart from the secondary problems of safety and security of supply arising from error and fraud, there is the primary question of responsibility. Shouldn't Canadians be responsible for our own health care, rather than outsourcing the supply of parts? If Americans or Mexicans or Haitians or whoever are shipping out plasma rather than using it within their own health care systems, doesn't it mean that there is something wrong with those systems?




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By jaybeejustme (anonymous) | Posted April 20, 2014 at 20:01:56

There is a need for this because not enough people donate. I see nothing wrong with being paid. People can lie without being paid, with this program there will be more donors that is so desperately needed common sense.

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