WHO Says Countries Should Be Self-Sufficient In (Unremunerated) Organs And Blood by Krawiec and Roth (now open source)

The published version of our paper is now widely available:

Kimberly D. Krawiec and Alvin E. Roth, “WHO Says Countries Should Be Self-Sufficient In (Unremunerated) Organs And Blood,” in James Stacey Taylor and Mark J. Cherry, eds., Markets in Human Organs for Transplantation: Controversy and Contention., Routledge, November 2025 (open source) https://www.taylorfrancis.com/reader/download/5885e1ba-c9af-4547-941c-821a2afaa7ee/chapter/pdf?context=ubx  

From the introduction:

[The nonremuneration principle] is only half of a WHO policy, broadly accepted around the world, that mandates both national (or sometimes only regional) self-sufficiency and an absence of remuneration for both blood products and transplantable organs (hereafter, the “twin principles”) (WHO 2009, 2023). This self-
sufficiency mandate, though less examined than the ban on  remuneration, presents a real hurdle to progress in transplantation, especially for smaller and low and middle income (LMIC) countries. 

"WHO’s insistence on self-sufficiency inhibits cooperative kidney
exchange efforts (as well as other innovations) among countries that
would benefit all concerned, especially the LMIC that the policy is purportedly designed to help. As will be discussed, the policy’s effect on blood products, especially when combined with the no remuneration rule, is even more stark – no country that fails to compensate donors is self-sufficient in plasma collection and few LMIC collect sufficient supplies of whole blood.
 

"This chapter critiques these twin principles, making several central points. In Section 2.2, we discuss the twin principles as applied to blood products, noting the particularly pernicious effects on plasma supply and availability, especially in poorer nations. In Section 2.3, we turn to transplantation, emphasizing the numerous benefits of international cooperation and cross-border transplantation – benefits that would be undermined by self-sufficiency, especially in smaller countries and those without well-developed domestic exchange programs. We illustrate this point with examples drawn from several noteworthy instances of cross-border kidney exchange.
 

"In Section 2.4, we argue that the current discourse around remuneration and organ donation is frequently overdramatic and unhelpful. Although nearly every effort to increase organ donation and transplantation presents ethical challenges, not every such effort amounts to “trafficking” or “a crime against humanity.” These labels stifle helpful deliberation, progress, and consensus. Section 2.5 concludes with recommendations for a saner approach to the scarce resources of blood products and transplantable organs – one that is focused on international cooperation, rather than self-sufficiency; evidence-based policies, rather than a reliance on decades-old
assumptions and understandings; and the use of pilot studies and trials to test the ethics, safety, and efficacy of incentives in various settings."

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Here's the book:

 

Commercial plasma collection in the US: the Jaworski report for 2025

 Peter Jaworski, a tireless student of blood donation around the world, has published a report on the plasma industry.  It's full of interesting facts, a few of which are highlighted below.

America’s Plasma Contribution to the World: 2025
Launching the Georgetown Blood and Plasma Research Group and the annual state of the U.S. plasma industry report  by Peter Jaworski 

"I am proud to announce the official launch of the Georgetown Blood and Plasma Research Group. Housed at Georgetown University, this initiative will serve as a dedicated academic hub for research on the ethics and economics of global supply chains for not only blood plasma, but blood, bone marrow, and other medically-useful substances of human origin. Our goal is to provide data-driven insights, foster serious philosophical discussion, and be a home for interdisciplinary research.
 

"This 2025 Annual Report is the first contribution to that mission. 

...

"As of December 31, there are 1,247 plasma collection centers in the United States (including four centers in Puerto Rico).

"To put this into perspective: The U.S. is now home to more plasma centers than community colleges (just over 1,000) or Kohl’s department stores (around 1,175). There are almost as many plasma collection centers as Denny’s restaurants (around 1,300). 

...

"we can look at the economics of independent plasma companies. Their business is to sell plasma to fractionators, not to make medicine from the plasma.

"The current selling price of a liter of plasma is around $190, give or take $10.

• Donors receive between 30-40% of that revenue, or around $70 (an average donation is 850 - 880 mL, requiring more than one donation to equal a liter).
• The center spends a majority of the remaining revenue on costs like employees, supplies (“softgoods”), testing, and facility overhead.
• The plasma center will pocket around 8-12%, or around $15 in profit. 

...

"The U.S. plasma industry does more than save American lives, it provides the material for life-saving therapies for patients around the world.

"The 62.5 million liters collected in the U.S. in 2025 represents around 68% of global plasma collections for the manufacture of medicines. About 52% of those collections will end up in medicines to treat American patients, while the remaining 48% will end up treating patients in the rest of the world."

The debate over compensating organ donors is heating up

  It's a new year, and maybe there will be progress in increasing organ donation.  Here's a video in which Elaine Perlman explains the End Kidney Deaths Act, which might be debated by Congress this year, and would be an attempt to increase living donation by allowing some compensation (in the form of tax credits) for kidney donation.  And there are  a slew of articles in medical journals (of which I sample two) saying that the first and most important rule of organ transplantation is that donors should not be compensated (and that the same goes for other SoHOs (Substances of Human Origin) such as blood plasma. 

 

"Passing the End Kidney Deaths Act isn’t just an ethical decision—it’s a practical solution to one of the most pressing public health challenges in America.
100,000 Americans are counting on us to get the End Kidney Deaths Act to the finish line. The choice is clear and 2025 is our year. Let’s contact Congress now to pass the End Kidney Deaths Act and ensure a future where no one dies while waiting for a kidney. Because saving lives is not only ethical—it’s our responsibility."

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And here are two articles reaffirming their opposition:

Promoting Equitable and Affordable Patient Access to Safe and Effective Innovations in Donation and Transplantation of Substances of Human Origin and Derived Therapies
Cuende, Natividad MD, MPH, PhD1; Tullius, Stefan G. MD, PhD2; Izeta, Ander PhD3; Plattner, Verena PhD4; Börgel, MSc, Martin5; Ciccocioppo, Rachele MD6; Correa-Rocha, Rafael PhD7; Koh, Mickey B. C. MD, PhD8,9; De Angelis, Vincenzo MD10; Gondolesi, Gabriel E. MD, MAAC11; ten Ham, Renske PhD, PharmD12; Porte, Robert J. MD, PhD13; Hernández-Maraver, Dolores MD, PhD14; Hawthorne, Wayne J. MD, PhD15; Sureda, Anna MD, PhD16; Orlando, Giuseppe MD, PhD17; Haraldsson, Börje MD, PhD18; Ascher, Nancy L. MD, PhD19; Dominguez-Gil, Beatriz MD, PhD14; Oniscu, Gabriel C. MBChB, MD20
Author Information
Transplantation 109(1):p 36-47, January 2025. | DOI: 10.1097/TP.0000000000005169

 Note which ethical principle is at the top of the list.

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And this report speaks of global kidney exchange, but not for the poor...

 Expanding Opportunities for Living Donation: Recommendations From the 2023 Santander Summit to Ensure Donor Protections, Informed Decision Making, and Equitable Access, by
Lentine, Krista L. MD, PhD1; Waterman, Amy D. PhD2; Cooper, Matthew MD3; Nagral, Sanjay MS, FACS4; Gardiner, Dale MD5; Spiro, Michael MBBS6; Rela, Mohamed MS, FRCS, DSc7; Danovitch, Gabriel MD8; Watson, Christopher J. E. MD9; Thomson, David MD10; Van Assche, Kristof PhD11; Torres, Martín MD, MS12; Domínguez-Gil, Beatriz MD, PhD13; Delmonico, Francis L. MD14;  On behalf of the Donation Workgroup Collaborators*
Transplantation 109(1):p 22-35, January 2025. | DOI: 10.1097/TP.0000000000005124

 

"International KPE is acceptable if the donor-recipient pairs belong to a similar sociodemographic reality and are properly covered and protected by healthcare systems. GKE that exploits financial inequalities between pairs (or countries) must be prohibited."