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.