Medicaid, housing subsidies, the Supplemental Nutrition Assistance Program—these are some of the things that make up the backbone of the U.S.’s social safety net. And the federal government, guided by President Trump’s proposed budget for 2019, is seeking to make deep cuts to all three of them.
Yet while this threatens the government’s social safety net, one of a different kind continues to expand. Americans are flooding into the country’s blood-plasma donation centers in greater numbers than ever before, seeking to make up for low wages or small benefits checks, or even as their only source of cash income during a spell of extreme poverty. Their blood plasma—which historically has been collected disproportionately in the country’s poorest communities—is fueling a multibillion-dollar worldwide industry.
Blood plasma, being a vital component of certain medical treatments, is extremely valuable, and there’s not much standing in the way of American adults who want to make some money off of what’s in their veins—so long as they weigh more than 110 pounds and are in good health. A standard visit lasts 90 minutes and usually pays between $30 and $50. Unlike other countries that ban giving plasma more than once a week or limit the number of sales in a year out of concerns for donors’ health, the U.S. permits up to two plasma donations a week, every week.
This can translate into a few hundred dollars a month—a significant sum to people who have few or no other sources of income. In 2015, one of us wrote an article for The Atlantic about people who sell their plasma to make ends meet, and other journalists have focused on them as well. But what’s gotten much less attention is the global, multibillion-dollar industry these donors are sustaining. It’s an industry that helps heal patients worldwide, but it’s also one that, to keep the blood flowing, depends on the existence of a large group of people desperate for cash.
There is a thriving industry built on plasma because the substance has no substitute in medical treatments for certain rare conditions, such as antibody deficiencies and hemophilia. As one company explained in an annual report, plasma comes from “the perfect bioreactor developed over millions of years of evolution: the human body.” In addition, many treatments are so plasma-intensive that they collectively require millions of liters of it each year; a year’s worth of therapy for someone with hemophilia might require the yield of as many as 1,200 donations. So, not only is there no substitute for plasma, but enormous volumes of it are needed. On top of that, global demand for it has steadily risen as many countries’ populations age and need more treatments that require plasma.
This all has been a boon for the industry. Over a decade, the number of donations—really, “sales” is a more accurate noun—in America tripled, from 12 million per year in 2006 to 38 million per year in 2016, according to the Plasma Protein Therapeutics Association, a trade group. The number of donation centers in the U.S. has more than doubled to meet demand, from fewer than 300 sites in 2005 to over 600 today. Global sales jumped from $5 billion in 2000 to $20 billion in 2015, and are expected to keep growing at a rapid clip well into the next decade.
The Number of Annual Plasma Donations in the U.S., from 1999 to 2016
Because plasma can be a medical necessity, companies that collect it tend to wield significant pricing power. These days, a liter of plasma that costs a company about $150 to collect and process could sell for in the neighborhood of $500—a substantial markup in any industry.
Because there are high barriers to entering the industry—it’s not easy for an entrepreneur to just up and start a medically sensitive operation—a few international companies command a large chunk of the market share and keep profits high. The industry thrives in the U.S. in particular because the country allows compensation of donors (many countries do not) and has some of the least restrictive plasma regulations in the world. In the United States, a person can donate up to 104 times a year, while in much of Europe, donors are limited to 45 times in a year. Little is known about the long-term health consequences of chronic donation, although a few years ago, Darryl Wellington wrote in The Atlantic about some of the effects he and some other “plassers” experienced, including extreme fatigue and blacking out.
The big firms in the industry include Grifols, CSL, and Octapharma, all three for which plasma makes up a substantial portion of revenues, and Shire, a bigger, more diversified biomedical company. America is very important to these companies’ continued success and growth: As the world’s largest plasma producer, the U.S. supplies 70 percent of the world’s plasma, but accounts for only 40 percent of global demand.
And production is ramping up. Grifols, for instance, plans to expand to 225 donation centers in the coming years, up from 171 in 2016 and just 80 in 2010. The company’s revenues increased sixfold between 2006 and 2016, a period during which other companies saw similar growth; as of 2015, Grifols said it was collecting 26,000 donations a day worldwide, with a majority of its centers in the U.S. The company controlled about one-fifth of the market for plasma therapies in 2016. (More recent figures aren’t publicly available, as Grifols has been less forthcoming in later annual reports.)
Octapharma, another leader in the industry, announced its intention in 2015 to double its plasma output over four years. At the time, the company said it was putting 400 million euros (nearly $500 million U.S. dollars) toward this goal. (Octapharma didn’t respond to a request asking whether its expansion is on track.) And in 2013, Bain Capital got into the business, taking over a company called Plasma Resources UK, the plasma supplier for the U.K.’s National Health Service. Then a few years later, Bain sold the service to a Chinese investment group, making a considerable profit.
When contacted for this article, Shire noted the medical importance of plasma treatments but declined to go into much detail about the workings of the industry. Neither Grifols nor CSL responded to a request for comment, and Octapharma referred us to the Plasma Protein Therapeutics Association, a trade group, which in turn said it could not comment on the business prospects or donor-compensation practices of its member companies.
These companies’ expansion plans are not just a bet on the ongoing necessity of plasma, but also that there will continue to be plenty of potential donors who could really use the extra money. While there are altruistic reasons for donating blood—CSL Plasma’s website frames the act as something that will “help people around the world live healthier, happier lives”—the industry’s success is undergirded by the consistently high number of people who simply need cash, particularly in the United States.
This makes the ethics of plasma donations tricky. While it’s disturbing that cash-strapped Americans feel forced to monetize their bodily fluids, donations represent an income source that many couldn’t stand to lose. Selling plasma is probably preferable to other survival strategies that may be riskier (or less legal), though it’s worth noting how little long-term evidence there is about the health risks of frequent donation. At the very least, considering the strength and prospects of the industry, donors could stand to receive a bigger share of the revenue generated by plasma sales—few, if any, donors could ever dream of affording the treatment that they make possible for others. (No major plasma-collecting company mentioned in this article would discuss this moral dimension of plasma donations.)
It does seem there is a place for compensated plasma donation in the U.S., in some form—it is not inherently morally objectionable. But what’s concerning is the extent to which many “voluntary” donations are anything but, with people depending on them in the absence of an adequate social safety net. And as that social safety net gets weaker, the plasma industry is only getting stronger.