A private corporation called Canadian Plasma Resources (CPR) recently opened clinics in the Canadian cities of Saskatoon and Moncton, N.B. At these sites, CPR offers people up to $50 in gift cards for a donation of blood plasma. This has sparked a national debate over the ethics of paying plasma donors.
People all across Canada rely on plasma-derived medicinal products (PDMPs) to treat serious immunological disorders. Canadian Blood Services is the agency tasked with managing Canada’s blood and plasma supply, but it does not pay donors.
Canada suffers a shortage of domestically produced blood plasma and has to import more than 80 per cent of the plasma needed to produce PDMPs from paid donors in the United States. This reliance on foreign sources poses real risks to our supply. American plasma goes to the highest bidder. If someone outbids us, our supply will be cut off.
This is why plasma self-sufficiency is an important goal. It’s also a goal that Canadian Blood Services shares. And evidence shows the only countries to have achieved self-sufficiency in plasma are ones that rely on a system of both paid and unpaid donations.
Despite this, Sen. Pamela Wallin has recently proposed a bill to ban all donor compensation in Canada. The main worry she cites is that “Canadian donors are not meant to be a revenue stream for private companies looking to make a profit.” This is a concern many Canadians share, and rightly so. There is definitely something nefarious about Canadian blood being used to line the pockets of corporate shareholders.
But it’s important to recognize that while this is an argument against allowing a company like CPR to profit from Canadian plasma, it is not an argument against compensating Canadian plasma donors.
This argument is grounds not to license any more of CPR’s clinics. It isn’t grounds to ban donor compensation — because compensation could be offered by a not-for-profit like Canadian Blood Services instead.
Payment could bolster the supply
We should not be surprised if a for-profit firm like Canadian Plasma Resources sells the plasma it collects from Canadian donors to the highest bidder. And the highest bidder may not be in Canada.
In other words, CPR can reasonably be expected — precisely because it is profit-oriented — to sell Canadian plasma abroad if it proves more lucrative than selling it here.
One of the primary reasons for payment is to increase Canada’s domestic plasma supply and to promote its ongoing security. To the extent that the profit motive threatens this goal, this is a good reason not to license any more for-profit plasma clinics in Canada.
But this is not a good reason to support Wallin’s proposed ban on donor compensation. To say that Canadian donors should not be a revenue stream for a private corporation has nothing to do with whether donors should be paid. Because payment could, of course, be offered by a not-for-profit agency. Lots of not-for-profit agencies — like our provincial health insurers — pay their suppliers. Canadian Blood Services could in principle do just the same.
A not-for-profit agency that collects plasma through compensated donation could ensure that the plasma collected in Canada would in fact serve to bolster the Canadian supply. Canadian Blood Services would not sell Canadian plasma abroad on the open market because its mandate is to protect the security of Canada’s blood supply.
A publicly governed compensatory scheme would realize the benefits of increasing our supply through incentivization, without the risk that Canadian plasma would go to whomever was willing to pay the highest price for it.
Commodification concerns overblown
There are other ethical considerations that get raised against donor compensation — that it’s unsafe, that it exploits donors and that it commodifies the human body.
But these worries are overblown in light of the fact that Canadians already rely on plasma purchased from the U.S. where donors are paid.
If paid blood was unsafe blood, (which it isn’t), we would already be at risk. And if paid donors are exploited, and their bodies wrongfully commodified, how do we justify buying plasma from paid American donors?
These particular arguments against paid donation have been deftly addressed in an open letter signed by more than 30 professional ethicists and economists.
Wallin’s main worry, meanwhile, is that CPR shouldn’t profit from Canadian blood. And we agree. But CPR’s profit motive doesn’t offer support for her proposed ban on all donor compensation.
In the interests of increasing the domestic Canadian plasma supply, which is an important and pressing goal, donors should be compensated.
And in the interests of protecting that supply and ensuring that Canadian plasma is used to treat Canadian patients, donors should be compensated by a public, not-for-profit agency like Canadian Blood Services.