Canadian Blood Services in talks around paid donations of plasma

Canadian Blood Services in talks around paid donations of plasma as supply dwindles. by Christopher Reynolds

"Canadian Blood Services is in talks with companies that pay donors for plasma as it faces a decrease in collections.

"The blood-collection agency issued a statement on Friday saying it is in “ongoing discussion with governments and the commercial plasma industry” on how to more than double domestic plasma collection to 50 per cent of supply.

"Canadian Blood Services has previously cautioned that letting companies trade cash for plasma - a practice banned in British Columbia, Ontario and Quebec - could funnel donors away from voluntary giving.

"The bulk of the non-profit agency's supply currently comes from abroad, including via organizations that pay donors."

HT: Frank McCormack

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

The Globe and Mail adds some detail:

Canadian Blood Services eyes getting plasma from paid donors amid supply challenges by Chris Hannay

"Industry observers say the most likely commercial partner for CBS is Grifols, an international pharmaceutical company headquartered in Spain. The company purchased a large-scale plasma processing facility in Montreal in 2020, and in January bought an existing for-profit plasma donation centre in Winnipeg.”

***********

See my full set of posts on plasma in Canada

Bleeding for Canada: plasma exports from the US to Canada

In the HuffPo:, Peter Jaworski begins his rant about the blood supply with a good line about food:  Commodifying Blood Donation Could Solve Canada's Shortfall

"Many people think blood is special in a way that means it shouldn't be "commodified," or bought and sold on a market. It is a basic human need. It's not like the latest gadget or a pair of shoes; it is to be revered, not remunerated.

"I'm glad we don't think food is special in this way. If we did, imagine how many people would die of starvation, or would suffer from hunger.

This past December, the Ontario legislature preserved the sanctity of the exchange of blood through Bill 21, entitled the "Safeguarding Health Care Integrity Act." Schedule 1 included provisions from Bill 178, the Voluntary Blood Donations Act", which prohibits paying and receiving payment for blood, either directly or indirectly. With this bill, the legislature has made the giving and receiving of blood a sacrament.

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

Of course Canadians don't have to pay other Canadians for blood plasma. If you look at the Harmonized Tariff Schedule (HTS) administered by the U.S. International Trade Commission (USITC), you find that HTS number 3002100210 stands for Human Blood Plasma, and in 2013 Canada had imports $29,274,584 worth from the U.S., where of course we compensate plasma donors.

HT: Josh Penrod

Blood plasma in Canada: should compensation for donors be banned?

I am one of the signatories of a long letter arguing that Canada (which imports most of it's blood plasma products from the U.S.) should not ban the compensation of Canadian plasma donors.

Here's the letter:
Ethicists and Economists express concerns about banning compensation for plasma donors with regards to ensuring the security of a safe Immune Globulin Product Supply.
Submission to the Expert Panel on Immune Globulin Product Supply and Related Impacts in Canada

Here's the press release:
Ethicists and economists express concerns about banning compensation for plasma donations

Paying for plasma to be legal in Alberta

 Reason magazine has the story:

Canada Inches Closer to Allowing More People To Be Paid for Plasma--For too long, our northern neighbors have depended on plasma imported from the U.S. to meet demand. With the passage of new legislation in Alberta, this may change.  by LIZ WOLFE 

"Albertans will soon be able to receive payment for their blood and plasma donations. Bill 204, the Voluntary Blood Donations Repeal Act, was introduced by Tany Yao, a member of the legislative assembly for Alberta's provincial government, and passed in the legislature this week. It must now get royal assent—a mere formality—for it to become law. The bill overturns a 2017 prohibition on paid plasma, and will allow private companies to pay plasma donors for their efforts. If they so choose, people will still be able to donate blood and plasma without receiving compensation via Canadian Blood Services.

...

"United Nurses of Alberta's president Heather Smith told Global News that "the government is putting its ideology and desire to support profiteers above what is actually safe for Albertans and Canadians." Elsewhere she said that "donating blood should not be viewed as a business venture."

HT: Peter Jaworski

Explaining plasma donation

In recent posts I've commented on the repugnance (in Canada and elsewhere) to paid plasma donation, which is legal in the U.S.. (The U.S. consequently supplies much of the world's plasma needs.)  One question facing the plasma industry is how to defend against compensated plasma donation being seen as a repugnant transaction.

I think they are already very well equipped to communicate the need for plasma proteins, which provide treatments for a host of diseases, and which are used around the world.  But to the extent that (paid or unpaid) donation needs to be defended and encouraged, I would expect to see more stories like this one, from Australia.

This man's blood has saved 2.4 million babies
'I'd keep going if they let me,' says 81-year-old with magical plasma.

"The man with the golden arm

"Harrison's blood is valuable because he naturally produces Rh-negative blood, which contains Rh-positive antibodies. His blood has been used to create anti-D in Australia since 1967.

"Every ampule of Anti-D ever made in Australia has James in it," Robyn Barlow, the Rh program coordinator who recruited Harrison, told the Sydney Morning Herald. "Since the very first mother received her dose at Royal Prince Alfred Hospital in 1967."

Harrison was the program's first donor.

"It's an enormous thing ... He has saved millions of babies. I cry just thinking about it."

Since then, Harrison has donated between 500 and 800 milliliters of blood almost every week. He's made 1,162 donations from his right arm and 10 from his left.

...

Harrison's retirement is a blow to the Rh treatment program in Australia. Only 160 donors support the program, and finding new donors has proven to be difficult. Additionally, attempts to create a synthetic version of anti-D have failed."

Societal Support for Paying Plasma Donors in Canada By Nicola Lacetera and Mario Macis

Here's a concise summary of recent work by Lacetera and Macis, as a Cato Institute Research Brief:

Societal Support for Paying Plasma Donors in Canada
By Nicola Lacetera and Mario Macis

They begin with a concise statement of why repugnance is important for economics:

"The legal status and regulation of economic transactions do not depend only on considerations regarding their economic efficiency, but also on whether a society supports the occurrence of trades through a price mechanism (if at all). Concerns that individuals engaging in certain transactions may be exploited or unduly influenced, that the terms of trade may not be fair, or that some transactions violate human dignity, the sanctity of life, or traditional institutions may lead a society to prohibit certain trades. These principles may take priority over material considerations and may contribute to defining common identities or a collective conscience that allows complex societies to be tied together. "

The article is "based on and includes excerpts from Nicola Lacetera and Mario Macis, “Moral NIMBY-ism? Understanding Societal Support for Monetary Compensation to Plasma Donors in Canada,” Law and Contemporary Problems 81 (2018): 83–105, https://scholarship.law.duke.edu/lcp/vol81/iss3/5.

Poll: majority of Canadians approve of paying plasma donors

New survey results from Peter Jaworski
Canadians think that pay-for-plasma is “morally appropriate.”

"A significant majority of Canadians (63%) believed that paying Canadians for plasma donations was “morally appropriate.”

By age, 18-34 year-olds were most likely to think that pay-for-plasma was “morally appropriate,” with 75% saying so. 70% of 35-54 year-olds, and 49% of those 55 or older thought pay-for-plasma was morally appropriate.

By region, 64% of Atlantic Canada, 69% in Quebec, 61% in Ontario, 70% in the Prairies, 65% in Alberta, and 56% in British Columbia held that opinion.

The provinces of Ontario (2014), Alberta (2017), and British Columbia (2018) have all recently banned pay-for-plasma citing moral objections as part of the motivation behind the prohibitions"

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."

An open letter to Canadian health authorities on laws against compensating Canadian plasma donors

 The letter is available on a website called Donation Ethics: Ethicists and Economists for Ethical Donation-Compensation Practices  organized by Peter M. Jaworski and  David Faraci. (I am among the signers.)

"Ethicists and Economists express concerns about banning compensation for plasma donors with regards to ensuring the security of a safe Immune Globulin Product Supply.

"Submission to the Expert Panel on Immune Globulin Product Supply and Related Impacts in Canada

"INTRODUCTION

We are professional ethicists in the fields of medical ethics, business ethics, and/or normative ethics, and academic economists who study how incentives and other mechanisms affect individual behaviour. We all share the goal of improving social welfare.

"The Provinces of Québec (1994),1 Ontario (2014),2 and Alberta (2017)3 have passed Voluntary Blood Donation Acts or their equivalents that prohibit, amongst other things, compensation for plasma donations for purposes of further processing into plasma-derived medicinal products (hereafter: “PDMPs”), like Immune Globulin (hereafter: “Ig”). Currently, the Nova Scotia legislature is debating a Voluntary Blood Donations Act,4 and the British Columbia government has suggested that it is interested in pursuing similar legislation.5

...

"CONCLUSION

"In our view, none of the moral objections to the compensatory model are persuasive. Furthermore, there is a strong moral presumption against standing in the way of a model that is the most likely to promote security not only of Canada’s supply of PDMPs, including Ig, but also of the global supply. We urge Québec, Ontario, and Alberta to reconsider the Acts currently prohibiting compensation in their provinces.

"Finally, we note that well-informed opponents of the compensatory model should not suggest that PDMPs, including Ig, made with compensated donors are riskier or less safe than PDMPs, including Ig, made with uncompensated donors. This presumption may be harmful to patients."

Paying for (imported) blood products in Britain

Yesterday's post about paying for blood plasma in Canada reminded me of this story that The Guardian ran earlier in the year:
Blood money: is it wrong to pay donors?
"In some countries, people get paid for giving blood. And in the UK, we have to buy in plasma. But is safety compromised when money changes hands?"

"A recent black-and-white documentary, Blood, about a mobile blood collection unit in rural Russia, shows scenes familiar to many: dusty halls, anxious donors queuing to register, the occasional struggle to find a vein. Cups of tea, too, albeit just for the team.

Then there are the differences. Donors sit upright on uncomfortable, hard chairs. Some have just come off night shift; others have no money for food. Staff are concerned about how many units will test positive for blood-borne viruses. Potential donors worry about being accepted. A woman without an up-to-date residency certificate is turned away. A man insists he should be allowed to donate; he is broke and desperate for the 850 roubles (£8.85) payment. It is clear that most donors come for the money: for some, it is a lifeline.

Russia isn’t alone in paying donors – the US, China and Germany do, too. In Britain, however, we donate 2m units a year, with no payment – following the World Health Organisation recommendation that blood donation be voluntary. This is not only for altruistic reasons, but also for safety. “The safest blood donors are voluntary, non-remunerated donors from low-risk populations,” says the WHO.

...

"Nevertheless, thousands of NHS patients receive blood plasma from paid donors. This contains clotting factors and antibodies. Thousands of individual donations go into each dose of clotting factors – used to treat haemophiliacs who are bleeding – or immunoglobulins (antibodies) used to treat people with autoimmune diseases, severely damaged immune systems, or some serious infections.

After the outbreak of bovine spongiform encephalopathy (BSE), known as mad cow disease, some recipients of UK plasma products developed the fatal brain disease variant Creutzfeldt-Jakob-disease (vCJD). As there is as yet no adequate screening test for this, British plasma has not been used since 2002, when we began to import it from the US."

**********

HT Alex Nichifor

Plasma in Canada, and repugnant transactions--a podcast interview

 I was recently interviewed by Kate van der Meer, a Canadian patient affected by the plasma shortage of 2019. Her experience inspired her to look deeper into the plasma supply chain and raise awareness to the negative implications of the Voluntary Blood Donations Act. Part of this awareness campaign is the Plasma For Life Podcast Series, of which this interview is a part. 

(Her website is  www.plasmaforlife.org.)

.