Payment, compensation and replacement - the ethics and motivation of blood and plasma donation

Abstract

The supply of blood and plasma to produce haemotherapies varies around the world, but all environments need donors to furnish the raw material. Many countries still lack adequate supply, and the question of what amounts of blood and plasma are required for optimal treatment is still unresolved. The issue of compensating donors has been a controversial and emotive one in blood transfusion for many decades. Donors are conventionally classified as paid, voluntary or replacement, and a level of stigma, based on safety and ethical considerations, has been attached to paid donation. This review points to evidence which renders many of these concerns redundant. Purist arguments against compensated donation have little basis in evidence and would lead to many of today's voluntary donors being designated as paid, because of the large range of incentives used to recruit and retain them. Misplaced application of 'Titmussian' volunteerism has precipitated its own safety and supply problems. Current systems of compensation and replacement are needed to maintain supplies of essential products and lead to safe products in controlled environments. We propose that a plurality of routes towards donation is an appropriate paradigm in the heterogeneous landscape of blood and plasma product supply.

The Market for Blood

“…For instance, in 2006 the US health care system used usage rates for plasma products. For instance, in 2006 the US health care system used 105 grams per/1,000 people of the dominant plasma product (immunoglobulin) 105 grams per/1,000 people of the dominant plasma product (immunoglobulin) which was more than 250 percent of the rate in Italy, the United Kingdom, Germany, which was more than 250 percent of the rate in Italy, the United Kingdom, Germany, the Netherlands, and Japan (Flood et al 2006), suggesting that the noncompensated the Netherlands, and Japan (Flood et al 2006), suggesting that the noncompensated plasma collection system might be limiting potential usage in many countries. plasma collection system might be limiting potential usage in many countries.…”

“…Demand for plasma products has also increased rapidly. For instance, the annual supply of albumin-often used in the treatment of shock and severe burnsannual supply of albumin-often used in the treatment of shock and severe burnsincreased 20-fold from 30,000 pints at the end of the war to over 600,000 pints by increased 20-fold from 30,000 pints at the end of the war to over 600,000 pints by 1990 (Peters 1996) and intravenous immunoglobulin-often used to fi ght infec-1990infec- (Peters 1996 and intravenous immunoglobulin-often used to fi ght infections-has increased more than fi ve-fold from 15 to 80 tons from 1990 to 2006 tions-has increased more than fi ve-fold from 15 to 80 tons from 1990 to 2006(Flood et al 2006. (Flood et al 2006).…”

“…The volunteer system, however, has not done well in meeting plasma demand. The United States is the only country that is totally self-suffi cient in all blood and The United States is the only country that is totally self-suffi cient in all blood and plasma products (Flood et al 2006) and has accomplished this using a mostly plasma products (Flood et al 2006) and has accomplished this using a mostly for-profi t plasma industry. Most other countries have to import at least some plasma for-profi t plasma industry.…”

“…The United States, Germany, and Austria collect a substantial share of plasma The United States, Germany, and Austria collect a substantial share of plasma from paid donors, with the United States collecting 70 percent of the world supply from paid donors, with the United States collecting 70 percent of the world supply (Flood et al 2006). US plasma donors are typically paid $30 to $60 per donation (Flood et al 2006).…”

“…US plasma donors are typically paid $30 to $60 per donation (Flood et al 2006). US plasma donors are typically paid $30 to $60 per donation depending on donation frequency (Blood Plasma Donation Tips 2013).…”