Is it ethical to pay blood donors?

Writing at Maclean’s, Anne Kingston has an interesting column up about the application by Canadian Plasma Resources to begin paying for blood plasma donations at two locations in Ontario. Currently Ontario, like most of Canada, doesn’t allow any such payments, but support for such a change may be growing. At the very least, the federal government (unlike most provincial governments) hasn’t explicitly denounced the idea.

From the article:

Canadian Plasma Resources isn’t the first entrant to the pay-for-plasma market; Winnipeg’s Cangene Plasma has been paying for plasma for decades. But it’s proving to be a game changer that’s exposing public interests, political expediency and marketplace realities. Eighty per cent of plasma products used in this country are already produced from paid-for plasma in the U.S. So the real question is: what are the consequences to the Canadian blood system and public health care if Canadian donors are paid for plasma?

The question of blood-system safety remains a flashpoint in Canada, two decades after the “tainted blood” scandal of the late ’80s and early ’90s. More than 20,000 Canadians became infected with HIV and hepatitis C due to improperly screened blood and plasma from paid donors in Haiti and American skid rows. The tragedy led to the creation of Canadian Blood Services and Héma-Québec in 1998, set up to rebuild and oversee the blood system. It also resulted in the Krever commission, which recommended blood donors “should not be paid for their donations, except in rare circumstances.” The World Health Organization agrees: it wants all countries to move to unpaid donation systems by 2020 due to studies pointing to volunteers having the lowest prevalence of blood-borne infections.

But the high demand for plasma is bridging the public and private realms: the viscous, yellow liquid is used both in transfusions and as a raw material for a $20-billion biopharmaceutical sector growing at 10 per cent a year. Fractionation technology separates plasma proteins into life-saving therapies—albumin to treat burns, clotting factor for bleeding disorders and intravenous immunoglobulin (IvIG) for infections and immune disorders. The market for IvIG, in particular, is booming, with Canada one of the highest per capita users. If current clinical trials using IvIG to treat Alzheimer’s are successful, it could result in a new market worth $7.2 billion in the U.S. alone by 2017, Bloomberg News recently reported.

There’s clearly a lot of baggage around blood donations in Canada. And it’s interesting that we currently use a lot of pay-for-plasma services – just none of the blood that’s used in donations comes from such sources. So, what do you think, should Canada allow more cash-for-blood companies to operate? Should that blood be used both for product development as well as for blood transfusions?

Jonathan McLeod

Jonathan McLeod is a writer living in Ottawa, Ontario. (That means Canada.) He spends too much time following local politics and writing about zoning issues. Follow him on Twitter.


  1. When I was in college, I sold plasma twice a week. You got $15 for your first donation in a week, and $20 for your second donation in the week. This was walking distance from the campus so, like, *EVERYBODY* on campus donated twice a week and got their $35.

    An equally important question could easily be: “How much plasma do you want?”

    If the answer is “eh, not much”, then the ethics of paying for it have one pretty strong dynamic that balances everything out and can lead you to conclude that you can get buy on donations. If the answer is “we need the amount that would be provided by everybody at a local college donating twice a week”, then maybe you want to look at spending money.

  2. The ethical question for me relates to the practical effects of such a policy. If we pay for blood donations, the option is most likely to be taken up by people who are in serious need of money, i.e., the poor. The middle quoted paragraph above confirms this. If this causes them to donate blood to the extent that they’re damaging their own health, then it’s a serious problem and a bad policy – and the less healthy you are in the first place, the more likely it is that you’ll see adverse effects from donating blood. It’s also probable that poorer people are more likely to be anemic, which would make the blood less useful, aside from other issues of diseases that may be more prevalent among poorer people (although if they didn’t know they were sick, and their contact information was kept, the donors could – if the program was well-managed, which I have doubts on – also be informed if they had a disease).

    I strongly suspect that the downsides would outweigh the upsides.

    I do think that it is absolutely unethical for a private company to make money off selling blood to the government health system – this is something donated by people, to be used for a vital medical purpose; there’s no roof for profit in that purpose.

    (Also, I’m kind of amazed that, with all the scientific advances we’ve made, we can’t yet synthesize blood for medical purposes.)

    • Would putting the centers in college towns help at all with the whole “poorer people tend to have less desirable blood” thing?

      • I don’t know how much Canada does the “college towns” thing. US universities are older, so you’ve got situations where towns grew up around an educational facility. Most of the main/largest universities in Canada are in the major cities, though there are exceptions (Guelph, ON comes to mind as a smallish town with a prominent university). In any major cities, I think you’d face the issues I outlined.

        A lot of university students tend to be low-income, too. I really have no idea what the illness ratios of college students : other low-income-people : general population are.

    • I do think that it is absolutely unethical for a private company to make money off selling blood to the government health system – this is something donated by people, to be used for a vital medical purpose; there’s no roof for profit in that purpose.

      The company in question, Canadian Plasma Resources, appears to already be in business and collecting plasma from unpaid donors. That’s the status quo: plasma from donors is used by pharmaceutical companies to create products that are sold.

      • yeah, i mean the current state is that donated blood will be sold or used for paid services no matter what. paying for it is a step up. right now we rely upon goodwill and people with a sense of civic duty (in nyc that happens to be religious organizations, especially jewish ones) and as someone involved in trying to get the # of donors to go up, it is a ridiculous slog uphill.

        we already offer all kinds of secondary inducements along social signaling lines – shirts, stickers, other stuff with “i donated” or “i saved a life” on them – dropping 20 or 25 dollars in cash or gift cards is still a very minor amount of money to pay versus what a hospital actually pays for blood and blood components.

  3. Off topic – I was at the NDP convention in Montreal this weekend. Did you follow the convention? Are you going to post on it? If the answer to both the above is no, would you be averse to me putting together a guest post on the subject for this blog?

    (I’m a New Democrat, but I don’t intend such a post to be completely partisan. I think there was some interesting stuff at the convention that I’d like to discuss – it was a significant and contentious moment in the evolution of the NDP – and it was my first time attending any party convention so I have some more general observations from an outsider’s perspective as well.)

    • I would really like to read a post about this from either of you.

      A former member of the Young NDP who was required to list that affiliation on her US immigration application.

      • Seriously? As in, “Are you now or have you ever been….”?


        (Or do you just have to list any foreign political affiliations?)

        • When I was called in for Jury Duty, I had to answer the question “Have you ever disagreed with any military or foreign policy decisions by the US government? If yes, please list.”

          They gave me three lines with which to list any and all disagreements I have had with military or foreign policy decisions by the US government. Not three pages, but three lines.

          The case had nothing to do with the military (It was a serial killer! I kid you not!). The prosecutor did grill me on my answer to that question, though. She was looking for any reason to get me out of the jury pool, so she tried to paint me as an anti-government fanatic during questioning. She didn’t succeed and had to use a strike to keep me off the jury.

          The culprit is still on death row.

    • Stupid American question… so what’s the deal with the NDP? I know that it’s a liberal party and I am under the impression moreso than the Liberal Party. So is it the party for people who think that the Liberal Party is for corporate sellouts? Like our Naderites, except viable?

      I watched a Canadian political debate in 2000. It was fascinating though I fear I looked at it so much through American eyes. I liked Stockwell Day (to the horror of my Canadian friends) and, oddly enough, the Bloc guy (Gilles Duceppe, looking it up). He made me think of southern politicians (not in a bad way, and not connected to secessionist impulses).

      • This turned out longer than I planned; it’s now a recap of recent Canadian political history. But things have changed so much lately that you need it in order to understand what the NDP is.

        The NDP is (or, with certain changes that occurred this weekend, perhaps “was” – we won’t know for certain until it gets into office) a social democratic party, to the left of the liberals. It strongly supports workers, has a clear dedication to the well-being of people excluded by society (some of its current issues of interest are exploitation of migrant workers, homelessness, and the atrocious conditions on First Nations reserves), believes that trade agreements must serve the broader interest of the people of Canada and not hand over control of domestic policy to corporations, that rehabilitation is better than punishment with regard to the justice system, and that Canadian foreign policy should focus on peacekeeping and social justice in the world (including stopping Canadian mining companies from exploiting and mistreating people in other countries). It openly believes that government programs (health, education, social supports) can and do improve people’s lives. Unlike either the Liberals or Conservatives, it is opposed to corporate power and to the ideology that lower taxes on the rich mean more growth. It championed positions other parties would never think of – it was opposed to the war in Afghanistan and called for negotiations well before other parties began adopting that view. Up until very recently, it was a perpetual third (or fourth) party, the punchline of jokes for political commentators, a bunch of rabble-rousing radicals to its opponents and the conscience of Canada to its supporters. The Liberals constantly condemned it for splitting the progressive vote; the NDP constantly responded that the Liberals were corporate tools little different from the Conservatives.

        The Liberals have, for a long time, described themselves as “Canada’s natural governing party” – from 1993-2004 they not only had a majority government, but were basically without any viable challengers. Their policies are basically close to the US Democrats, but they were, for that period and after, not a party of ideology; their electoral claims weren’t their beliefs, or an ability to inspire, but “we can govern, and govern well (and nobody else can)”. They slashed social support, foreign aid, and government programs of all kinds, but they managed to turn a substantial deficit into a large surplus. By the 2000s, the only thing conservatives could find to complain about was that the surpluses were too large and showed that the government should be cutting taxes. But…the Liberals got arrogant, they got complacent, the Conservatives made hay out of a political scandal, and they lost power.

        When people say Canadian Conservatives are to the left of American Democrats, it’s not true. Our Conservatives have been channelling the Republicans (including union-busting, Mideast warmongering – they’ve cut off relations with Iran and think Israel can do no wrong – slashing of social supports, raising the retirement age to 67, utter disregard for the environment, and withdrawal from international conventions). The Conservatives cut taxes, spent irresponsibly, and promptly turned that surplus back into a deficit as soon as they got back into power (the recession obviously didn’t help, and they did engage in stimulus spending so they weren’t as fully nuts as the Republicans’ anti-Keynesian right, but on the whole we’d still have a surplus or only a small deficit, even with stimulus spending, if it wasn’t for their misgovernance).

        The Canadian political system underwent a very dramatic change in 2011, with what was probably the most dramatic and paradigm-shifting election in Canadian history. The Liberal Party, which had been in a period of serious decline and changing leaders like a person changes shirts, completely collapsed. The NDP caught the support of Québec – something nobody expected other than the NDP leader Jack Layton and the NDP organizers working there, as the NDP had never had any significant support base in Quebec. Even the candidates the NDP was running in Quebec were surprised; some of them had never had any expectation of being elected. They took 57 out of 75 seats in Quebec, destroying the separatist Bloc Quebecois (which was reduced to only 4 seats and lost party status), gaining the first federalist majority in Quebec since the early ’90s. With the backing of Quebec and significant support in other regions, the NDP got a third of the seats in Parliament and became the Official Opposition for the first time in its history; the Liberals became a third party for the first time in their history. The Conservatives got a majority government (and engaged in some Nixon- or Rove-level electoral illegalities that haven’t been getting near enough attention). In addition, the Green Party got its first seat ever in Canadian history.

        The NDP took a serious hit after the election when our leader, Jack Layton, whose popularity had a lot to do with the election success, died of cancer only shortly following the election; last year we chose a new leader, Thomas Mulcair (from Quebec).

        The NDP, now having a shot at governing after the next election (scheduled for 2015), have been trying to moderate their image. Issues and positions that might be seen as “fringe” have been dropped, and the emphasis is on pulling together and winning the next election, and minimizing the amount of damage the Conservatives do in the meantime. However, the NDP are still significantly to the left of the Liberals. (The Liberals, for their part, have been struggling without a great deal of success to develop policies and a grassroots. They’ve just chosen Justin Trudeau as their leader, which is kind of like if the Dems were in a period of political exile and chose an attractive Kennedy without a lot of prior interest or involvement in politics.)

          • This is a lot less organized than what I wanted to say, and a lot less focused on the convention. You can make it a guest post if you like, but I’d want to do a separate post on the convention and what the recent evolution of the NDP means, if you can give me your email.

  4. There’s a difference between plasma, which is currently paid for in the US and is what Canada is considering paying for, and whole blood, which is not paid for in the US or Canada.

    In fact, the WHO “Towards 100% Voluntary Blood Donation” document, despite being cited by the article, appears not to be referring to products derived from fractionated plasma, since it places the US among the countries with 100% voluntary nonremunerated blood donation.

    • The use of “voluntary” there makes me think that there’s an issue somewhere with vans grabbing people off the street to extract their sweet, sweet plasma.

      It seems to me that if we’re worried about infections, we would do well to come up with a good screening system so that paying people wouldn’t be a problem. Would that dramatically increase plasma avalability?

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