Money for Blood is Good for All

The Economist: For years [Barzin Bahardoust] has been trying to pay Canadians for their blood plasma—the viscous straw-coloured liquid in blood that has remarkable therapeutic powers. When his firm, Canadian Plasma Resources (CPR), tried to open clinics in Ontario in 2014, a campaign by local activists led to a ban by the provincial government on paid plasma collection. Undeterred, he tried another province, Alberta—which also banned the practice last year. Then, on April 26th, when CPR announced a planned centre in British Columbia, its government said it too was considering similar legislation. CPR has managed to open two centres, in far-flung Saskatchewan and New Brunswick. Even these have faced opposition.

The global demand for plasma is growing, and cannot be met through altruistic donations alone. Global plasma exports were worth $126bn in 2016—more than exports of aeroplanes.

…Only countries that pay for plasma are self-sufficient in it. (Italy, where donors are given time off work, is close to self-sufficiency.) Half of America’s plasma is shipped to Europe—20m contributions-worth. Canada imports 80% of its plasma products from America. Australia imports 40% of its plasma products, too.

It’s a very odd “ethical policy” that leads Canadian provinces to ban paying Canadians for plasma but then import paid plasma from the United States. I am one of the signatories (along with Al Roth, Vernon Smith and Gerald Dworkin among others) of a letter that argues for the efficiency and ethics of allowing compensation for blood plasma donation. The Economist riffs of this letter in a very good op-ed:

The aversion to paid plasma rests on three reasonable-sounding but largely groundless propositions. The first is that it is unsafe. Payment might encourage donors to conceal dangerous behaviour—such as intravenous drug use. In the 1980s and 1990s, tainted blood products infected half the world’s haemophiliacs with HIV, along with tens of thousands of plasma donors in China. But modern plasma products do not carry such risks. They are heat-treated and bathed in chemicals to sanitise them (an impossibility for blood for transfusion). Since the adoption of these techniques there has not been a single case of transmission of HIV or hepatitis via plasma products. Doctors agree that plasma products from paid donors are just as safe as those from unpaid ones.

A second argument is that, if people are paid for their plasma, fewer will volunteer to donate whole blood for transfusions. (Paying for whole blood would be unwise, since it cannot be sterilised as plasma can.) But there is no evidence that paying for plasma diminishes the supply of donated blood. That is why, in Canada, more than 30 economists and philosophers wrote an open letter arguing against bans on paid plasma. Americans voluntarily donate as much blood per person as do Canadians.

A third argument is that paying for plasma preys on the poor. It is possible that those selling plasma need the money and therefore might give too often. In America plasma donors can give twice a week; those in Europe can give just once a week. There is no evidence of harm to their health in either case, but more long-term study would be prudent.

Those against allowing payment suggest using voluntary donors instead. Yet every country that does not pay ends up importing plasma. And the fact that America is by far the dominant supplier carries risks of its own. The dependence on a single source leaves the rest of the world vulnerable to an interruption of supply. To protect their people, therefore, other governments need to diversify their supplies of plasma. Paying for it would make a big difference.


Thin Edge of the Wedge? Paying people for plasma leads to paying them for kidneys and eye balls. Before you know it there is a massive market in keeping rich White guys in the First World alive by harvesting the organs of poor Third World people.

It looks bad if nothing else.

I know. We have the ideal situation right now where everybody dies. 3 cheers for equality.

It is not ideal, but yes. In the words of one of Heinlein's characters, up to now Death has been the Great Democrat. The idea of the rich buying organs from the poor is problematic. It also looks awful. The anger that it is likely to cause is likely to be a real problem.

The rich getting better medical care is fine by me if it is part of a process that leads to better health care for all. A great new drug, paid for by the rich, is great. It will be available for everyone soon enough. But the organ trade is literally a zero-sum game. Rich people in the West can only live longer by causing poor people in the Third World to die sooner. Say what you like about French aristocrats or Russian factory owners or Chinese landlords - they weren't taking other people's organs.

"Rich people in the West can only live longer by causing poor people in the Third World to die sooner." Hasn't life expectancy been rising throughout the world. This comment shoes how ignorant you really are. And if you're sooooooo concerned about the poor being left behind, why not just have the government pay a fixed amount for organs. The US already pays for kidney transplants. Just add in an extra $15k to the donors. Rich and poor alike would get the organs. Also, almost by definition, trade is positive sum.

That is an astonishingly bad reading of what I said. Not so much a willful misunderstanding as a flat out refusal to read a damn thing I wrote.

Yes, it is great that life expectancies are rising. It is a shame that more people do not credit the West for doing this. But that doesn't mean the West can do what it likes because on average life expectancy is improving. Life for Africans, and certainly for African slaves, probably improved as a result of the slave trade. Doesn't mean it was a good idea.

It seems to me that the "rich White guys in the First World" and the "poor Third World people" both live longer, the first for obvious reasons, the second because they have more money

But what about this?

Health providers in Europe and Canada have plasma because they obtain it from US donors who were paid. They already pay donors for plasma, they just launder it through intermediaries.

The proposed change is that the health providers continue to purchase plasma from compensated donors, but that they stop pretending it's better if the paid donors are exclusively foreigners.

So as a counter, the US has a large prison population. They owe a debt to society. What is wrong with taking it from them twice a week?

That would solve the problem too.

Prisoners are a vulnerable population and we should thus be careful about exploiting them. This argument applies to poor people as well. However, with poor people, we have a counter argument - banning the practice harms them by taking away their options (in the same way that closing 3rd world factories for bad work conditions forces the workers into joblessness or even worse jobs that they avoided by working in the factory, or passing minimal living space regulation to protect tenants raises prices and consequently forces the tenants being "protected" into homelessness). This counter argument does not apply to prisoners.

My employer exploits me because I'm poor.

So we should ban you from working the same way we ban you from donating blood plasma. After a couple months of joblessness you won't be around anymore to be exploited. 10/10 solution.

Just define donating plasma as work and there is no problem with paying for it. After all, if you manufacture something, whether a car or plasma, you have done work.

"we should thus be careful about exploiting them"

They exploit other people. Making them give plasma is just payment.

Plenty of crimes don't involve exploiting others, like non-violent drug offenses

Selling drugs certainly exploits. Drug users often steal to support their habit, also exploitation.

Casual drug users don't go to prison, despite the myth.

The US does not have a plasma shortage because it pays donors. Are you suggesting the US start harvesting prisoner plasma (and possibly organs?) to sell to Europe and Canada?

Probably not a good idea to incentivize the government to take more prisoners when it needs resources.

There is plenty of evidence suggesting that Southern states' heavy use of prisoner labor encouraged higher incarceration rates in the aftermath of emancipation, when (to put it mildly) the labor market was heavily disrupted.

What about GMO plasma? Some human DNA is put on a cow and bingoooo =)

They're today in Phase 1 of the FDA approval process. Perhaps this post should aim at how regulations slow down innovation ;)

Moral purity is worth any price.

But the Canadians are not getting moral purity and not paying any price. 80% of the plasma used in Canada is from paid donors (in the U.S.) They could also ban imports of plasma from countries with paid donors. That would be actual 'moral purity', but it would exact a big price on Canadians -- so they dare not do it. The existing Canadian laws are just virtue signalling. It's 'moral wankery' not 'moral purity'.

If the Canadians want to avoid their citizens being "exploited" by blood-for-pay transactions, it seems like they've found a great solution. it's not obvious why the government of Canada, whose job it is to improve the lives of Canadians, should be all that worried about American moral purity.

Make Canada Great Again

At the age of ten, Canadian children are required to have a small operation that severs connections between the impulsive part of the brain and the logic center. Quite painless and smoothes away uncomfortable contradictions like BC Premier Horgan raising the price of gas to save the planet while simultaneously complaining about the rising price of gas.

You can always pay in something else than money, as in Israel organ donors getting preferential treatment ( Or just limiting paid donations to once a month.

What? Canada another country where homo economus doesn't dwell? Who knew?!

Yes, because it's definitely the activists who are paying the full price for banning unrelated party 1 for trading with unrelated party 2.

I'm sympathetic to the argument -- and giving time off as compensation is a great idea -- but this is in fact a very poorly written op-ed.

>Doctors agree that....

Really? This is all you got? A bland, completely meaningless and unsupported assertion that "doctors agree"? Even the gum people were more convincing with their "4 out of 5 dentists" garbage.

>more than 30 economists and philosophers wrote an open letter arguing that....

Oh my God, you somehow made it worse. Philosophers wrote a letter, huh? Wow! That's a serious argument to base your national health policy on. And they even got some economists to sign it too? As if philosophers and economists ever have anything else to do? Any how many people signed it -- more than 30? Can you not count past 30? Or did you intentionally avoid saying 32, because saying "more than 30" leaves open the possibility that it was several hundred?

>There is no evidence that...

You said this twice, and it's the mark of someone spewing BS. It's classic NYT-style, tossing-turds-at-the-masses "argument." Ignore all the evidence against you, and simply claim it does not exist. It's so much easier than refuting things! Just claim that everyone against you is making everything up! For fun, or possibly for hate, I guess. There is literally no evidence! Dear God, man.

Also, the article said "Paying for whole blood would be unwise, since it cannot be sterilised as plasma can." This betrays another serious failure of research.

I remember when I was an exchange student in Germany, the local university clinic would pay 45 DM for 450ml of blood. You could donate once every 3 weeks. What made this much safer than blood donated in the US is that they counted on repeat donors, so they could use a much more reliable testing procedure: They run tests on every donation, but they don't include it in the general blood supply until the same donor has come in again and passed all the tests a second time. Then the previously donated 450ml is considered clear, and the next 450 is put on probation until the next visit, and so on. Tests run on US blood donations, in contrast, only have the one sample to work with, and they run the risk of not detecting recently acquired HIV infections.

I look back fondly on our blood donation days. My friends and I made it a social event. We were doing a good deed, the money wasn't trivial, we'd get tipsy faster after a donation, and with each visit we got a printout of all the results of all the tests that were run on all our previous donations. There was something reassuring about that. My last report must have had 12 or so lines, because I went back so many times.

Back in the US I knew I wouldn't be paid for blood, but I decided to donate anyway. But then some asshole told me that if I ever had gay sex or used needle drugs or recently lived in Europe, my blood is not good enough for America. Because of the exchange program, that last one applied to me. I told him about my dozen plus donations in Germany, but he was like "Naa, your blood could have mad cow Euro-cooties, no thanks." That was a long time ago, and maybe by now they got rid of the obviously discriminatory and patronizing screening questions, but I honestly haven't tried donating again.

Those bans are all still in effect. I think some of the services finally unbanned gays, but my clinic still asks "have you ever had sex with a man, even once"?

My wife gives blood often and it really irks her to be asked that question each time.

Not as much as it would irk you to hear her answer...

Sorry I couldn't resist :-)

No blood money!

I gave/sold plasma, white blood cells, and peripheral stem cells (you get a lot more for the last two) while in college. I sat there with needles in my arm either reading a book or watching a movie. I was surrounded by mostly poor black men. Not a single one of them was complaining about the money they received. To say you are taking advantage or exploiting some population by offering money for plasma shows they have no knowledge of what giving plasma entails.

You get to the plasma center and they do a little finger prick to test the blood for various things. Then you piss in a cup to make sure you are doing drugs or whatever. Then, you sit there for about 45 minutes (from a quick google search, it seems like it takes longer these days) with a needle in the crook of one arm (this is not painful). In the days before everyone had a smartphone, I just read, but several people seemed to enjoy watching the tv shows that were on. After 45 minutes, they take the needle out and give you cash (back in 2003 it was $20 for the first 4 times you gave that month, $25 for every additional "donation"). There. That's it. In the summers, I would do this before going to work (giving twice a week was like adding an extra 1/2 day's pay, for only 1.5 hours of "work"). I doubt most people thought about how much their plasma was helping others (I didn't, I just did it for the money), but if you thought about those kinds of things at all, I bet you'd feel pretty good about your activity (which is much more than you can say about the jobs that the bullshit-job guru Mr Graeber has such disdain for).

A quick google search suggest that you can get paid $30-$40 per visit (which takes about 90 minutes). So if paying someone $20 an hour to sit and read or watch tv or surf the web on their phone for something that is essentially painless and perfectly safe is now considered exploitation, then I am perfectly willing to be exploited.

Freedom of choice!
You are free to give us your blood, or die of hunger.
There are no other choices on offer.
Whats that? A more just society where few feel the need to sell body parts to survive?
No, that's just crazy talk! Not possible.

Well, you used to be able to work for below minimum wage, but we banned that. It is exploitative. We banned prostitution for the same reason. We haven't figured out how to ban people from dying of hunger, but once we do, the poor will thrive thanks to our top-down imposed Progress and Virtue.

Our economy used to produce middle class jobs where a single income was sufficient to support a family.

Our economy used to produce middle class jobs where a single income would buy you a tiny house, one shitty car, and enough food to feed you, your wife, and 2 kids, and it still does.

I do not see why your argument singles out plasma donation if your objection is that there is no guaranteed living income. That should apply to doing any work at all, whether as an employee or an owner.

Though I am not sure where people are dying by hunger in Canada, Australia or Europe, where the proposed changes would take place.

Isn't the problem in the U.S. these days too LITTLE hunger?

Another fantastic article by Alex.

It is always the way of activists to reduce freedom for their own enjoyment.

Sure, first, you promise that the plasma is safe because it's pasteurized. Later, you complain about the hurdles faced by those who want to buy unpasteurized plasma. All the while, you work to gain acceptance for all this body fluid trafficking by claiming it is strictly for "medicinal purposes," just like Granny Clampett with her moonshine. The end result will be buying unpasteurized plasma just for kicks with all the pious rationalizations stripped away.

I'm kind of joking, but kind of not. I believe Alex Tabarrok would also object to any legal obstacle to someone selling his leg to someone else for a barbeque, so all the little reasons why selling plasma is good for everyone feel like unimportant embellishments.

Why do you hate America? Plasma is one of our most important exports, and by gaining a dominant market position we have an important trade advantage. Why shouldn't Trump be able to threaten to cut off plasma exports in trade negotiations? There is no shortage of plasma in Canada. We have a comparative advantage in plasma production.

The reason for high US exports of plasma is the fear of vCJD in blood in the UK specifically, and in Europe in general. Globally, the fear is of malaria, et al.

In particular, the UK NHS bought a US plasma provider to replace UK plasma after the discovery of vCJD and the global fear of using blood or plasma that might contain vCJD, basically anyone in the UK.

Canadians have a weirdly mythologized view of our health care that often prevents better service.

Won't pay for blood plasma but you can pull a grand a month as a sperm donor. Some precious bodily fluids are more precious than others.

I'm a long term plasma donor and something about this doesn't add up, at least to me. I donate plasma in Austria at BioLife and I'm allowed to donate every 72h - not just once per week as the article cites. Then there is *whole blood* donation which is organized by the Red Cross. In Austria it is prohibited by law to be paid for whole blood donations for many of the reasons cited in the article and yet according to Red Cross there is no shortage of whole blood which comes exclusively from domestic donors in Austria:
How come Austria has no shortage of whole blood?
A technical detail for those who never donated either plasma nor whole blood: plasma is just one part of your blood which machines can filter out. When donating plasma, the blood is removed from the body, the plasma filtered out and then the left over blood is pumped back into the veins. For that reason the process isn't that taxing compared to whole blood donations where one can feel dizzy for some time until the the red blood cells are replaced. For people with lower iron levels this can be especially problematic.
So, plasma donation: paid and little taxing
Whole blood donations: unpaid, more taxing
That's the reason why I donate plasma, not whole blood and I'm surprised there is no bigger trend towards donating plasma in a place like Austria.

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