Dear Canada: Don’t Ban Paid Blood Plasma Donation

The United States has been called the OPEC of blood plasma because it exports hundreds of millions of dollars worth to other countries. Why does the US dominate the blood plasma industry? Because in the U.S. it’s legal to pay donors which increases supply. Some provinces in Canada have also allowed paid donors but 80% of the blood plasma given to Canadians is imported from the United States and, to make matters worse, some provinces have banned or are considering banning paid donation. A very good letter opposes the ban:

We are professional ethicists in the fields of medical ethics, business ethics, and/or normative ethics, and academic economists who study how incentives and other mechanisms affect individual behaviour. We all share the goal of improving social welfare.

We have strong reservations regarding any Act or legislation (hereafter: “Acts”) that would prohibit compensation for blood plasma donations…….Both the ethical and the economic arguments against a compensatory model for blood plasma for further manufacture into PDMPs are weak. Moreover, significant ethical considerations speak in favour of the compensatory model, and therefore against the Acts.

The letter carefully discusses many of the objections such as that paid donations will drive out unpaid:

The compensatory model leaves open the possibility of donors’ opting out of compensation, or the operation of a parallel non-compensatory model. The United States does just this, and has an approximately 50% higher voluntary, unpaid, per capita blood donation rate than Canada. Germany, Austria, and the Czech Republic, where plasma donors can be compensated, likewise all have higher rates of voluntary, unpaid per capita blood donation than Canada.

Is paid blood plasma less safe?

Dr. Graham Sher, the CEO of Canadian Blood Services, has said, “It is categorically untrue to say, in 2015 or 2016, that plasma-protein products from paid donors are less safe or unsafe. They are not. They are as safe as the products that are manufactured from our unremunerated or unpaid donors.”

The letter is signed by two Nobel Prize winners in economics, Alvin Roth and Vernon Smith, by philosophers like Peter Jaworski, who did most of the heavy lifting, and by experts who have studied incentives and blood donation closely like Nicola Lacetera and Mario Macis. I am also a signatory.

Comments

So that is. Everything mustbe for sale. Even blood.

I understand you don’t like it and do not want to be part of it. But, just out of curiosity, what is the ethical basis that make you think your voice should be considered even when the transaction involve two free willing individuals that do not even know you?

The same ethical basis that allows banning incest, prostitution, drugs trade. I believe there is right and there is wrong.

Yes, you' re right: for instance I exercise my right not to sell my blood (very precious safe 0 group, negative rh) to a person who' s dying for bleeding, while could pay for it, and I exercise my right not to buy something I can' t afford without the revenue of my blood. Rights are everything in human life !

"I believe there is right and there is wrong."

Yes, and you believe it is OK that others suffer and perhaps die because of your narrow belief on this matter.

One can't cut corners morally. Two wrongs don't a right. Never will.

What does the Prophet Bandarra say about it?

I don't know what you are talking about. I am talking about Jesus and the union of the faithful with Christ.

It's a good thing too. Because it's clear that the "Prophet Bandarra" was a nut case.

So is it the 11th commandment that thou shalt not pay for blood?

"The same ethical basis that allows banning incest, prostitution, drugs trade"

Really? In those cases, there are at least potential harms. But in the case of selling blood plasma, both paid donor and recipient benefit -- there's no potential harm on either side. Would you object to people selling their urine (it was used in laundries in ancient Rome) -- are some replaceable body fluids inherently more sacred than others? How about selling their hair for wigs? Or ear wax and toenail clippings if there were markets for those? If something triggers your 'ick' response, does that constitute an 'ethical basis' to justify a ban?

"In those cases, there are at least potential harms."

There are potential harms in everything from leaving home to boarding an airplane. I am talking about morals.

What is immoral about paying people for blood?
Shouldn't the morality of something be judged by actual harms and not by primitive disgust instincts?

What is morally right about banning paid plasma donations, especially given that the policy results in a shortage of blood plasma?

Who is supposed to decide what’s right and what’s wrong? Traditional voting?

“There are people who think the best way to distinguish between right and wrong is by counting noses”
Jonathan Swift

Who is supposed to decide what’s right and what’s wrong? Traditional voting?

Try Googling for the occasions where Tyler has condemned things on "deontological" grounds.

What is immoral about being paid or paying someone for plasma? I don't get it. Should the doctors and nurses who take the blood from the donor also not be paid? What about the doctors and nurses who use the donated blood? Perhaps we should have a rule that only unpaid volunteers can handle other people's blood, just to be safe that no one is being immoral. (Sorry, I couldn't resist the snide remark. But seriously, why is this immoral?)

Here we go, again ... For those opposed to legalization and blood markets, this may be of relevance: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2332596

Are you willing to let people die rather than have their precious bodily fluids be morally sullied by the taint of filthy lucre?

So that is who we became. Convenience over morality.

Oh, I see. Are organ donations banned in Brazil?

Oops, I did not understand that this Charbes character was the most recent embodiment of our Thiago. The rhetorics definitively matches

No, I am not. I can assure you I am myself, not another person writing in my name.

I think he's given up on pretending to be Brazilian. It's clearly the same poster.

I think Charbes A. is autistic.

"I think he’s given up on pretending to be Brazilian. It’s clearly the same poster."
No, it is not.

"I think Charbes A. is autistic."
No, I am not. Maybe you are.

No, liberty and economics understanding over morality and scarcity.

Saving lives = convenience? Only in Brazil.

I get your point. Plasma is needed and has to be obtained.

Still, I was uneasy recently when I drove past a plasma center early one morning and saw a crowd of wastrels and hobos waiting outside for the place to open.

Do upright people who don't need money donate plasma? Do they sell their plasma and then give the payment to charity? I haven't heard of such. People like me don't have any skin (er, blood) in the game.

I have considered offering to become a kidney donor but have not done so yet. I would not do it for money, and I'd prefer not to do it at all. But there are a lot of sick people out there who need kidneys, and I have one more than I need. What should I do?

"Do upright people who don’t need money donate plasma? Do they sell their plasma and then give the payment to charity? I haven’t heard of such"

I've donated plasma via the Red Cross.

But do upright people who don't need money donate plasma?

When I was a college student, I tried to donate blood to the Red Cross, but they seemed utterly uninterested. I then found the Alameda Contra Costa Blood Bank, and I donated regularly there. This was whole blood, not plasma. Plasma is replaced pretty quickly, but whole blood requires something like two months between donations. I've donated a total of over two gallons of blood.

I donated blood from the time I was 18 until I was in my late 30s and began taking a medication that ruled it out. Was sorry to stop.

If I were eligible to donate plasma, I wouldn't go to that plasma center. The image of people so desperate -- for alcohol or food or whatever -- that they were selling their bodily fluids sticks with me.

I'm not saying it isn't necessary because it does appear to be necessary.

This is so obvious it pains the idea that it seems still worth discussing.

Time to seriously push for a market for organs. Kidneys including living donors, other organs in case of dead donors. I read that New Zealand started with something last year.

Tabarrok had a prior blog post on organ donations and the ethical issue of paying donor not for the organ but for the lost income attributable to being away from work. I believe it was New Zealand or Australia that adopted (or was about to adopt) such an arrangement. I recall that it was unclear whether the payment was a fixed sum or a function of actual lost earnings, the former looking more like a payment for the organ. As for payments for organs, I am agnostic: Paul (1 Corinthians 15:50) teaches the resurrection of the body at the Second Coming but not the earthly body, but the distinction is not clear since the resurrected body of Jesus included the wounds inflicted on him at His crucifixion. The cautious believer would keep her organs, just in case.

'Time to seriously push for a market for organs.'

What do you think the Bartley J. Madden Chair in Economics at the Mercatus Center spends a noticeable amount of time doing?

Mostly ignoring you.

Dear Canada - ignore this, it just being history, and just a single example of what happens when a dedication to profit over public health occurs. But do make sure to tighten effective regulatory oversight to keep the profit motive in check, just in case somebody else develops a clever way to cut costs to increase their ROI.

'German clinics have been swamped by demands for HIV tests this week, as panic spread in the wake of the scandal over infected blood donations. Revelations that companies have been selling blood products contaminated with HIV could undermine Germany’s opposition to European plans to do without blood from paid donors.

At the centre of the furore is UB-Plasma, a small company in Koblenz which sold plasma and blood products. It was closed when the authorities learnt that three German patients infected with HIV last spring had received products from UB-Plasma.

Norbert Weise, the public prosecutor in Koblenz, said last week that UB-Plasma had been cutting costs by pooling plasma from several donors before
testing it for HIV. The law requires each donation to be tested individually. If the virus is too diluted, tests may fail to register it.' https://www.newscientist.com/article/mg14018991-200-hiv-scandal-could-put-paid-to-blood-trade/

I don't trust Germans either.

Germans would agree, which is why the owner of UB Plasma and a manager were sentenced to four years in prison, while a laboratory doctor was sentenced to three years. As an example to others of what happens when the pursuit of profit leads to death, because trusting people to do what is right when profit is involved is clearly not the sort of thing that should be based on trust.

The danger of pursuit of profit leading to death is why it would be a good idea not to pay brain surgeons -- or any other medical specialists -- more than, say, fast-food workers. After all, obviously we want to attract only selfless, saintly, public-spirited folks to serve in the sacred field of medicine, and not people who are even partly motivated by the prospect of earning a good living.

"The danger of pursuit of profit leading to death is why it would be a good idea not to pay brain surgeons"

And Farming of course. Society couldn't function if we were to charge money for something as fundamental as food.

And the answer is better testing or banning paid donations?

Obviously we should ban. Rayward mentions a crooked home builder in another thread, therefore we should ban house building.

We need to ban Volkswagens too, they are a criminal organization.

The U.S. exports about $19 billion worth of blood (although that number includes animal blood; I can't find a source separating them). Presumably that blood isn't used for frivolous reasons, and drying up that market out of nebulous ethical concerns will leave a lot of people fighting for their lives. Yes, mishandling can kill and should be regulated against, but not having the blood can be fatal too.

Before mad cow disease, there was a long history of Germany selling blood supplies to the U.S. I.e., they're apparently not opposed to allowing the dealers in blood products to buy and sell; just the donors.

Between various types of Hepatitis I wonder how people have died from blood transfusions infections since the 1940s? Several hundred million? Let's not include AIDS.

How many have been saved?

The existence of blood banks would seem to be barrier to innovation in creating artificial blood that is disease free.

There has been research into blood substitutes for years. Mostly funded by the Department of Defense. I would not be surprised if the amount spent has been in the billions. To date, one has not been found.
https://en.wikipedia.org/wiki/Blood_substitute

You know, when I ponder complex questions about medical and biological safety issues, my first thought is "Well, what do people with economics degrees have to say about this? Especially the ones with awards from Scandanavians for promoting statism."

We can ask Rush Limbaugh if he has any thoughs on this.

You're opposed to statism but you're for the state banning a private exchange? Hmmm.... Something doesn't add up...

Economics is about trade-offs, the exchange of goods, and social welfare. How is this issue not about these two things?

Because partisans just can't stop finding ways to stick it to those evil statists.

As for Czech republic - I'm not totally sure about this, but I think the law forbids paying the donors, however allows paying some form of cost compensation. Which, in the end, is not very high, but not trivial either.

So my idea for at least the beginning of a market in organs:
Let people bequeath the value of their organs to their heirs.
In other words, even if you still can't be paid for your organs while you are alive, if you die in an accident, your children will be able to get an inheritance of several thousand dollars for each usable organ. This would incentivize a lot of relatively poor people to sign up as organ donors in lieu of having a life insurance policy. They die, the organs are harvested and sold, the money goes to their estate, and their heirs split it up according to their will.

To be clear, there's not a lot of market value in organs and only a little in tissue donations for someone who dies unexpectedly, is diseased or old. Generally speaking, good organs come from living, young, relatively healthy donors (or on those on life support). Once you die, most of the organs aren't usable.

Not everyone who dies in an accident dies before they get to the hospital. I've heard of people who died of drug overdoses or in accidents donating while they were in a coma on life support.

Sure, but you have to realize it's a rare event for a young, healthy person to die on life support. And generally speaking, any detectable or suspected drug use disqualifies you as an organ and tissue donor.

Organs from dying/dead people will never be a plentiful supply. Which makes the ban on selling even worse.

Yes. It seems to me so much easier to introduce this idea rather than the kidney sale from living persons, what I think they are tinkering with in NZ.

When I lived in Canada, I remember arguing in favor of paid plasma donation at work with a colleague. Her response to me was that I had "screwed-up morals."

In Canada, medical ethics are funny business.

Do it Canada, low income USAers need options.

It’s immoral to compensate Canadians for their blood.

So we’ll pay Americans instead.

It’s the same argument they use to block oil pipelines. Transporting oil from province to province is bad. Importing it from Saudi Arabia is fine.

Canadians find truth in their feelings. Less so in logic.

The United States also exports a lot of sperm, and attracts a lot of foreigners seeking infertility treatment, because of its generally broader conception of reproductive freedom.

Here you go: https://www.usatoday.com/story/opinion/2017/09/13/please-dont-end-nafta-canada-needs-your-bodily-fluids-peter-jaworski-column/632826001/

We should not get

Plasma

From

Shithole Countries

As it will damage our bodily fluids.

No dollars for blood.

Can we make a list of things the "Pro-choice" crowd is against: Others please add to my list.

The choice to pump your own gas.

The choice to post Backpage Ads where payment is in 'Roses'.

The choice to sell your blood/plasma/kidney/etc.

Yes, Canada should definitely legalize paid plasma

thestar.com/opinion/contributors/2018/01/16/its-time-to-legalize-paid-plasma-donations-in-ontario.html

#yespaidplasma

I SELL my plasma 2x per week for 4 weeks [every 3 months]. I am starving college student. I don't do drugs, hardly drink and am actually a health [fitness and nutrition] freak. However, I am 1 or 2 of all the people there with a paperback book.

I wish I didn't have to, but the cash really helps.

I wish I can sell my blood. I don't see why we can donate plasma but not blood [other than the fact blood takes weeks to recuperate].

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