Bloody Well Pay Them

The United States is one of the few countries in the world where plasma donors are paid and it is responsible for 70% of the global supply of plasma. If you add in the other countries that allow donors to be paid, including Germany, Austria, Hungary, and Czechia, the paid-donor countries account for nearly 90% of the total supply.

Countries that follow the WHOs guidance to rely exclusively on voluntary, unpaid donors all have shortages of plasma (hmmm…what’s the WHOs track record like?) So what do these countries do? Import plasma from the paid-donor countries. The United Kingdom, Australia, New Zealand and some Canadian provinces, for example, prohibit paid donors and they import a majority of their plasma from paid donor countries. (See chart at right).

As Nobel prize winner Al Roth puts it, in his gentle way:

I find confusing the position of some countries that compensating domestic plasma donors is immoral, but filling the resulting shortage by purchasing plasma from the US is ok.

The UK, Australia, New Zealand and Canada can afford their moral hypocrisy but their decision to forbid paid-donors reduces the world supply of plasma driving up the price and harming people in poorer countries.

I have cribbed from an excellent new report by Peter Jaworski, Bloody Well Pay Them: The Case for Voluntary Remunerated Plasma Collections.

Previous MR posts on plasma.

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It's the slippery slope argument: first comes paying for blood then comes paying for body parts. That would never happen. It would if a certain person had his way. I represented the co-founder of a not for profit transplant organization, which "harvested" organs as well as plant them. One of the problems with harvesting is that the organization never knew when an organ was "available" (usually upon the death of the donor). Speed really mattered, a lot, because the donee usually was not in very good shape. A harvester was like being a fireman: lots of time sitting around waiting, and then a mad dash to harvest and deliver the organ. Looking at the issue this way makes one more sympathetic to the view of that certain person.

And we should allow the sale of organs, especially kidneys. Many people die each year from kidney failure, the sale of kidneys would save them.

I'm pretty sure hospitals sell organs to one another after they harvest them from the deceased; it wouldn't be such a huge step to compensate living donors, as well.

Everyone in the operating room gets paid except the donor.

+1, Highly paid.

But that smuck donating the organ, well of course we can't pay him, because that would be immoral. /sarcasm

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This is why lots of effort is being put in to keeping organs alive outside the body. Donating by live donors is 'noble' but unwise.

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There's no slippery slope, because they're qualitatively different situations. Plasma replenishes itself in the donor after donation. Organs don't.

Remember those chain letters from a while back about waking up in a bathtub with your organs missing? I always wonder if we allow paid organ markets how often that nightmare scenario would happen.

While some quick research suggests it's just an urban legend (you need a matching kidney, specialized equipment and training, and have a narrow time frame), even if it were real then legalizing the market would surely make the risk of stealing someone's organs even less appealing.

You sure about that? When the price of copper goes up, piping and wiring get fenced. When the price of kidneys go up, I would expect the same. Seems like market fundamentals to me.

Surely the price of kidneys would come down? No change in demand, but a far more elastic supply.

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"You sure about that? When the price of copper goes up, piping and wiring get fenced. "

That's because they are easy to steal and easy to sell. Organs would be far harder to steal (and still be useful) and far harder to sell.

Nobody is stealing F-15's.

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What about livers?

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No one rational cares about your imaginary problems.

Paying works. Not paying doesn't.

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And/Or: would the strict application of Alex's proffered logic merely permit (or would it positively require) legalization of prostitution?

A quirk of California state law allowed the porn industry to gain a foothold and grow there. As I understand it, it is illegal to pay someone to have sex with you but it is legal to pay someone to have sex with a third party. Laws draw all sorts of arbitrary distinctions.

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Funny how our country, the richest in the history of mankind, can not deal with the coronavirus crisis effectively while Brazil, which has been so slandered by all the right-thinking people, communists and Putin-puppets, has figured it out earlier than most and has been able to reopen its economy.

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Do poorer countries allow paying for plasma?

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Why does it drive up the price rather than just increase production by "exporters"?

It's less clear to me this is due to insufficient donor pool in voluntary nations. It may be more to do with scale and costs of equipment, and the US simply being a cheaper source.

"Why does it drive up the price rather than just increase production by "exporters"?"

Because the pool of everybody in the world is much smaller than the pool of exporters and a greater supply will drop price given a constant demand. It's a very basic supply curve.

Plasma production can't be scaled up within the current export countries without recruiting more donors which is almost certainly going to involve some increase in costs.

But scaling up plasma fonation in England and Wales, for ex, is easy and cheaper than scaling up further in the US? For sure?

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Basically, you and Alex seem to be judging here that importers are simply being morally inconsistent and irrational.

But it may be that they're simply following the cost incentives to allow the US to specialise as an exporter, and then import, at a lower cost than domestic "production".

It would be cheaper to collect paid plasma in London, Toronto, Calgary, Sydney, and other large population centers, than to collect in Frederick, Maryland. But you can’t pay donors in those big cities, so plasma centers expand in smaller, less efficient U.S. cities, like Frederick, instead.

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Then there is no need to prohibit donations in those assumed comparatively disadvantaged countries.

"Prohibit" Vs "Actively run a state managed plasma donation program with a fixed price to donors".

A prescription to pay donors in a country like the UK with a strong centralized state run healthcare sector, rather than import, is not "deregulate and let the free market sort it out"; it's functionally advocacy a state subsidised import substitution policy. And that's something countries should do, even at cost to themselves, so that in theory export prices for American plasma to other countries be lower because SuPpLy & DeMaND?

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If that was what they were doing there wouldn't be any need to make it illegal, the US would compete and win based on price.

+1, if it was legal but cheaper to import from the US, that's just normal trade. But since it's illegal to pay, we don't actually know what the trade market looks like.

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Apparently, you have either never heard of the Law of Supply and Demand or failed (miserably, imho) to understand it. Admittedly, it isn't a law of physics, but it's rational to assume, in a specific case, that it will hold, absent evidence to the contrary. What AT neglects to mention is that corruption, coercion, and theft, and risk of complications, as well as storage and distribution logistics might be important in the determination of whether there is "state capacity" to properly supervise such a system. I'll also note that back 50 years ago (?) there were what I deemed (but I was young and even more gullible) credible claims that in certain African countries, people were being drained of blood which would seem to be a damn good reason for a culture today to be distrustful of of blood donation.

lol, looks like MR commentors really love policies of import bans and import substitution, and aren't big fans of international trade. Who knew?

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Plasma donation helps both the donee and donor.

-1, It's not a symmetrical trade. it helps the donee to a far greater extent than the donor. Indeed, it probably helps the paid nurse who extracted the plasma to a much greater extent than it does the donor. Ergo, we pay the donor to balance the trade.

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"...the position of some countries that compensating domestic plasma donors is immoral,"

... but it's a primary purpose of government in all countries to impose tribal morality upon the general population,

witness the U.S. where victimless "crimes" clog our courts and fill our prisons.

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Why are using the English language terms to refer to Germany, Austria & Hungary but the non-English term to refer to the Czech Republic? Tres bizarre.

Czech Republic is also known as Czechia in English. In Czech, it is Česká republika or Česko.

https://en.wikipedia.org/wiki/Czech_Republic

Czechia's a new one on me, but I like it.

I had to look-up the word "Czechia" in Wikipedia a week or two ago. I think I first encountered it in statistics on covid-19. And now suddenly it's a broadly accepted term? hmmm. Is there a reason for the change from Czech Republic? I've always been puzzled by why it is appropriate to refer to Germany and not Deutschland, and on and on. Granted not all countries have stable names, but it just seems that the best name for a country is the English alphabetic conversion of the country's name in (one of) it's official language(s)) [although, recently the inclusion of non-standard characters especially in European words has increased dramatically. I've been looking for a "standard for usage of characters" for English, but haven't found anything like it. Odd, but maybe it's progress - no Standard but then no puckered-a__holes getting in a swivet about violations, either.]

Czechia officially asked the United Nations to refer to it using the shorter form "Czechia" in 2016, on the grounds that "Czech Republic" is too unwieldy for everyday conversation. I suppose the usage has only gradually filtered out to other organizations. Nothing to do with COVID.

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Along parallel lines, the United States has a surplus of donor sperm for export, because it permits anonymous donation and most other Western countries do not.

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It’s almost like this policy works perfectly. Focus blood harvesting in the worlds most developed country rather than a race to the bottom where our blood supply comes from the Congo.

That said cowen getting aids from some Congo blood the donor was paid 13 cents for would by cosmically deserved.

Alex getting it would be flat out hilarious. Cowen is smart enough to pretend to oppose this policy while understanding its reason for existing. Alex isn’t that kind of thinker.

The examples mentioned were: "The United Kingdom, Australia, New Zealand and some Canadian provinces".

So sure, it's fair to point out that we should be wary of importing plasma from third world countries. However, your comment was basically a strawman attack.

How is it a straw man each defector from the policy weakens the ability of the WHO to put pressure on third world countries to adhere to the policy. The only thing the WHO is good for is bullying third world countries into not following their bad instincts.

It's a strawman because Alex specifically listed first world countries with much the same standard in medical care as the US and you replied as if he had included third world countries. You shifted the context from something he did say to something he didn't say. That's a strawman argument.

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Wasn't there heavy push back during the AIDS crisis against refusing blood donations from gays? The blood banks took all comers, despite the risk, in order to avoid bad press. Lots of hemophiliacs, plus people like Asimov, paid the price for it. So maybe the US has its act together in incentivizing donations, but ideological conundrums like these pose other threats. Via Randy Shilts' book, "And the band played on".

No gays were forbidden from giving blood up until 2015. The issue for people like Asimov is a lot of black dudes love getting fucked in the butt but don’t consider themselves gay. Down low bruthas killed a lot of people like Isaac.

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Maybe blood should be tested before being used in transfusions. Unless you think it is OK for people getting contaminated blood from straight donors.

Are they testing all of the blood already for most anything? Because, if not, then profiling your donor group can go a long way towards reducing problems.

"Are they testing all of the blood already for most anything?"

I hope they are. Otherwise, a transfusion is much more of a Russian roulette than most of us ever realized. One-fifth of the new AIDS cases in the USA are women. Most of them got it through heterosexual sex, not drug-use, so banning gays and drug users (supposing both groups follow the honor code and self-report) won't exactly do the trick. And this is just AIDS, a notoriously difficult (but not impossible) STD to get as a heterosexual man. Other diseases are much easier to get as a non-gay male. What about them?

My comment was related to the period covered by the book I mentioned, the 80s, not to what is happening today. But even if a measure does not solve 100% of the problem, it is still useful to implement.

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Banning homosexuals is dumb. Banning anyone who has engaged in high-risk activity (most especially anal sex) within whatever the time window is between infection and the emergence of a testable level of antibodies) is not.

Nobody banned homosexuals.

What was banned was "men-who-have-sex-with-men" and their female partners. Lesbians were never effected nor were gay men who never had sex. Straight women who had sex with bisexual men were. The locus was centered firmly upon the higher prevalence of STIs in the MSM population (which continues to this day) and the greater likelihood of anal sex transmission (which is much higher when a male acts as both a top and bottom with positive insertive anal sex being the single highest risk of transmission).

Last I checked, (maybe five years ago) this was resulting in something like five lives saved per annum. Evolution since then is hard because we have had a dramatic rise in PrEP and PEP, but we are also seeing folks engage in riskier behaviors.

All of the blood is screened six ways to Sunday, but there will always be some that escapes detection. You can do other things (like leukoreduction, which is becoming universal) to decrease odds but at some point the cost is more than screening out the highest pre-test probability donors (e.g. blood irradiation might decrease transmission rates but is expensive, time consuming, and has other problems).

For what it is worth we also screen out a lot of other high risk behaviors including things like travel to places with endemic diseases that are hard to screen post-donation (e.g. Mad Cow), IVDU, and recent piercings/tattooing.

And it is always a trade off, with historically low blood stocks from Covid (scared donors), we are now loosening the recommendations to increase the blood supply (e.g. waiting periods were just dropped from 18 months to 3, we are accepting more PrEP/PEP instead of abstinence), this comes with real risk, but given our current shortages it is less than what we gain from better supply.

Duh. The comment is directed at both the morons with actual irrational bigotry against gays and against the other set of morons who think removing these kinds of restrictions is some kind of civil rights victory (I'm looking at you California).

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This is one of the oddest tales I've come across about the trade in bits of blood.

‘Hundreds of people with haemophilia in England and Wales could have avoided infection from HIV and hepatitis if officials had accepted help from Scotland, newly released documents suggest.

A letter dated January 1990 said Scotland’s blood transfusion service could have supplied the NHS in England and Wales with the blood product factor VIII, but officials rejected the offer repeatedly.

Large volumes of factor VIII were imported from the US instead, but it was far more contaminated with the HIV and hepatitis C viruses because US supplies often came from infected prison inmates, sex workers and drug addicts who were paid to give blood but not screened.’

https://www.theguardian.com/uk-news/2020/jan/03/refusing-scottish-help-a-grave-error-in-blood-scandal-letter-says

Who would want Scottish blood? I would rather die.

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You forgot to mention the newly liberated gay scene having the time of their life and not willing to take any BS from the Man and had been praised for donating blood for the Hep B sufferers. This from the book "And the band played on".

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"but it was far more contaminated with the HIV and hepatitis C viruses because US supplies often came from infected prison inmates,"

Prisoners are barred from blood donation to the Red Cross.

"Persons who have been detained or incarcerated in a facility (juvenile detention, lockup, jail, or prison) for more than 72 consecutive hours (3 days) are deferred for 12 months from the date of last occurrence. This includes work release programs and weekend incarceration. These persons are at higher risk for exposure to infectious diseases."

The events happened in 1990. What were the procedures then?

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Ah yes that most noxious of species the low born Brit conservative that only believes the guardian when it is bashing the US.

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"The UK, Australia, New Zealand and Canada can afford their moral hypocrisy but their decision to forbid paid-donors reduces the world supply of plasma driving up the price and harming people in poorer countries."

And their ok with that.

they're

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"but their decision to forbid paid-donors reduces the world supply of plasma driving up the price and harming people in poorer countries."

No, it doesn't. People in poor countries have as much blood as people in rich countries. If you are worried about them, you can donate funds for helping created safe, well-mainted, well-staffed blood banks in poor countries. Or you can at least save your crocodile tears, fascist.

"Or you can at least save your crocodile tears, fascist."

Well you certainly told me. /sarcasm

"If you are worried about them, you can donate funds for helping created safe, well-mainted, well-staffed blood banks in poor countries."

So, the solution for the moral hypocrisy of "UK, Australia, New Zealand and parts of Canada" is for me to donate. Ha, ha, why not just go ahead and blame the third world for being poor then, in either case you are refusing to put the blame where it lays.

Again, no one is taking plasma from anyone. You are a liar.

Well I didn't claim that people were "taking plasma" from anyone, so you appear to be confused about what I said.

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What is better free than paid? Love - and blood donations. When paid, the motives change and you attract donors who are more often carrying hepatitis et al. . (Read that ages ago - was it Paul Samuelson?) Here in Germany I got 20€ or so "compensation" for my blood-letting and free soft-drinks/cookies, not "pay", God forbid. Stopped after my M.A.. Heard they give out chocolate now. I may check them out. Next year? When they pay 100, I will be back - this week. Made me feel better anytime.

Read the report. That’s no longer true for plasma used to make plasma therapies. No transmission of any infection in over 25 years, with millions upon millions of uses. They use heat treatment, solvent/detergents, nanofiltration, UV lights, etc. on plasma when they make the plasma therapies. You can’t do that with blood and plasma used for transfusions. Which is why we pay for plasma for plasma therapies, but not when it’s used for transfusions.

It’s also irrelevant, since every country imports plasma therapies made from paid American donors. Unless you think Canadian, Australian, and Kiwi donors have dirtier plasma than Americans, and carry viruses that can’t be eliminated or inactivated through the fractionation steps.

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I'm Australian. When I was going through a rough financial time, I thought I should donate blood and get the money from it (because I used to live in the US where this was possible). Then I heard there was no financial benefit. I didn't go--the cost of feeling a bit bad afterwards was too much me. Surely the moral is incentives = good, especially when dealing with selfish people like me.

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Not relevant to the bigger point, but the UK doesn't use locally donated plasma either. The reason why the UK imports plasma products isn't squeamishness about payment, it's that plasma products are considered higher risk for BSE/vCJD transmission than packed red cells.

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My small Canadian city once had a non-profit plasma center. It was shut down. My understanding is that this was done, not because of a lack of voluntary donors, but because it is cheaper to buy plasma from the US than to collect it in Canada.

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Which Canadian provinces import plasma?

I'm sceptical how much better the world will be if people are paid to donate blood. I'm not against the idea, but "moral hypocrisy" is a bit much imo

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If we can't bring ourselves to compensate an organ donor, we really shouldn't be compensating anyone else down the chain (beyond reasonable cost reimbursement).

This program of convicing people to donate an incredibly valuable irreplaceable body part item into the chain of commercial parasites is a remarkable feat of salesmanship.

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In that picture you look like you should be on a Kraftwerk album cover.

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Hypocracy is pervasive, but it is oh so much easier to see in other people rather than ourselves.

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I know it sounds totally bizarre, but sometimes people have moral values. Yeah, I know, weird, right. Economic man has no moral values.

When I was in Bhutan, I learned it was a Buddhist country. Despite archery being the national sport, the idea of hunting, fishing or killing animals was regarded with revulsion. I was surprised to find meat on the menu. The Bhutanese would not countenance slaughtering animals, but they had no problem with Indians doing so.

This is not as strange as one might think. In many societies, slaughtering animals is considered unclean and morally suspect, but it is perfectly jake to hire buy dressed meat from someone in a class, caste or ethnic group who has no such scruples.

I think economists would call this something like exporting or outsourcing externalities.

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Always found it fascinating that border town plasma donation centers are largely Mexicans coming to the US to donate their plasma https://www.nytimes.com/2009/12/06/business/06plasma.html

Also, doesn't the American Red Cross sell donated plasma (which they won't compensate for) to pay for other operations?

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Do poorer countries allow to makepayment for plasma?

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