Breast milk plan to purchase and sell breast milk cancelled in Detroit

Steve Leider writes:

"An Oregon-based company Medolac (partnering with the Mothers Milk Cooperative) was trying to expand its program of buying breastmilk from nursing mothers with surplus milk into Detroit.  However, several local groups reacted very negatively, arguing that this would cause many mothers to sell all their milk (therefore harming their own children).  Ultimately it caused the company to cancel their plans."

Here's a positive story on the proposal, focusing on a seller of breast milk (who produced more than her baby could consume), followed by many negative stories (focusing on the possibility that women would sell breast milk even if they did not have a surplus):

 Breast milk company cancels campaign to recruit Detroit moms

"She breast-fed Jaden, but when Johanna was born, she wouldn’t latch on to breast-feed.

So Short was getting up at 4 am to pump and put that milk the in the freezer. Eventually, she said she wound up with an overflowing freezer stuffed with 2,000 ounces of breast milk.

"I had a storage problem! I just didn't have anywhere else to put more frozen milk," she laughs. 

For a while, Short was donating that milk to a local, non-profit milk bank.

But a friend told her about Medolac, which pays moms $1 an ounce for breast milk.

The company says it then sells that milk, at a profit, to hospitals, where it helps premature babies.

Over the next nine months or so, Short says she sent about 5,400 ounces to Medolac.

"It did help cover some bills. I bought myself a porch swing! That was my treat to myself because I really wanted a porch swing! And we definitely paid bills with it. There was a time when my husband was working fewer hours, so it really helped us cover bills."

And, Short says she originally planned to stop breastfeeding Johanna after a year. But she's continued, because of Medolac.

"It was a great incentive for me to continue and make a little bit of extra money and help some other babies who need it."

**************

Detroit moms protest breast milk banking effort

"A group of Detroit women is accusing an Oregon breast milk bank of exploiting women by asking them for their breast milk — a particular concern given the city's deep poverty, low rates of breastfeeding and high infant mortality.

That effort, they say, will take the precious substance — packed with potentially life-saving health benefits — away from Detroit babies."

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 Company offering to buy breast milk creates controversy (video of news broadcast, with interviews)

*******************

Oregon firm drops plan to buy Detroit breast milk

"An Oregon-based company has backed away from a plan to purchase breast milk from Detroit mothers, saying Thursday that opposition from community groups made the environment here “toxic.”

"Detroit organizations unleashed a firestorm of questions last week and argued the plan by Medolac Laboratories smacked of exploitation of the city’s impoverished mothers. Detroit has the highest infant mortality rate in the nation, as well as the greatest percentage of children living in extreme poverty.

...

"Kiddada Green, executive director of the Black Mothers Breast Feeding Association, called the Lake Oswego company’s decision not to collect breast milk in Detroit a “victory to Detroit mothers.”

Artificial breast milk may be on the cellular agriculture horizon

 Cellular agriculture isn't just aspiring to produce meat; now breast milk is queueing up as a (still distant) possibility.

The New Yorker has the story:

Biomilq and the New Science of Artificial Breast Milk. The biotech industry takes on infant nutrition. By Molly Fischer

"New ventures in the world’s oldest food reflect our era’s enthusiasm for tech-based solutions to perennial human problems."

...

"The process of making breast milk in a human body begins during pregnancy, when hormonal changes prompt mammary cells to multiply. After delivery, two of the pregnancy hormones—estrogen and progesterone—drop off, while prolactin remains. This spurs the mammary cells to draw carbohydrates, amino acids, and fatty acids from the mother’s bloodstream, and to convert these raw materials into the macronutrients required to feed a baby. In Biomilq’s case, the mammary cells come from milk and breast-tissue samples provided by donors, and the cells multiply in vitro under the care of a team of scientists tasked with keeping them “happy.” The cells are then moved to a hollow-fibre bioreactor—a large tube filled with hundreds of tiny porous tubes that are covered in a layer of the lab-grown cells. As nutrients flow through the small tubes, the cells secrete milk components into the large tube, where they collect.

"Describing the results as “milk components,” not “milk,” is a crucial distinction. Biomilq has demonstrated that its technology can produce many of the macronutrients found in milk, including proteins, complex carbohydrates, and bioactive lipids, but it cannot yet create them in the same ratios and quantities necessary to approximate breast milk. Other elements of breast milk are beyond the scope of the company’s ambition. A mother’s antibodies, for example, are present in her milk, but they aren’t produced by the mammary cells, and, because Biomilq’s product will come from a sterile lab environment, it won’t offer any kind of beneficial gut bacteria.

...

"“It’s as fraught as abortion,” Jacqueline Wolf, an emeritus historian of medicine at Ohio University and the author of a history of breast-feeding and formula in the U.S., aptly titled “Don’t Kill Your Baby,” told me. “There’s almost nothing that raises more social issues than infant feeding.” Wolf dates the emergence of what became known as “the feeding question” to the eighteen-seventies, when mothers across the country began raising concerns about their milk supply. “The big change that was sparked by urbanization and industrialization was suddenly having to pay attention to a mechanical clock,” she said. Earlier infant-care manuals had advised feeding a baby when he showed signs of hunger. Now medical advice put infants on feeding schedules as rigid as railway timetables. But, as Wolf pointed out, “to build up a milk supply, you need to put the baby to the breast often, especially in the first few months.” The women complaining that they lacked sufficient milk were not, as one theory had it, suffering from the ill effects of too much education during puberty. Rather, they were following advice unwittingly engineered to fail.  

...

"By the nineteen-forties, most mothers were giving birth in hospitals, where orderly routine—babies in nurseries, bottles on schedules—often took priority over the personal attention required to initiate breast-feeding. 

...

"Commercial infant formula from brands such as Similac and Enfamil took off in the fifties—a modern amenity that sat comfortably alongside Betty Crocker cake mix and Cheez Whiz. (Formula had also made it easier for women to work outside the home.) At the same time, the decade saw the rise of some of breast-feeding’s most influential evangelists. The La Leche League was founded in 1956 by seven Catholic housewives in the Chicago suburbs who wanted to create a forum for breast-feeding mothers to share questions and advice. La Leche occupied a tricky cultural position, at once radical and conservative: on the one hand, it encouraged women to claim control of their bodies and to defy voices of institutional authority; on the other, the intended result of this rebellion was a world in which a mother’s place was unequivocally at home.

...

"Meanwhile, the alternative to breast-feeding—formula—began to take on a sinister light. An industry that had presented itself as a best friend to mid-century mothers showed a different face in its dealings abroad. New reports linked Nestlé’s aggressive marketing of formula to infant deaths in the Global South, making the case that the company’s product had been pushed on families who lacked the resources (such as clean water) to bottle-feed safely. Instead of a scientifically perfected modern convenience, formula became “The Baby Killer,” in the words of one influential pamphlet. A years-long global boycott of Nestlé ensued. In 1981, the World Health Organization adopted a resolution that aimed to ban the promotion of substitutes for breast milk. The U.S. was the only country in opposition. (Today, Nestlé stresses its compliance with W.H.O. code.)

...

"products intended to provide complete infant nutrition (that is, formulas) must clear more hurdles than other foods. A new product must, among other things, undergo what are essentially clinical trials, which can involve recruiting hundreds of babies to participate.

...

"The distribution of human breast milk has traditionally taken place at nonprofit milk banks, and recent attempts to introduce commerce into this transaction have stirred controversy. In 2014, a company called Medolac, selling shelf-stable human milk, announced that it would expand its milk-bank program in Black communities in Detroit. The plan was scrapped after backlash from community groups and activists, who called out the company for its low pay in comparison with its pricing and for reinforcing historical injustice. (At the time, the company denied allegations of exploitation.) Biomilq seems keen to avoid any impression of similar obliviousness. Egger told me that the company has encouraged employees to read Andrea Freeman’s “Skimmed,” an account of racial inequities perpetrated by the formula industry. And even as Biomilq describes itself as “women-owned” and “mother-centered,” it also notes that “lactation is not only for cisgender biological mothers.” 

********

Related posts on breast milk.

The market for breast milk

Should breast milk be bought and sold?

Andrew Pollack in the NY Times has the story:
Breast Milk Becomes a Commodity, With Mothers Caught Up in Debate

"Breast milk, that most ancient and fundamental of nourishments, is becoming an industrial commodity, and one of the newest frontiers of the biotechnology industry — even as concerns abound over this fast-growing business. The company that owns the factory, Prolacta Bioscience, has received $46 million in investments from life science venture capitalists.
...
"But the commercialization of breast milk makes many people uneasy. They worry that companies might capture most of the excess breast milk and make products that would be too costly for many babies, while leaving less milk available for nonprofit milk banks.

“The competition comes in the form of how much surplus breast milk is there in the country and who’s getting it,” said Kim Updegrove, executive director of the nonprofit Mothers’ Milk Bank at Austin. “The nonprofit milk banks have a long history of providing milk to the sickest babies, and provide it based on medical need and not on insurance reimbursement or financial resources.”

Debate is also intense over whether women should be paid for their milk or donate it altruistically. Opponents of payments, worried about breast milk “farming,” say women might try to increase their milk output unsafely, hide health problems that could make the milk unsafe, mix in cow milk to increase volume or deprive their own babies so they can sell more."

Here are my earlier posts on breast milk.

Shortages of blood, and breast milk

 The pandemic is putting strains on many supply chains, including those for donated (unpaid) medical supplies like blood and breast milk.  The pandemic is impacting both potential donors, and the ability of blood banks and milk banks to staff drives for additional supplies.

Here's a statement from the American Red Cross:

Red Cross: National blood crisis may put patients at risk

"The American Red Cross is facing a national blood crisis – its worst blood shortage in more than a decade. Dangerously low blood supply levels are posing a concerning risk to patient care and forcing doctors to make difficult decisions about who receives blood transfusions and who will need to wait until more products become available.

"Blood and platelet donations are critically needed to help prevent further delays in vital medical treatments, and donors of all blood types – especially type O − are urged to make an appointment now to give in the weeks ahead.

"In recent weeks, the Red Cross had less than a one-day supply of critical blood types and has had to limit blood product distributions to hospitals. At times, as much as one-quarter of hospital blood needs are not being met.

"Pandemic challenges

"The Red Cross continues to confront relentless challenges due to COVID-19, including about a 10% overall decline in the number of people donating blood as well as ongoing blood drive cancellations and staffing limitations. Additionally, the pandemic has contributed to a 62% drop in blood drives at schools and colleges.

************

Here's a story on breast milk from the Guardian:

‘Now, now, now. We need help now’: US warning over breast milk shortage as donations plunge. Demand for breast milk has surged during the pandemic, but supply from milk banks has fallen as people head back to work.  by Melody Schreiber

"“​​Demand has been surging in hospitals, primarily,” said Lindsay Groff, the executive director for the Human Milk Banking Association of North America (HMBANA). “At the same time, supply has dipped.”

"At all 31 milk banks in the US and Canada associated with HMBANA, milk donations are declining, down as much as 20% in some places.

"Milk bank directors say they’re not at a crisis point yet, but they will be if shortages continue.

“There’s no need to panic,” Groff said. But if “you feel compelled to help someone [by donating breast milk] – now is the time. Now, now, now, we need help now.”

"Donated breast milk can help medically fragile infants – those that are “too small and too soon and too sick”, as Kim Updegrove, executive director of Mothers’ Milk Bank at Austin, puts it – to overcome a range of potentially devastating conditions, from prematurity complications to heart and stomach problems. Necrotizing enterocolitis, an inflammation of the intestines, is a leading cause of death for premature babies, but breast milk can help prevent it.

...

" the pandemic has increased the need for donor milk. Studies have shown that contracting Covid-19 during pregnancy when you’re not vaccinated increases the chance of having a premature baby, who might then benefit from donor milk. Parents who become very ill from Covid are often unable to care for their babies or to pump milk for them.

Breast milk sales and bans

Cambodia is banning more than surrogacy (see Wednesday's post):
Ban on breast milk sales throws spotlight on growing international trade

"Cambodian authorities have permanently banned the sale and export of human breast milk after suspending exports from a US company that has been collecting it from impoverished mothers for more than two years.

The ban has put the spotlight on a global trade in breast milk to other mothers, bodybuilders, cancer patients and breast-milk fetishists.

 ...
Cambodian women have been earning between $US7 and $US10 ($9 to $13) a day for selling their milk to the company.

Ambrosia Labs issued a statement saying "we believe in empowering the mothers of Cambodia with a way to make money while nurturing their families, as well as others, through the donation of their excess milk".

"We work hard to set and monitor guidelines to ensure that we are not taking milk out of infants' mouths," the company said, adding it does not accept milk from mothers of infants younger than six months.

But Ing Kantha Phavi, Cambodia's Minister of Women's Affairs, said the sale of breast milk could stunt children's growth and development and thwart the government's efforts to promote breastfeeding among new mothers.

The ban has been welcomed by the United Nations' children's agency, UNICEF, in a country where breastfeeding has been in decline.

"Breast milk could be considered as human tissue, the same as blood, and as such, its commercialisation in Cambodia should not be supported," the agency said.

"Cambodian welfare groups also welcomed the ban.

"Even if women agree to do it voluntarily, they often have no other choices and face economic pressure," said Ros Sopheap, the director of the women's rights group Gender and Development for Cambodia."
***********

In related news, here's a story from the South China Morning Post, about what appears to be a small but growing domestic market:
Chinese mums cash in on latest and lucrative craze: selling surplus breast milk
Although the trade is not large, the commodity can sell online for as much as US$22 per 250ml

The market for mothers' milk

The main consumers of human breast milk are infants, but here's a story that caught my eye:
A Manhattan chef recently began serving cheese made from his nursing wife’s milk. Legendary critic Gael Greene samples the now-banned fromage.

"It’s the unexpected texture that’s so off-putting. Strangely soft, bouncy, like panna cotta."

Aside from some articles that Steve Leider pointed out to me, which are now several years old, I don't find much online about the market for mothers' milk. But in 2007, it apparently looked like the market for wet nurses might be making a comeback.

Outsourcing Breast Milk:
"...wet-nursing (hiring a woman to breast-feed your baby), which most of the Western world abandoned in the 19th century, is making a minor comeback among young moms. So is cross-nursing, in which mothers breast-feed one another's babies. Both reflect several cultural trends: more U.S. babies--upwards of 70%--are breast-fed than at any time in at least 50 years, more women work outside the home, and more young women undergo breast surgery. Advocates argue that milk sharing lets women be good moms while fulfilling other goals. Says Natalia Chang, 29, who has cross-nursed with her San Jose, Calif., neighbor: Breast milk is "a communal commodity around here."

"Not everyone is comfortable with this freewheeling baby feeding. Milk banks, which sell bottled breast milk, already make some people squirm; the idea of physically breast-feeding a child not your own evokes even deeper taboos. Rhonda Shaw, a sociologist who studies shared nursing in New Zealand, where the trend is also up, says many confuse "adult meanings of eroticism with breast feeding ... Sometimes people associate a woman breast-feeding another woman's baby with pedophilia." Even the pro-nursing group La Leche League has concerns about milk sharing because, in addition to helpful immunities and antibodies, viruses can be passed through breast milk."
...
"Even if you accept that cross-nursing is for the collective good, wet nurses magnify the discomfort that many people already feel about the wealthy employing less advantaged women to do domestic duties. That's why the few women who hire wet nurses--mostly because they have adopted, have had breast implants or reductions or have high-powered careers--keep it a secret, for fear of being judged bad mothers. Still, Robert Feinstock, who owns CertifiedHouseholdStaffing.com a Los Angeles--based agency that supplies wet nurses nationwide, says demand has steadily risen in the past four years, even though the standard fee of $1,000 a week is more than the average nanny gets.
"Brenda (whose last name is withheld to protect her clients' privacy), 42, has wet-nursed 10 babies in the past seven years partly to help send her own two kids to college. She has mulled over the social implications of her work--because she's black and eight of the families she has worked for are white. "A friend asked me, Don't you feel like you're the mammy?" she recalls. But she finds her job fulfilling, and sometimes amusing. "If you're someplace with the family and the baby starts to pull at your blouse or put his hand in your bra, that can be embarrassing," she says, laughing."

Breast milk exchange?

Ben Greiner writes:

This might be an interesting upcoming story on repugnance: Due to the general positive effects, but also the social pressure to breast feed, there seems to be a developing exchange market for breast milk. For example there are organizations like

http://worldmilksharing.net

or

http://www.hm4hb.net

or

http://www.eatsonfeets.org

who actively promote breast milk sharing, in particular also with strangers over the internet and/or facebook.

However, in particular in the U.S. mothers are starting to ask for money in exchange for breast milk. There also seem to be stories about some mothers diluting their breast milk with water to make more money out of them. Another issue is hygiene and sterilization.

So I guess in short or long there will be a discussion about whether it is ok to share or even sell breast milk, and if trade is allowed, about how to regulate this trade given baby safety risks etc.

The market for (and marketing of) baby formula

 The Lancet has a series of articles on baby formula.  It begins with this editorial, and is followed by three articles:

Unveiling the predatory tactics of the formula milk industry, The Lancet, Published: February 07, 2023 DOI:https://doi.org/10.1016/S0140-6736(23)00118-6

"For decades, the commercial milk formula (CMF) industry has used underhand marketing strategies, designed to prey on parents' fears and concerns at a vulnerable time, to turn the feeding of young children into a multibillion-dollar business. The immense economic power accrued by CMF manufacturers is deployed politically to ensure the industry is under-regulated and services supporting breastfeeding are under-resourced. These are the stark findings of the 2023 Breastfeeding Series, published in The Lancet today."

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VOLUME 401, ISSUE 10375, P472-485, FEBRUARY 11, 2023 Breastfeeding: crucially important, but increasingly challenged in a market-driven world, by Prof Rafael Pérez-Escamilla, PhD  Cecília Tomori, PhD Sonia Hernández-Cordero, PhD Phillip Baker, PhD Aluisio J D Barros, PhD MD France Bégin, PhD Donna J Chapman, PhD Laurence M Grummer-Strawn, PhD Prof David McCoy, PhD Purnima Menon, PhD Paulo Augusto Ribeiro Neves, PhD Ellen Piwoz, PhD Prof Nigel Rollins, MD Prof Cesar G Victora, PhD MD Prof Linda Richter, PhD on behalf of the 2023 Lancet Breastfeeding Series Group†  Open Access Published: February 07, 2023 DOI:https://doi.org/10.1016/S0140-6736(22)01932-8

"When possible, exclusively breastfeeding is recommended by WHO for the first 6 months of life, and continued breastfeeding for at least the first 2 years of life, with complementary foods being introduced at 6 months postpartum.9 Yet globally, many mothers who can and wish to breastfeed face barriers at all levels of the socioecological model proposed in The Lancet's 2016 breastfeeding Series."

 VOLUME 401, ISSUE 10375, P486-502, FEBRUARY 11, 2023 Marketing of commercial milk formula: a system to capture parents, communities, science, and policy by Prof Nigel Rollins, MD  Ellen Piwoz, ScD Phillip Baker, PhD Gillian Kingston, PhD Kopano Matlwa Mabaso, PhD Prof David McCoy, DrPH  Paulo Augusto Ribeiro Neves, PhD  Prof Rafael Pérez-Escamilla, PhD  Prof Linda Richter, PhD  Prof Katheryn Russ, PhD  Prof Gita Sen, PhD  Cecília Tomori, PhD  Prof Cesar G Victora, MD  Paul Zambrano, MD  Prof Gerard Hastings, PhD  on behalf of the 2023 Lancet Breastfeeding Series Group  Open Access Published:  February 07, 2023 DOI:https://doi.org/10.1016/S0140-6736(22)01931-6

"Despite proven benefits, less than half of infants and young children globally are breastfed in accordance with the recommendations of WHO. In comparison, commercial milk formula (CMF) sales have increased to about US$55 billion annually, with more infants and young children receiving formula products than ever. "

 VOLUME 401, ISSUE 10375, P503-524, FEBRUARY 11, 2023 The political economy of infant and young child feeding: confronting corporate power, overcoming structural barriers, and accelerating progress by Phillip Baker, PhD Julie P Smith, PhD Prof Amandine Garde, PhD Laurence M Grummer-Strawn, PhD Benjamin Wood, MD Prof Gita Sen, PhD Prof Gerard Hastings, PhD  Prof Rafael Pérez-Escamilla, PhD  Chee Yoke Ling, LLB  Prof Nigel Rollins, MD Prof David McCoy, DrPH  on behalf of the 2023 Lancet Breastfeeding Series Group†  Open Access Published: February 07, 2023 DOI:https://doi.org/10.1016/S0140-6736(22)01933-X

"The first and second papers in this Series8,  9 present several reasons for the global rise of CMF in human diets, including the CMF industry's exploitation of parental anxieties; ubiquitous marketing; and absent or inadequate protection and support for breastfeeding within health-care systems, work settings, and households. In this Series paper, we look further upstream and examine the root causes of low worldwide breastfeeding rates10 to understand why so many women and families are prevented from making and implementing informed decisions about feeding and caring for infants and young children; why so many policy makers and health-care professionals are co-opted by CMF marketing and other commercial forces; and why so many countries have not prioritised and implemented policies to protect, promote, and support breastfeeding. It is important to note that we use the terms women and breastfeeding throughout this Series for brevity, and because most people who breastfeed identify as women; we recognise that not all people who breastfeed or chestfeed identify as women."

**********

Among my previous posts on milk are some noting that there are shortages of human breast milk, and that in many places the sale of breast milk is banned (in some places out of concern that poor mothers would sell their milk instead of feeding their children, and in some places out of concerns that the sale of breast milk is repugnant even from mothers who produce milk in excess to their children's needs.)  

Thus (in different times, places, and circumstances) there is repugnance both to the sale of mothers' milk and to the sale of substitutes for it.

Breast milk

The barriers to sale of human breast milk seem to be falling. Duncan Gilchrist points me to this article in Wired: Liquid Gold: The Booming Market for Human Breast Milk, which reports a booming private market, at high prices.

"Most body fluids, tissues, and organs—semen, blood, livers, kidneys—are highly regulated by government authorities. But not breast milk. It’s considered a food, so it’s legal to swap, buy, or sell it nearly everywhere in the US. This accounts, in part, for the widely varying quality and safety standards in the online market for milk. For their part, Prolacta and nonprofit milk banks have rigorous screening processes for potential donors, including tests for drugs, hepatitis, and HIV. But Only the Breast and the volunteer sites, which see themselves more as communities than commodity markets, don’t screen donors or assume responsibility for the milk they help disseminate."

Regulation of human and animal milk, in the U.S. and France

Here's an article full of interesting observations:

Mathilde Cohen, Regulating Milk: Women and Cows in France and the United States, 65 American Journal of Comparative Law, 469 (2017)


"Much like nineteenth-century milk reformers lobbied for a safe cow's milk supply in the cities, twenty-first-century public health officials are calling for the regulation of human milk.
...
"Milk is peculiar, however, in that, unlike other embodied forms of labor, it is also a food, cutting across species in two ways.15 Humans do not typically eat other humans' body parts or bodily fluids, yet human milk is their primal food.' 6 Humans do not typically turn to animals for sex cells, wombs, or sex, yet they commonly consume animal milk.
...
"The analogy between human and animal milk is sure to offend some. Much of human life and thinking, especially in Western cultures such as France and the United States, is concerned with distinguishing humans from other animals.
...
"I argue that some of the social and legal norms that have shaped the relationship
of the French and Americans to animal milk equally apply to human milk.
Why compare the United States to France? These are two of the biggest dairy consuming and producing countries in the world, 26which regulate animal milk production with little concern for animal welfare. Yet, the French and Americans entertain different cultural and regulatory approaches to human and animal milk, presenting us with a puzzling chiasm. The American sanitary regulation for animal milk is stricter than the French, resulting in a federal ban on raw milk.27 France, the birthplace of pasteurization, 28 is laxer, in part because raw milk is a necessary ingredient in its prized cheeses. With respect to human milk, the picture is reversed. The United States is the more permissive country, a land of no law, where American women can freely trade their milk. In France, human milk is so stringently governed that French women are prohibited from giving their milk to others, even for free, unless they turn to state-controlled milk banks."
...
p486. "In France, at the peak of the wet-nursing profession in the 1880s, close to 100,000 infants were placed in the care of wet nurses-about 10% of the children born in the country at the time."
...
p494. "Under French law the sale of human milk is illegal because milk is considered a bodily part similar to an organ.153 Article 16-1 of the French Civil Code states, "The human body, its elements and its products may not form the subject of a patrimonial right."54 Lactariums possess the exclusive right to process and distribute human milk.1 55 They are prohibited from paying donors for their milk 156-which, incidentally, has resulted in a state of near-constant shortage. Before the HIV/AIDS crisis, lactariums did compensate donors "for the time spent for the milk donation." 157 Since 1992, donors can no longer be indemnified. 158 The official explanation for this shift is that compensation would be contrary to the principle of gratuity of contracts pertaining to bodily parts."
...
p506. "The milk-sharing website, OnlyTheBreast.com, hosts wet-nursing classified ads. A recent example read:
'I am a Surrogate who is due to deliver any time in the next 2-3 weeks. I am an over producer and will not have a child to feed so I am looking for a local family who is in need and would like to provide their baby with liquid gold. I am looking to nurse a baby during work hours (M-F) and can provide pumped milk for over nights and weekends. Occasional weekend feeds can be .'
**************

See my other posts on breast milk.

Market for human breast milk

The New Yorker reports on mother's milk: Baby Food. It turns out that this is a repugnant market: "Can a human-milk bank pay a woman for her milk? (Milk banks provide hospitals with pasteurized human milk.) No, because doing so would violate the ethical standards of the Human Milk Banking Association of North America." Long before breast pumps, mothers who couldn't or didn't wish to breast feed hired other lactating women as"wet nurses," but it turns out that this practice, while ancient, has also been repugnant in some times and places: "... contracts for wet nurses have been found on scrolls in Babylonia." ... "Mary Wollstonecraft, in her “Vindication of the Rights of Woman” (1792), scoffed that a mother who “neither suckles nor educates her children, scarcely deserves the name of a wife, and has no right to that of a citizen.” The following year, the French National Convention ruled that women who employed wet nurses could not apply for state aid; not long afterward, Prussia made breast-feeding a legal requirement. " The article also comments on fashion and socioeconomic class: "By the nineteen-tens, a study of a thousand Boston women reported that ninety per cent of the poor mothers breast-fed, while only seventeen per cent of the wealthy mothers did. (Just about the opposite of the situation today.)"... " (A brief history of food: when the rich eat white bread and buy formula, the poor eat brown bread and breast-feed; then they trade places.)"

Markets in human milk, placenta, and feces

I've blogged earlier about markets for breast milk, but here is an article that considers them also in connection with placenta and feces: 

The Law of Self-Eating—Milk, Placenta, and Feces Consumption by Mathilde Cohen, Law, Technology and Humans, 3(1), pp.109-122.

"Milk, Placenta, and Feces 

"Since antiquity at least, there have been markets in human milk. Until the twentieth century, they relied primarily on wet nurses hired (or forced) to nurse infants directly on the breast.14Ancient Egyptian, Greek, and Roman pharmacopeias called for human milk as a therapeutic substance to treat burns as well as ailments affecting the ears, eyes, and genitals.15Traditional Chinese medicine  employed  human  milk  in  a  variety  of  preparations  to  cure  diseases,  such  as  debilitation,  arthritis,  rheumatism, voicelessness, amenorrhea, eye infections, and poisoning.16

"Today, markets in human milk continue to thrive.17Such markets assume two main forms: 1) informal markets through which people give or sell their milk peer-to-peer via their social circles or online; and 2) formal markets whereby profit or non-profit organizations, such as milk banks and commercial human milk companies, collect, process, and distribute milk to hospitals and a few outpatients for a fee. Human milk is sought after by three main categories of consumers: infants, adults, and researchers.

...

"Placenta

"Human placentas are used for spiritual, nutritional, medical, pharmaceutical, and cosmetic purposes. Placentophagy, or the act of eating one’s placenta after childbirth, has been practiced in the Global North since the beginningof the home-and natural-birth movement in the 1970s.22It is not an unprecedented phenomenon. Indeed, historian Jacques Gélis reported that:

    "Placentophagy, the custom of eating the newly expelled placenta,     has existed at various times amongst people of very different         cultures. From the sixteenth century onwards, European travellers to     the new world were much struck by this custom, which they         unfailingly reported.23

"According to Gélis, placentophagy was also practiced in Europe; however, “doctors and churchmen  were  more  and  more repelled, from the end of the seventeenth century onwards, by this custom . . . so ‘repugnant to humanity."  In the past decade, placentophagy has reemerged as a mainstream practice in the U.S., where it has been described as “anew  American  birth ritual.25

"Few randomized controlled trials have corroborated the benefits of placentophagy. However, placenta eaters are motivated by the hope of obtaining nourishment, hastening post-birth recovery, warding off postpartum depression, facilitating lactation, as well as spiritual motives, such as connecting with the baby and the environment. Placentas can be eaten raw or cooked."

...

"Minimally processed placental membranes have significant commercial and medical potential to treat, among other indications, eye diseases and acute and chronic wounds. The for-profit American company MiMedx also “grinds up amniotic tissue from placenta into an injectable product to treat tendinitis, strains, and other ailments.”29Much  like  human  milk,placentas  are increasingly seen as reservoirs of stem cells and thus are attractive to the field of regenerative and tissue engineering, and, more recently, as potential sources for treating coronavirus patients."

...

"Feces

"Excrement is typically regarded as disgusting; however, the medical use of human and animal feces has a long record. Heinrichvon Staden notes that:

"Most prominent among the ingredients in the Hippocratic pharmacological ‘dirt’ arsenal is the excrement of various animals. ..  .  the  belief  in  the  therapeutic  usefulness  of  excrement  was  shared  by  ancient  Mesopotamian,  Egyptian,  Greek,  Chinese, Talmudic, and Indian healers. . . . There is, therefore, abundant evidence that . . . ‘excrement therapy’—was a cross-cultural phenomenon extant already in the ancient world.32

"In Chinese medicine, human feces were used 1,700 years ago as a “suspension by mouth for patients who had food poisoning or severe diarrhea.”33

"Fast forward to the twentieth century, the community of microorganisms that dwell in the human gut has been shown to play a crucial role in human health. Fecal microbiota transplantation (“FMT”) was first identified in the modern scientific literature in 195834and has rapidly grown in popularity since the early 2010s. FMT consists in the delivery of processed stool from a healthy donor into the intestinal tract of a sick person via an enema, colonoscopy, naso-duodenal tube, capsules, or other means. As microbiologist Mark Smith and his colleagues noted, “the goal is to displace pathogenic microbes from the intestine by re-establishing a healthy microbial community.”35FMT  has  proven  strikingly  effective  in  treating Clostridium  difficile, a potentially lethal infection that most commonly affects older adults in hospitals or in long-term care facilities, typically after the  use  of  antibiotics."

...

"Despite these differences, milk, placenta, and feces share two sets of core similarities that justify their grouping in this analysis. First, milk, placenta, and feces are tissues that can be severed from the body without harm or risk of harm. Notably, milk and feces  are  replenishable  bodily  substances,  while  the  placenta  is  a  transient  organ  expelled  from  the  body  during  childbirth. Thus, far from constituting “corpse medicine”42(i.e., medicine that uses human materials obtained from dead bodies), the use of such substances can be characterized as living food or medicine. There are also no adverse health effects associated with the act of donation. Quite the opposite, good health requires that people eject the milk, placenta, and feces they produce from their bodies.  

...

"Second, these three products have similar channels of circulation, including via private, domestic consumption, peer-to-peer markets, medical and research institutions, and global markets in foods, drugs, and cosmetics. This wide scope for circulation is possible due to the potential for DIY treatments alongside higher tech uses involving special processing and expertise. Milk, placenta, and feces are collected, processed, and distributed by banks similar to other tissue banks; however, aspiring consumers can  also  obtain  milk,  placenta,  and  feces  and  use  them  on  their  own.  Unlike  blood  transfusion  or  organ  transplantation,  no professional expertise or complicated equipment is necessary to achieve basic forms of consumption. Milk, placenta, and fecescan be obtained directly from their producersafter some screening (or not) and consumed as is or minimally processed at home. Conversely, bio-banks systematically screen donors, subjecting them and their samples to a battery of tests, before processing their  products  in  various  ways;  for  example,  by freezing,  thawing,  pooling,  enriching,  freeze-drying  (in  the  case  of  milk), irradiating (in the  case of placenta), encapsulating (in the  case of stool). This is a fast-evolving field.

...

"No uniform perspective  has emerged on the  legal  classification of the  various body materials consumed by humans. In this respect, milk, placenta, and feces provide a case in point, as they do not fit neatly within the standard legal classifications for comparable products, such as foods, drugs, tissues, cosmetic ingredients, or waste products. Different countries have adopted contrasting legal regimes—or no regimes at all—to regulate these substances.

...

"In  the  so-called  post-colonial  era,  the  law  of  self-consumption  illustrates  the broader phenomenon of a “jurisprudence of disgust,” to use an expression that Alison Young developed to describe the legal censorship of provocative or “obscene” artwork.71A  significant  dimension  of  contemporary  law  making  can  be  characterized  as  a  response  to  what  is  considered disgusting around or among us, which reflects an endeavor to confine and tame what repulses us. This is particularly obvious in the context of what legal scholar Kim Krawiec calls “taboo trades” (and economist Alvin Roth dubs “repugnant markets”); that is, the exchanges and transactions of products that are considered culturally immoral and uncaring, such as those involving organs, babies, sex, drugs, and corruption."

Breast milk and the marketing of breast milk substitutes during the pandemic

 

Here's an article in the Lancet:

Marketing of breastmilk substitutes during the COVID-19 pandemic by Christoffer van Tulleken, Charlotte Wright, Amy Brown, David McCoy, and Anthony Costello, October 08, 2020DOI:https://doi.org/10.1016/S0140-6736(20)32119-X

"It is of concern that the US$70 billion infant formula industry has been actively exploiting concerns about COVID-19 to increase sales, in violation of the WHO International Code of Marketing of Breast-milk Substitutes (the Code)1 and national law in many countries.

"Globally, infants who are not exclusively breastfed are 14 times more likely to die than infants who are exclusively breastfed.2 Lockdown measures have diminished household income, and the UN World Food Programme estimates that by the end of 2020, 265 million people may be facing food insecurity,3,  4 making breastfeeding even more important. Public bodies that are independent of industry influence, including WHO5,  6 and the Royal College of Paediatrics and Child Health,7 have unanimously asserted that no evidence exists to suggest breastfeeding increases the risk of infants contracting COVID-19, and that skin-to-skin contact remains essential for newborn health and maternal health.

"By contrast, large manufacturers of breastmilk substitutes have inappropriately positioned themselves as sources of public health expertise, and suggested various unnecessary hygiene measures, the use of expressed breastmilk, and the separation of mothers from their babies. Such recommendations undermine breastfeeding and thus increase the risk of infant death. Baby Milk Action and the International Baby Food Action Network8 have documented numerous infringements of both the Code and laws associated with COVID-19."

Markets for blood, milk, and sperm (new book)

Here's the announcement of a forthcoming book from Harvard University Press (by Professor Kara Swanson, whose earlier papers include The Birth of the Sperm Bank):

Banking on the Body

The Market in Blood, Milk, and Sperm in Modern America

Kara W. Swanson

Not yet available

Book Details

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$35.00 • £25.95 • €31.50

ISBN 9780674281431

Publication: May 2014

Available 05/05/2014

* Academic Trade

310 pages

6-1/8 x 9-1/4 inches

10 halftones

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Related Subjects

• MEDICAL: History
• HISTORY: United States: 20th Century
• LAW: Property
• MEDICAL: Health Policy
• SOCIAL SCIENCE: Sociology: General

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• About This Book
• About the Authors
• Table of Contents

Scientific advances and economic forces have converged to create something unthinkable for much of human history: a robust market in human body products. Every year, countless Americans supply blood, sperm, and breast milk to “banks” that store these products for later use by strangers in routine medical procedures. These exchanges entail complicated questions. Which body products are donated and which sold? Who gives and who receives? And, in the end, who profits? In this eye-opening study, Kara Swanson traces the history of body banks from the nineteenth-century experiments that discovered therapeutic uses for body products to twenty-first-century websites that facilitate a thriving global exchange.

More than a metaphor, the “bank” has shaped ongoing controversies over body products as either marketable commodities or gifts donated to help others. A physician, Dr. Bernard Fantus, proposed a “bank” in 1937 to make blood available to all patients. Yet the bank metaphor labeled blood as something to be commercially bought and sold, not communally shared. As blood banks became a fixture of medicine after World War II, American doctors made them a frontline in their war against socialized medicine. The profit-making connotations of the “bank” reinforced a market-based understanding of supply and distribution, with unexpected consequences for all body products, from human eggs to kidneys.

Ultimately, the bank metaphor straitjacketed legal codes and reinforced inequalities in medical care. By exploring its past, Banking on the Body charts the path to a more efficient and less exploitative distribution of the human body’s life-giving potential.

Here's the table of contents:

• Introduction: Banking for Love and for Money
• 1. Bankable Bodies and the Professional Donor
• 2. Banks That Take Donations
• 3. Blood Battles in the Cold War
• 4. Market Backlash
• 5. Feminine Banks and the Milk of Human Kindness
• 6. Buying Dad from the Sperm Bank
• Conclusion: Beyond the Body Bank

Breast feeding

Some people find the sight of breast feeding repugnant, and the usual way that makes the news is with a story like this: Breastfeeding 'upsets diners'. In the spirit of "man bites dog," this more unusual headline caught my eye: Woman Pleads Guilty in Drunken Breast-Feeding Case. The crime is child neglect, and the issue is that alcohol passes through the breast milk. "Attorneys believe it's the first such case prosecuted in North Dakota."

Banks for blood and sperm

At The Atlantic,  Rebecca Rosen writes about Banks of Blood and Sperm: How the idea of a "bank" shapes the way people think about storing and distributing body fluids, in an interview of  Kara Swanson, the author of Banking on the Body (which I blogged about here).

Very interesting.  For example:

"What happened as the metaphor [of a bank] became more used in the 1950s and 1960s, was that a backlash developed against the market implications of the metaphor. The doctors and lay people who ran blood banks in the 1950s and 1960s, pushed the metaphor to its extremes—they told patients that each transfusion was a “loan” that needed to be repaid. Patients could repay in kind, or pay stiff replacements fees instead—fees that a bank could use to buy blood from a professional donor—always with the goal of keeping sufficient inventory.

The emphasis on buying and selling led blood banks into trouble in the courts—attorneys for patients injured from transfusions (which happened sometimes, if mismatched blood was given, or the blood contained a disease) argued that banked blood was a product. Product liability law was developing to find the manufacturer of a dangerous product liable even without negligence. Doctors, blood banks, and hospitals were horrified to have themselves considered product manufacturers. They began to backpedal from the banking metaphor by trying to make banked blood seem less like a product exchanged in markets.

What happened, with blood banks, and also with other kinds of banks, is that the banking metaphor and the backlash encouraged doctors, patients, and those of us who might be suppliers, to focus on one aspect—the supplier. Was the supplying body paid or unpaid? Paid suppliers, who were obviously entering into a market transaction, were treating their bodies as a source of private property, and were acting as though they were selling a product. Unpaid suppliers, were seen as giving gifts, out of altruism, and keeping themselves out of a market."
...
"In law, we thus divide body products into two categories: those which we legally mandate as gifts only—all organs—and everything else, which can be gifted or sold, at the discretion of the supplier. Organs is defined broadly—bone marrow, for example, is an “organ.” This means that bone marrow, which can now be extracted from the blood in a procedure similar to the way blood plasma is harvested, cannot be sold by anyone. (Blood plasma is routinely sold, by the way.)
...
"I argue in the book that the simple pay-suppliers/don’t-pay-suppliers approach to thinking about body products, which resulted from the banking metaphor, needs to be replaced with more nuanced thinking. Should we treat different types of organs (hearts v. bone marrow) differently? Can we think about compensation schemes that are not free markets, but are managed to support the public goals of increasing body-product supply? Can those schemes protect suppliers and recipients alike by keeping suppliers safe from exploitation, and recipients safe from diseased products? I use history to suggest that the answers can sometimes be yes. Body products used to be routinely paid for, and doctors thought about these potential problems and addressed them. Over time, we have forgotten this past, and come to assume that buying body products is always dangerous and bad.

I like to remind people that lots of altruistic gestures are compensated—the doctors, and nurses, and everyone who works on a transplant operation are all in caring professions. They are doing those jobs because they want to help people (at least we hope and assume so). But we wouldn’t suggest that they shouldn’t be paid because to offer payment for such efforts would be insulting or immoral or cause their altruistic tendencies to be replaced by mercenary concerns.

Yet that is how we treat organ supply—that offering money would do all those bad things. Why should the supplier of a body product be the only person in that life-saving supply chain who is not compensated? People might choose not to be compensated, but if they want to be, and if more folks will act as suppliers with that incentive, why not?

To give a more specific historical example, let’s think about mothers’ milk stations in the 1930s. At that time, in most cities, such a station existed. It was established and supervised by a doctor or doctors, and its daily operations were run by nurses. Lactating women came to the station to express their breast milk and were paid by the ounce. Payment was used to ensure an adequate supply. The supply was used for sick and/or premature infants who lack a maternal source of milk."

**************
In the meantime, here's a news article published around the same time, from the business side:
More blood banks merging to cut costs--Officials cite need for new model

"The proposed merger of Green Tree’s Institute for Transfusion Medicine with Florida-based OneBlood is the latest in a series of blood bank consolidations nationally, symptomatic of lean times for hospitals as they try to cut costs and reduce transfusions.

The deal, announced July 25, would create one of the largest blood banks in the country, with combined revenues of $480 million, if it goes through. The two firms jointly distribute nearly 2 million units of blood annually, serving 313 hospitals in eight states.

Only the American Red Cross would collect and distribute more blood."

Everything for Sale? The Ethics and Economics of Compensation for Body Parts (Video of the panel discussion)

Here's the video of the panel discussion I participated in at Johns Hopkins on May 7, Everything for Sale? The Ethics and Economics of Compensation for Body Parts: the panelists were James Childress, Michele Goodwin, Alvin Roth and Debra Satz

The video, including introductions before and questions after, is an hour and 20 minutes. The introduction by Mario Macis starts around minute 6:40, and includes audience voting on questions of whether they would be in favor of regulated markets for kidneys, for hearts, for blood, for human eggs and sperm, and for breast milk. The panel discussion, moderated by Jeff Kahn, starts at minute 14, with each of the panelists, in alphabetical order, giving an 8 minute opening statement. (Mine begins at 33:20, and ends at 41:41, pretty close to the 8 minute guideline:) .)

The EU considers tightening bans on compensating donors of Substances of Human Origin (SoHO)

 Peter Jaworski considers an  EU proposal this month to harmonize across the EU bans on paying donors for Substances of Human Origin (SoHO).  Presently Germany, Austria and Chechia allow payment to plasma donors.

The E.U. Doesn't Want People To Sell Their Plasma, and It Doesn't Care How Many Patients That Hurts. The United States currently supplies about 70 percent of the plasma used to manufacture therapies for the entire world.  by PETER JAWORSKI 

"The European Union looks like it might take the foolish step of banning financial incentives for a variety of substances of human origin, including blood, blood plasma, sperm, and breast milk. The legislation on the safety and quality of Substances of Human Origin includes an approved amendment that says donors can only be compensated for "quantifiable losses" and that such donations are to be "financially neutral." This legislation is supposed to harmonize the rules across the 27 member countries, promote safety, with the ban on financial incentives intended to avoid commodification and the exploitation of the poor. 

...

"Already the E.U. is dependent on plasma collected in the United States for around 40 percent of the needs of its 300,000 rare disease patients. They're not as dependent as Canada because Germany, Austria, Hungary, and the Czech Republic allow a flat-fee donor compensation model and so are able to have surplus collections that contribute 56 percent of the E.U. total. The remaining 23 countries, each of which runs a plasma collection deficit, manage just 44 percent. 

"So what is likely to happen if the new rules make this flat-fee donor compensation model illegal? Will safety improve and commodification and exploitation be avoided? No, the E.U. will just become even more dependent on the United States."

Compensation for kidney donors debated in WSJ

Familiar positions, clearly stated, pro and con compensation for donors.
There are other reasons put forward for not rewarding organ donation, but the one espoused here (preserving "the ability for one to aspire to virtue") is perhaps the one I have the least sympathy with, as it seems to value the hope of heaven more than saving earthly lives...

How to Provide Better Incentives to Organ Donors
Three experts discuss strategies to address the shortage of organs available for people who need transplants

"We talked about options for increasing organ donation with Sally Satel, a doctor and fellow at the American Enterprise Institute and the beneficiary of two kidney donations; Alexandra Glazier, chief executive of New England Donor Services, which coordinates organ and tissue donation in six New England states and Bermuda; and Andrew Flescher, a professor of public health and English at the State University of New York at Stony Brook, and author of “The Organ Shortage Crisis in America.”
...
"WSJ: The gap between the number of people who need organs and the number of organs available continues to grow. Why is our current model failing to bridge that gap?

DR. SATEL: Having studied the issue for 12 years, since my first kidney transplant, I am convinced that the only solution—before technology makes donation from people obsolete, and it will—is to compensate potential organ donors.

PROF. FLESCHER: The way forward is living donation. Roughly 100,000 out of 120,000 folks who need an organ need a kidney, which can be procured from a living donor, as most of us are born with two kidneys. We need a way of getting everyone to care about the plight of folks on dialysis, not through any coercive measure, of course, but through simple exposure.

MS. GLAZIER: There is no question that need outpaces the supply significantly. That said, it’s important to recognize that the number of deceased organ donors in the U.S. has increased 26% in the past five years (2012-2017) and the number of organs transplanted has increased 28% over the same period. In the New England region, the increase was more than double this rate over the same time period.

...

"PROF. FLESCHER: I certainly do not think paying living donors is the way to go.

DR. SATEL: But what is left? I suppose the real question is what is so aversive about enrichment of some kind? Surely, we do it with plasma, egg, sperm, body, as in donations in medical schools, maternal surrogacy, breast milk, hair. We already pay for body products. And, of course, my colleagues and I do not recommend lump-sum cash, because we do not want to attract desperate, impulsive people who may regret acting. Instead, rewards could include things like tax credits, lifetime health insurance, a contribution to a 401(k) account or a tuition voucher.

PROF. FLESCHER: The introduction of money for a precious good comes at the cost of the ability for one to aspire to virtue, if not as hero, than as a civic-minded, socially conscious neighbor, free to act, and to be perceived as acting, out of the motive to offer help to one in need.

...

"WSJ: Sally, can you please sum up the central tenets of how compensation for living donors would work?

DR. SATEL: The principles of a system of compensation are these: 1. Informed consent. 2. Ensuring health protection, before and after. 3. An ample reward—something trivial amounts to exploitation. 4. Respect for autonomy of people who know what is in their best interest. 5. Expression of gratitude for the lifesaving act they performed.

I suggest a waiting period of six to 12 months to ensure that the would-be donor is sure he or she wants to proceed. And a noncash reward, because a cash reward will appeal to impulsive decision makers, and we need to avoid that.

Cascades of convalescent plasma for Covid-19, and chains of exchanges, by Kominers, Pathak, Sönmez, and Ünver

Covid-19 convalescent plasma is a new thing in the world, that came into existence only when the first human was infected and recovered from the Covid-19 disease that is now pandemic. It isn't clear yet whether it will be clinically valuable, but recovered antibodies have been valuable for some other diseases, so there's excellent reason to hope that will be the case now too.  And as the number of people grows who have recovered from Covid-19, it is likely that the supply of antibodies is growing much faster, since antibody-containing plasma can be donated once a month or so. (There are  ongoing studies of antibody production by recovered patients, examining how long the antibodies remain at high levels, post-recovery). Of course, most of that supply is sequestered in the blood of recovered patients, so there's a non-trivial issue of collection and distribution.

As readers of this blog know, many countries prohibit the sale of plasma. Will Americans continue to support a commercial market for Covid-19 convalescent plasma in the current pandemic?  A distinguished group of market designers has written a paper considering how to apply techniques developed for kidney exchange to the task of collecting convalescent plasma from recovered Covid-19 patients, if it becomes impossible to buy and sell it. In particular, they consider how to create chains of donations, without using money, to overcome the shortages they anticipate.

Here's an easy to read account by Scott Kominers, one of the authors.

How to End the Plasma Shortage for Coranavirus Patients

Scott Duke Kominers, Bloomberg News  May 11, 2020

"convalescent plasma is in short supply: although it’s hard to estimate precisely, some statistics suggest the U.S. may need twice as much as we have on hand.

"In a new paper, Parag A. Pathak, Tayfun Sonmez, M. Utku Unver and I propose a market design strategy that could help close the gap. Our approach makes use of two special features of the way plasma donation works.

"First, convalescent plasma is collected from recently recovered patients, which means that today’s patients become tomorrow’s prospective donors, assuming they manage to beat the virus. ... That suggests the shortage isn’t from lack of potential supply.

"Second, plasma donation is more than one-for-one: the typical donor can give enough plasma at one time for multiple treatments, and they can potentially donate more than once. As a result, assuming plasma therapy does help patients recover, there is a so-called flywheel effect: the more we use the treatment, the more plasma is available -- provided enough recovered patients are willing to donate.

"Many people would like to donate plasma to help a loved one, but can’t for various reasons:  Their blood types might be incompatible or they might live far away and be unable to travel. To address these sorts of obstacles, my collaborators and I suggest that each plasma donor could receive a voucher that can be used to give a family member or friend priority for plasma treatment. Because donation is more than one-for-one, it’s possible to honor vouchers while still increasing the pool of plasma available to treat other patients.

...

"A similar analysis suggests a role for a pay-it-forward system, where we make a point of treating patients who pledge to donate plasma, assuming they recover and are medically able to do so. Because recovered patients can typically donate more plasma than was needed for their own treatment, this again can help increase the plasma supply in the long run. As a result, my collaborators and I show that, somewhat paradoxically, prioritizing patients who pledge to donate can still end up expanding treatment for the patients who are unable to pledge, or just choose not to.

"Both of these policies are similar to systems we’ve used to expand kidney donation in the U.S.: Priority vouchers are sometimes granted when a living donor gives a kidney to a third-party before one of their family members needs a transplant. And pay-it-forward incentives are used in kidney exchange chains, where a patient with a medically incompatible prospective donor receives a kidney from a third-party donor, and then their donor later gives a kidney to some other patient."
******
Here is the paper itself:

Paying It Backward and Forward: Expanding Access to Convalescent Plasma Therapy Through Market Design
Scott Duke Kominers, Parag A. Pathak, Tayfun Sönmez, M. Utku Ünver
NBER Working Paper No. 27143
Issued in May 2020

Abstract: COVID-19 convalescent plasma (CCP) therapy is currently a leading treatment for COVID19. At present, there is a shortage of CCP relative to demand. We develop and analyze a model of centralized CCP allocation that incorporates both donation and distribution. In order to increase CCP supply, we introduce a mechanism that utilizes two incentive schemes, respectively based on principles of “paying it backward” and “paying it forward.” Under the first scheme, CCP donors obtain treatment vouchers that can be transferred to patients of their choosing. Under the latter scheme, patients obtain priority for CCP therapy in exchange for a future pledge to donate CCP if possible. We show that in steady-state, both principles generally increase overall treatment rates for all patients—not just those who are voucher-prioritized or pledged to donate. Our results also hold under certain conditions if a fraction of CCP is reserved for patients who participate in clinical trials. Finally, we examine the implications of pooling blood types on the efficiency and equity of CCP distribution.

Here's some of the motivation for their model:

"There is an active debate in economics and philosophy on the appropriate role of market-based

mechanisms with compensation for human products used in medicine or medical research like kidneys, blood, blood products, sperm, breast milk, bone marrow, and other.11 Since, as far as we know, there is no current market where infected patients can buy CCP or where recovered patients can sell CCP, we do not consider this possibility as part of our model.

...

"Because CCP is a form of plasma, a natural question is whether a compensated market for CCP will develop. In our model, there is no option to pay to receive CCP or be paid for donating CCP, but a donor can designate the voucher in our model to particular patient in need. As a result, our model of CCP falls between the two extremes described above. We expect that in a crisis moment, there is unlikely to be an active compensated market for CCP (even though it may be impossible to fully prohibit resale of vouchers). If a price-based market does develop, society may deem it unacceptable."

***************

I am more optimistic than they are about the likely available supply of convalescent plasma if it proves useful, through existing commercial channels. My optimism is based on the large thriving commercial market for plasma and plasma-derived antibodies in the U.S., and around the world.  I'll try to blog about the general plasma and antibody (immunoglobulin) market tomorrow, and perhaps more on Covid-19 antibodies later this week.