The Twisted Business of Donating Plasma

Since 2008, plasma pharmaceuticals have leapt 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.
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Bottles with blood plasma derivatives stand on a packing plant at the Octapharma company in Dessau, eastern Germany. (Eckehard Schulz/AP)

I needed the cash.

That was how I found myself laying in a plasma “donation” room filled with about 40 couches, each equipped with a blood pressure cuff and a centrifuge. A white-coated attendant (workers aren’t required to have medical or nursing degrees) pricked my arm. He separated my plasma from my whole blood into a large bottle, and returned my protein-depleted blood, which flowed back into my arm to rebuild my nutrient supply.

“My house is so noisy with four kids so I come here for my relaxation,” said a middle-aged, haggard-looking woman on the next couch, the plasmapheresis machine at her side whirring. A clinician instructed us both to pump and relax our fists, like cows milking our own udders.

Before leaving I received a calendar that mapped out my pay, if I maintained a twice-weekly schedule for subsequent donations. Even a $10 bonus on my next visit!

How did I get here? My rent was due. I had insufficient funds in the bank. I was 48-years-old, a journalist running short on cash from writing assignments and odd jobs. That was when I saw an ad offering $50 per plasma donation: blood money, or more specifically, payment for my time and any small pain involved in the process of having protein-rich plasma extracted from the blood. Regulars call it “plassing.”

The ad I’d seen featuring smiling attendants suggested an experience similar to one at a sedate hospital. The facility I entered buzzed like a school lunchroom. There were first-timers waiting to complete the initial medical exam, and regulars hurrying to check in at automatic computer terminals. Easily 50 to 60 “plassers” were present at any given moment, the crowd continually ebbing and flowing. All were like me—hopeful, needy, and impatient to get paid.

I received an oral examination. I was not surprised by the many questions about my sexual behavior, but I was taken aback by repeated questions regarding tattoos. Three times I was asked if I had lied and “really” had tattoos. After the clinicians tested a blood sample for protein levels, I underwent a bare-bones medical checkup. But I questioned its efficiency given that my examiner ran through scores of questions so fast I had to ask him to repeat himself. I spotted a sign: NO PAYMENT UNLESS DONATION IS COMPLETED.

"Plassers" receive payments on a special debit card that extracts a surcharge whenever they use it. Curiously, while my examiner hurried me through the screening, he did patiently lay out the payment scheme. Did he know how desperate I was? His “Don’t worry. You’ll pass” attitude may have expressed condescension, unprofessionalism, or benevolence.

My extraction went smoothly. I left with a ray of hope that I could “plass” next month’s rent money. The literature provided at U.S. centers ubiquitously states that "donating plasma is safe." Its side effects are limited to "mild faintness and bruising." (My brochure also added, "Other possible side effects will be explained by our medical staff," though I can’t say any such explanation stayed with me.) But the following day my body received an impromptu schooling in the price tag of the world I had entered.

It happened at about five o’clock the next day. Unexpectedly, with no apparent cause or logical relationship to physical exertion, I felt my legs go rubbery. I was Silly Putty. This was something more than “mild faintness” and particularly disturbing because of the aspect of a random attack. I suddenly felt so weirdly fatigued that I couldn’t stand on my feet. I barely reached the couch before I passed out for five hours straight. Luckily, I was safely ensconced at home. But since I substitute teach as well as freelance write I woke up wondering: What would I do if that happened at my day job?

What had happened? I had received my welcoming to the subtle physical changes, possibly exacerbated by work and poverty, which may be the upshot of plassing. And my research began.

* * *

Biotest, CSL Plasma, Yale Plasma. These are some of the funny corporate names that dot my state, New Mexico, and maybe yours. Or OctaPharma. Or Biolife. Plasma reaped from paid U.S. donors makes up about 70 percent of worldwide collections. The United States is conversationally known in the industry as “the OPEC of plasma collections.”

But why plasma?

Proteins in the plasma collected at places like Biotest are necessary for the manufacture of a wide range of pharmaceuticals produced by for-profit corporations. The industry burgeoned in the 1950s thanks to a boom in new drugs for hemophiliacs. Plasma centers have historically worn the scarlet letter in the blood-collection universe.

Hospitals, Red Cross units, and nonprofit agencies relying on voluntary donations reject the plasma center model because cash incentives for whole blood may give donors an incentive to lie, heightening risks of a tainted supply. Such risks are higher overall for whole blood, too.

Prior to the AIDS crisis, plasma collection practices were often under the table, but the medical community still operated under a general assumption that those standards for plasma were good enough. The assumption proved disastrously wrong. Industry practices eventually cost the hemophiliac community dearly.

Throughout the '60s and '70s, plasma companies minimized their own overhead costs by relying on chancy prison populations paid a pittance: $5 to $10 dollars per “plassing” donation. Roughly 50 percent of American hemophiliacs contracted HIV from bad plasma-based pharmaceuticals (a much higher infection rate than that suffered by gay men at the time), making worldwide plasma medication HIV outbreaks the industry’s most publicized scandal.

People with hemophilia filed class-action suits. These included substantial evidence that a major plasma company continued to distribute “old supplies” of bad medications after becoming aware of the AIDS infection. The public was dismayed to discover that the industry operated under the protection of federal and state blood shield laws, limiting its liability.

By the 1990s, the industry’s public reputation reached a low point, with American collections dwindling, U.S. federal regulators clamping down, and revelations coming to light that spoke poorly of industry oversight and humanitarianism. Even before the AIDS crisis devastated U.S. plasma collections, other controversies, such as incidents of hepatitis C infection in plasma pharmaceuticals, led corporations to keep overhead low and avoid regulation by transporting the payment-incentives collections system to penniless countries abroad.

In the 1990s, China attempted to develop a plasma market to compete with Western companies by touting money for plasmapheresis in China’s most impoverished province, Henan. Villagers that were too poor to afford condoms soon realized they could earn more money by selling plasma than by farming the land, but the facilities offered substandard sterilization techniques, needles, and blood bags. By 1995, Henan Province had become a blood farm built on a criminalized plasma economy. Thousands of Chinese donors became infected with AIDS and Hepatitis C.

Today, many plasma products for hemophiliacs have been outdated by medical advances, but the industry thrives producing albumin for burns and intravenous immunoglobin, used to treat immune disorders and neurological conditions. The industry has returned to the United States in a big way with the help of brighter, user-friendly advertisements that include appeals to public service and reminders of the economy’s downfall to encourage donors. The number of centers in the United States ballooned during the Great Recession, with 100 new centers opening and total donations leaping from 12.5 million in 2006 to more than 23 million in 2011.

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Darryl Lorenzo Wellington is a poet and journalist based in Santa Fe, New Mexico. His work has also appeared in The Nation and Dissent.

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