A Bloody Exchange

How much would you charge for one of your kidneys? $1,000? $100,000? Sure, the general medical consensus is that you can live with one kidney. But what if that kidney fails? At best it sounds like a gamble. At worst, you die.  But if someone offered you enough, would you take it? How much will it be? 

The truth is that it doesn’t really matter in the United States. Since Congress passed the National Organ Transplant Act in 1984, it has been illegal to sell human organs, though a person can choose to donate their organs. While the sale or donation of organs might sound sinister and distant, a topic reserved for black markets or postmortem specifications on drivers licenses, blood donation, which is fundamentally comparable, is probably a little more familiar. 

There are manifold opportunities to give blood, especially for young, rosy-cheeked students. Blood drives pop up on college campuses like zits on a 13-year-old (as you might be familiar with (the former, not latter (maybe both))). But selling blood, while technically legal, is stigmatized: in practice, hospitals don’t buy blood labelled as “sold,” largely because of the shadowy ethical foundation surrounding these sales. For many people, something seems rather distasteful about the idea that people can profit off the sale of a part of the human body. So, when you give your blood, you donate it. An act of total altruism.  

While you can’t walk out of your neighborhood blood drive with a crisp $50 bill in pocket, you can donate blood plasma for compensation. Plasma is a part of your blood—55 percent of it to be precise—and is largely composed of water, in addition to electrolytes and hundreds of proteins. In your body, suspended amidst the plasma, are white blood cells, red blood cells, and platelets. Once separated from the rest of your blood, plasma is a worn-out, off-yellow liquid.

Having tripled in size from 2008 to 2014, plasma pharmaceuticals now constitute a nearly $20 billion industry. Plasma, used for research and development of medicines for hemophiliacs, treatment of serious burns, and certain immune disorders, has settled into a cozy and expanding niche in the American medical industry—indeed, only in the American medical industry. The U.S. supplies around 94 percent of the plasma used around the world. A portion of donated plasma goes toward research, but the rest fuels the production of a variety of pharmaceuticals.

The industry of plasma donation has a scarred and tumultuous history. In the mid-20th century, companies interested in harvesting plasma compelled prisoners to “donate” by offering them pennies on the dollar as compensation. In the 1980s, reckless medical practices during plasma withdrawal resulted in a wave of HIV and hepatitis spread by the ingestion of drugs that contained donated plasma. Plasma sales shot down for a few years because of the scandal, but, after the implementation of stricter regulations and oversight of plasma extraction, the market began to grow again. Total “donations” jumped from 12.5 million in 2006 to about 23 million just five years later. Although most plasma donations are compensated for, clinics unflinchingly use the term “donation,” trying to escape the ethical ambiguities involved with selling parts of the human body. 

While health standards for plasma donation improved, regulation of Big Plasma’s business practices and ethics remained sorely lacking, and now a select few companies dominate the field. The Federal Trade Commission (FTC) complains in a 2011 report that “the plasma-derived products industry has operated as a tight oligopoly,” and describes “intentional sharing of competitive information” by companies to avoid “oversupplying the market or starting a price war.” The FTC adds, “There was evidence of a history of coordinated activity in the industry, and that is going to raise concerns when you’re reducing the number of competitors.”

While the journey of blood plasma after extraction is tremendously complex, the donation process itself is relatively simple. After sitting in a waiting room of a plasma clinic for what can often stretch to a couple hours, you’re brought to a part of the clinic lined with identical, sterile hospital beds. Standing to the side of each bed, as though guarding it, is a complicated medical device with tubes running in and out of it. In an explanatory video by BioLife Plasma Services, which operates a clinic in Colorado Springs, this instrument is referred to, rather ambiguously and ominously, as “the separation device.” Once connected to the machine, the “separation device” draws blood from your arm as you flex and relax your fist to stimulate blood flow. It separates out plasma and then, for another few minutes, pumps plasma-deprived blood and a sterile saline solution back into your arm. The newly-extracted plasma is sent to labs for further “fractionation,” where specific proteins are separated from the rest so that they can be used in pharmaceuticals. 

Overall, the process seems benign enough. Most clinics incessantly claim that no long-term consequences exist. But Dr. Roger Kobayashi, an immunologist at UCLA, warned during an interview with ABC News that “we really don’t know what the long-term effects [are] because it’s a relatively new phenomenon.” That’s largely why other medically advanced countries have balked at allowing plasma pharma businesses to take off. 

Recent Colorado College graduate Isaac Radner donated plasma in the Denver area. He recalled feeling that something was off during the process. As the non-plasma constituents of blood were pumped back into his arm, he “had an awful feeling of pressure building up in [his] vein.” Since this part of the cycle only happened for five minutes at a time, Radner didn’t have time to mention the discomfort to an attendant. He added that during his visit there was a shortage of saline, which is normally used to help rehydrate patients—a shortage the clinic claimed was “nationwide.” They made him drink a Gatorade before he could leave, a common policy to ensure a patient’s well-being. Radner might have walked out of the clinic $50 richer, but he was left wondering if everything had gone right. After a prolonged reflection on selling his plasma, Radner would soon decide that donation just wasn’t worth it.

Talecris Plasma Resources is hidden amongst one of those brutalist medical industrial parks, its windowless brick exteriors matching that of the surrounding buildings. When I stopped by to learn more (I have wretched, iron-rich blood, so I can’t actually go through the donation process), the clinic didn’t seem too different from a regular doctor’s office. Though the clinic was lacking in Legos and subtly outdated copies of Sports Illustrated Kids, I might as well have been at my old pediatrician’s office (kind of). A row of machines was visible from the waiting room, where patients entered their basic personal and medical details. Hidden from view, an attendant screamed first names and last initials to summon the next donor in line. The attendants aren’t doctors, nor are they required to have nursing certification.

I visited the clinic at 10 a.m. on a Monday, and the eight or so patients in the waiting room represented a diversity of age, gender, and race. After aimlessly milling around the small waiting room, I approached the receptionist in hopes of learning about the process. But, she demanded to see my Social Security card and that I pass an initial exam to learn anything more. 

Few of the patients appeared young and healthy, of the ilk that campus blood drives seek out. A couple of the plasma donors with whom I’ve spoken mentioned that, at clinics they attended, most other patients “seemed like they might really need the money.” This sounds presumptuous and pejorative, and perhaps it is. But there might be some truth to it. The industry exploded during the Great Recession of the early aughts, as thousands of Americans lost their life savings and looked for quick sources of income anew. About 80 percent of the plasma donation clinics in the U.S. are, suspectly, located in the country’s poorer neighborhoods—places where poor health is endemic. 

This disproportionate distribution has aroused a fair amount of criticism of the industry for targeting poorer Americans, who are far more willing to supply plasma than their wealthy counterparts. Watchdogs of the industry wave a red flag at this paradigm and often suggest that incentivizing poor and disadvantaged patients to donate plasma makes it more likely that they will have contagious diseases and that they will lie about these pre-existing conditions to get the promised compensation. The presence of this structure of incentives led to the late-century wave of infections from plasma donation, though hematological health screening has improved greatly since then due to market growth and greater pressure for accountability.

Dr. Kobayashi puts the result of this targeting of poor Americans succinctly when he says, “A simple gift of life has now evolved into a multinational, highly profitable corporate enterprise...what was once an act of altruism has now evolved into an act of necessity or desperation.” Sure, to some extent people can do what they please with their body, as they should be able to. But in well-established market economies, some unsavory realities emerge with regard to body commodification. When you’re poor, selling your plasma can become less of a choice and more of a necessity. Thus, we see the overwhelming majority of plasma clinics in impoverished neighborhoods. These neighborhoods are populated with marginalized people who have been shoved, by that brutish invisible hand, into needing a $50 stipend from selling a part of their body to put food on the table. Does the donor really have a choice? At clinics like Talecris, most donors are repeat donors. They speak of ritualized processes, like using their left arm for the donation one week and then their right arm the next week. 

It strikes me as imposing and pretentious to tell the people waiting in the lobby of Talecris Plasma Resources that they shouldn’t be able to sell their plasma for $40 to 60—that they’re “commodifying their bodies,” or that it’s wrong. Even if the process takes you three hours, the donor is earning far more than what a minimum wage job could offer in the same span of time. It certainly seems like a worthwhile use of their time. 

Clinics like Talecris insist that any compensation they provide is for the time spent donating, not for the plasma itself. They tirelessly obfuscate the fact that you are profiting off of a part of your body. Testimonial videos, forums, and Facebook pages are filled to the brim with customers gushing over how good it feels to “save someone’s life.” Explanatory videos feature cartoon characters like “Grif the Elf” who is apparently “looking for way [sic] to make a difference in his community year round.” 

Many plasma donors speak warmly of their experience. As a bonus, the compensation allows them to get their kid a Christmas gift or the week’s groceries. One donor celebrates, on Facebook, how “the donor compensation gives me a little bit of money to spend on the kids every week after my wife spends all of mine.” Another proposes an idea: “How about special recognition rewards for the most loyal and dedicated donors. I am coming up on donation #200 since November of 2015. By the calculations, I’ve donated over 43 U.S. gallons of plasma to date.” 

Hannah Bollen, a junior at Colorado College, noted that, for her, donating plasma and blood was “a form of community service.” Her comment was reminiscent of the remarks made by dozens of Talecris’ donors. She donated plasma at a blood drive run in the Worner Campus Center, so she wasn’t compensated. But when I pressed her to consider getting compensated for her plasma, she conceded that it might “stop feeling like community service.” 

Plasma donation in its current form may strike you as benign, and it very well might be. But it raises a series of important questions about a person’s freedom with their body and the shadier, more insidious side of market economies. Medically modernized countries (mostly the U.S.) draw an arbitrary line between the ways people should and shouldn’t be able to sell parts of their bodies. Our medical system turns up its nose at selling blood but screams to buy a part of that blood from you. 

A couple years ago, a 2011 Federal Appeals court case made it legal to sell your bone marrow, a body part previously forbidden from being sold under the 1984 National Organ Transplant Act. We all-too-easily lead ourselves into simple delusions, comfortable ones. Like that the $50 from a plasma donation center is for “your time” and not a part of your body. Or that selling plasma is substantively different from selling blood. Or that it should be legal to sell bone marrow, but selling a kidney should not be.  

The market for blood plasma is, to me, not so much  a cultural infection—something bad in and of itself—as it is a symptom. No, the government shouldn’t be able to tell anyone that selling a part of my body to make a needed $50 is wrong. But the fact that any American would need to do this in the first place is profoundly discouraging. Perhaps there is more to why the U.S. is the only medically modernized country that has embraced the unfailing advances of Big Plasma. We are seduced by profit motives, and struggle to see beyond them. 

America has so much trouble helping those citizens who really need its help. With such a destitute and inadequate net for social welfare, it makes sense that market solutions avail themselves to people who need $100 more a month than they are getting. And when the market’s solution involves selling a part of your body, it is not evidence of the moral shortcomings of donors, but rather a glaring indictment of the American government’s treatment of its disadvantaged.