Black Market for Blood

According to this AP article, Bulgaria is experiencing first-hand the concept of repugnant transactions:

"It's a grim reality for patients and families in Bulgaria, a struggling EU nation where donors are troublingly scarce, hospitals are strapped for funds and blood traders — mainly Gypsy, or Roma, men — are thriving...

..once a deal is struck, a donor hanging out nearby — or at most a phone call away — is summoned, and turns up at the blood clinic masquerading as a relative. He gets a proof of donation certificate and sells it to the desperate family. The blood heads off to be checked, and if it is found to be disease-free it goes toward filling the clinic's reserves."

It seems the Bulgarian legal apparatus is largely tolerant of the black market, most likely as it believes it to be a critical driver of blood supply. But one must wonder to what degree the presence of a black market crowds out altruistic donors ("voluntary blood donation has been gradually shrinking here over the past two decades..."). At the same time, a black market is less efficient (from a social standpoint) than a publicly operated market for blood; the middlemen are presumably taking much of the rents. So while the jury is still out on whether enforcement of the ban of blood sales or a public embrace is best, this interior solution cannot be optimal.

So why can't Bulgaria get more people to go under the needle? Repugnance has put the Bulgarians in a prickly (groan) spot.