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'Blood Money': Inside the global business of selling plasma

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09 June 2022, Saxony, Leipzig: Employees work in the central laboratory of the Haema AG blood and plasma donation service on modern analysis equipment for blood and plasma samples. In the modern blood processing and logistics center, blood and plasma samples collected throughout Germany are analyzed. The supply situation is currently critical in Saxony because the willingness to donate is declining. However, plasma-based drugs are still urgently needed for the treatment of chronic, genetic and various life-threatening diseases. Photo: Waltraud Grubitzsch/dpa-Zentralbild/dpa (Photo by Waltraud Grubitzsch/picture alliance via Getty Images)
09 June 2022, Saxony, Leipzig: Employees work in the central laboratory of the Haema AG blood and plasma donation service on modern analysis equipment for blood and plasma samples. In the modern blood processing and logistics center, blood and plasma samples collected throughout Germany are analyzed. The supply situation is currently critical in Saxony because the willingness to donate is declining. However, plasma-based drugs are still urgently needed for the treatment of chronic, genetic and various life-threatening diseases. Photo: Waltraud Grubitzsch/dpa-Zentralbild/dpa (Photo by Waltraud Grubitzsch/picture alliance via Getty Images)

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Millions of Americans sell their blood plasma every year. It’s part of a global, multibillion dollar business.

"If you go to the Red Cross ... you are limited to donating 13 times a year — once every 28 days," Kathleen McLaughlin, author of the new book Blood Money, says.

"If you go to a for-profit plasma center to sell plasma, you can do it twice a week, up to 104 times a year."

But what is plasma used for, and why is it a big, largely hidden business?

Today, On Point: Inside the for-profit business of selling blood plasma around the world.

Guests

Kathleen McLaughlin, journalist. Author of the new book Blood Money: The Story of Life, Death and Profit Inside America’s Blood Industry. (@kemc)

Dr. Morey Blinder, hematologist. Professor of medicine at the School of Medicine at Washington University in St. Louis.

Also Featured

Patrick Herdener, longtime blood plasma donor who donates more than 100 times per year.

Darryl Wellington, journalist who has reported on the plasma economy. Poet laureate of Santa Fe, New Mexico. (@darrylwellingto)

Cory Lyons, Columbia, South Carolina resident who sold plasma in college.

Jenni Hecht, Sturgis, Michigan resident and plasma seller.

Kathi Young, Cameron, North Carolina resident and plasma seller.

Mary Seebach, Middletown, Ohio resident and plasma seller.

Interview Highlights

What is plasma and why is it important?

Dr. Morey Blinder: "Plasma is the liquid part of blood, which is about 55% of the total blood volume. The rest of the blood is composed of the cells, such as red cells and white cells and platelets. And there are ways to donate the blood as whole blood, usually through volunteer donor programs. And then there are ways to donate. Just the plasma that we've been speaking about. The plasma is usually collected in for-profit centers, and the whole blood that's collected is generally volunteer, the donors are not reimbursed for this financially. And so there is a difference there. And in fact, the FDA requires that products be labeled as volunteer or paid donor."

On what makes it such a medically valuable resource

Dr. Morey Blinder: "There are thousands of proteins that are in plasma. Some of them are at very high concentration. All of the plasma donor collections that are made are fractionated. They are not directly given back into individuals from a paid plasma donor. So the fractions that are most commonly used are albumin, which is needed in blood. It helps those on volume expand or if you will. It's used in a lot of clinical situations. A second product is the Immunoglobulin that Kathleen has taken. It can be typically as an IVIG or intravenous Immunoglobulin. And then the third group of products are the blood clotting factors that were used predominantly for hemophilia and related bleeding disorders, but other blood clotting problems as well. So that is where most of the plasma is processed and turned into."

On researching the global plasma industry

Kathleen McLaughlin: "About 20 years ago, I was diagnosed with an autoimmune disease. Quite rare. And the treatment for it is a medication that is made from human blood plasma. It's called intravenous human immunoglobulin. So it's the immune particles that are extracted from plasma. And I have on average, a half a dozen to ten infusions per year to keep this illness at bay. They're very long, boring, tedious infusions of kind of a lot of medication. They take about 6 hours each time.

"And I have a lot of time to think sitting in a chair, just sort of watching this fluid drip into my own veins. And for 20 years off and on, I've thought about where this medication comes from and who is donating and selling plasma to provide it. And I just got to the point where I needed to try and figure that out."

On Kathleen's beginning experience with blood plasma

Kathleen McLaughlin: "I lived in China full time for 15 years. I was a reporter there, and I moved there knowing that I needed this plasma drug. I also moved there knowing that China had had a big plasma debacle. So back in the 1990s, China had tried to create what they called the plasma economy, where they were paying poor farmers for their blood plasma. And then the plan was to turn it into profit making drugs like the one that I take.

"Right around that time, HIV entered the blood system. We hadn't yet figured out how to kill viruses in blood, and it spiraled into an AIDS catastrophe in rural China that killed a whole lot of people. So I knew about this, and I also knew that China had banned foreign blood products because AIDS was viewed as a foreign disease and a foreign virus. So my solution was to smuggle in my own plasma drugs. So I would pack them in my suitcases. And every time I would come across the border, I had to check a little box on the customs form that said I was not carrying blood products because they were very explicit about it. But in fact, I was.

"And then this was, I would say, a very different time in China. I don't think I could do this now. This was throughout the 2000's and early 2010's. I would take my plasma drugs that were made and sold in the United States to a hospital in Beijing or Shanghai where I lived and asked them to infuse them into my veins. So if you can imagine doing that, just showing up at a hospital with drugs and saying, Can you put these in for me? But they did. And I lived like that for years. So that was the beginning of my experience. And then when I moved back to the U.S. in 2016, I realized that the United States had actually created the plasma economy that China sort of tried to create. We did it while nobody was paying much attention."

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The motivations of people in the plasma industry

Kathleen McLaughlin: "It is a choice we made accidentally, if you will. I don't think that most people have really thought about why we decided to do things this way. There hasn't been a big national debate over what should we pay for and what shouldn't we pay for. I think that most people draw the line at, you know, you shouldn't be able to sell a kidney. So there are three things that you can get paid for in the United States, plasma, sperm and eggs.

"And I don't think we've had a big debate about that. I mean, most countries in the world ban the ban the payment of or ban, paid plasma donation. So we are very unusual in the context of the rest of the world. I will say, though, I think that I think that our thinking on this is a little bit confused because people do get paid for it. A lot of people donate or sell their plasma. But I also see this as a very altruistic thing.

"And many of the people that I interviewed, you know, the person that you interviewed at the top of the show who is selling his plasma a hundred times a year, he has continued doing it because he wants to help people. And this was really yes, most people I have spoken with do it because it pays and they need the money. At the same time, they're very happy to be able to contribute something back to people who need it. So if you're poor, you don't often have the opportunity to help out in an altruistic way in terms of like giving money to a charity or, you know, donating in other ways because you don't have a financial cushion that allows you to do that. Selling plasma kind of offers this ideal in that way where you're getting paid, but you're also giving back.

"And I just wonder how we came up with the societal view on this, that donating blood is heroic. You know, it's a great thing to do. And, you know, people should be celebrated for it. People talk about it all the time. If you donate blood, you get a little sticker. You tell your family. But if you're donating or selling plasma, it's stigmatized as something that people don't generally talk about even with their own family. The fact is, as a recipient of plasma products, I know that what people are doing is very altruistic. I mean, it allows me to live a very normal life."

On the plasma industry in the 1970s and 1980s

Dr. Morey Blinder: "I would also say that we've had our own calamity here in the United States. Plasma collection was started in the 1960s, predominantly for hemophilia patients to collect the factor that was needed to treat the hemophilia, and it flourished in the 1970s until it all came crashing down. In the AIDS epidemic, it's wiped out. A generation of hemophiliacs were infected with either hepatitis or HIV, predominantly in the late 70's and early 80's, and the plasma industry in the United States had had dried up to some degree after that.

"So we have had our own catastrophe with this. It's always seemed to me that it's been a little bit unsavory. It's not usually on the fringes of it. It's more on the fringes of medical care. There aren't doctors that staff these clinics or even nurses. So I think that there is some certainly good that comes from this. But the way it's done does seem a little bit uncomfortable. And I think that may be the angst that we're all having here."

Companies are making money off of it, but profit in health care is not unheard of. So. Where is the harm?

Kathleen McLaughlin: "We really don't know the long-term effects. These studies are not long term. And I think that people who are doing this deserve as much care and concern as wealthy people in our society do. And to me, what's going on right now, because this is a hidden economy, because it is stigmatized, because a lot of people tend to look down on this practice is we are not giving adequate care and concern to people who sell plasma. I also think that really, in many ways, this industry is just a symptom of the problems in our society. And what I mean by that is there are a lot of college students, for example, who sell plasma.

"And to me, that's just a symptom of the problem, which is university education is too expensive. And the fact that we're expecting 19-year-olds to figure it out and go out and sell parts of their blood is quite disturbing without having a national conversation of is this who we want to be? Do we want to really be the kind of country where we expect 19- and 20-year-olds to sell pieces of themselves to fund their education? So I haven't found, you know, strong evidence that there is something wrong with this industry or this practice. I just think most people who haven't been broke before are unaware of it.

"And we need to change the stigma around it because it's all related to a stigma against poverty that we have in this country. So it's more to me, a matter of figuring out if this is who we want to be. I also think that people should get paid more. You know, I think we should understand how much profit is being made, who's making that profit, and why aren't the people who are selling plasma getting more of that money? You know, and I think that, as Dr. Blinder pointed out, the lack of long-term studies, we actually need to invest in long term studies on the health of plasma donors and see if 104 times a year, twice a week is actually okay for a person's health."

Related Reading

The Atlantic: "The Twisted Business of Donating Plasma" — "Since 2008, plasma pharmaceuticals have leaped from $4 billion to a more than $11 billion annual market. Donors desperate for the cash incentive from high-frequency “plassing” may be putting their health, and the public’s, at risk."

This program aired on February 28, 2023.

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