In Britain, however, we donate 2 million 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. A study in New Zealand showed that offering payment would put off some donors.
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. The plasma trade is global, with companies exporting worldwide. Currently, all products used in the UK come from safe sources, but with plasma is in increasingly short supply, which may have to choose between denying patients plasma-based treatments, or buying them from more risky sources.
Turning blood into a commodity opens the door to commercial pressures: donors are dishonest about their risk factors, companies turn a blind eye and cut corners. If you are on skid row, plasma donation is a good way to pay for your next fix, and companies keen to exploit worldwide demand may not be too assiduous in checking the honesty of potential donors, or in screening them. For years, prisoners in Arkansas donated plasma and recipients developed the blood-borne infections it contained. Despite revelations of poor screening, companies continued to buy plasma taken from prisoners until 1994. China, too, has an appalling record. A Chinese company running an illegal collection passed inspections by the authorities, but in 2006 was shown to be selling plasma infected with hepatitis C. Britain can’t claim an unblemished record, either – from the 1970s to the early 1990s, thousands of people given NHS blood products developed HIV and/or hepatitis C.
We now import our plasma via a government-owned company. But in 2013, the government sold an 80% share of the business to Bain Capital, a US venture capital group. Many feel uncomfortable about introducing the profit motive to the supply of blood products.