Lisbeth Witthøfft Nielsen considers ways of increasing the pool of voluntary unpaid plasma donors in Canada.
Canadian Blood Services and Hema Quebec are responsible for the day-to-day administration of blood supply to Canadian hospitals. This includes the distribution of whole blood and fresh frozen plasma for transfusions, as well as the distribution of plasma protein products to treat patients with bleeding disorders, immune disorders, and other rare diseases.
According to Canadian Blood Services, Canada’s need for plasma used in plasma protein products has increased in the last ten years from approximately 600,000 litres per year in 2007 to 1,000,000 litres per year in 2016.
Currently, Canada’s voluntary blood collection system is able to meet 100% of the demand for plasma used for transfusions, but only 25% of the demand for plasma used in plasma protein products such as Immunoglobulin (for example used in treatment of patients with haemophilia). Typically this plasma is recovered from altruistic whole blood donations made in Canada and the U.S. Only a small percentage of this plasma comes from donors who undergo apheresis. Apheresis is a process by which the donor’s blood passes through a machine that separates out the plasma after which a plasma-substitute is added to the blood which is then returned to the donor through a needle in the arm. The remaining 75% of plasma protein products is imported by Canadian Blood Services from private American and European companies who collect plasma from paid donors.
In Canada, provincial and territorial governments decide whether to allow payment for plasma. Currently, Ontario and Quebec are the only two provinces that explicitly prohibit payment for plasma. Two months ago, in February 2016, Canadian Plasma Resources opened a for-profit plasma collection clinic in Saskatoon. Donors can give plasma once per week and are paid a $25 gift card for each donation. Canadian Plasma Resources has announced that they also hope to open a pay-for-plasma clinic in Nova Scotia. In response, on April 20th the Nova Scotia NDP called for legislation banning private for-profit plasma clinics.
Those who defend commercial plasma collection argue that a financial incentive such as a gift card may attract more donors and thereby help to fill the gap between supply and demand for plasma-based products in Canada. And, among these proponents of for-profit plasma collection, there are some who claim that there is double standard in prohibiting paid donations in Canada, when the Canadian supply already relies heavily on plasma from paid donors in other countries.
However, paid plasma donations may have negative consequences for the existing voluntary blood plasma collection system:
First, the introduction of private, for-profit plasma collection clinics may limit options for voluntary unpaid donations by pushing Canadian Blood Services out of the business of plasma collection for plasma protein products. Private plasma collection companies, collect plasma for manufacturing using apheresis. Canadian Blood Services, on the other hand, relies primarily on plasma recovery from whole blood donations. It also uses apheresis for plasma collection, but currently it only has seven plasma collection clinics that use apheresis. If there is expansion in the private sector, will the public sector have any ability to compete? Attempting to fill the gap between supply and demand for plasma protein products through private for-payment collection sites, may take focus away from exploring ways to make apheresis through Canadian Blood Services more accessible to voluntary donors.
Second, although for-profit plasma clinics may attract new “donors,” they may not actually increase the donor pool. It is not clear how many donors paid donations can attract, nor how introducing private for-profit-paid-donation will impact altruistic donors’ motivations to donate. Many factors can affect people’s motivation to help others through donation of biological material. Some voluntary paid donors may benefit from social recognition for their contribution. Various non-remunerated incentives, such t-shirts or a lottery ticket, may help to encourage voluntary donation. In addition to non-monetary incentives, there may be opportunities to expand the donor pool within the existing voluntary donation system by improving education about plasma donation to existing and potential donors.
Meeting the demand for plasma protein products is a challenge because of the speed with which this demand is growing. Canadian Blood Services predicts that the demand of plasma will increase to approximately 1,300,000 litres in 2020. For commercial companies such as Canadian Plasma Resources this increasing demand represents a significant business opportunity. Addressing this problem by allowing commercial collection with paid donation in Canada may be desirable from the point of achieving self-sufficiency. There may be problems, however, with increased reliance on commercial companies for both collection and manufacturing.
Considering that the current non-profit system has proven successful in achieving sufficiency in supply of whole blood and fresh frozen plasma for transfusions, a good place to start may be to make voluntary plasma donation sites more accessible to Canadians nationwide and to explore different ways of increasing the pool of voluntary plasma donors.
Lisbeth Witthøfft Nielsen is a Research Associate at Novel Tech Ethics and a Lecturer in the Department of Bioethics in Faculty of Medicine at Dalhousie University.