Should we compensate blood donors?

Dr Eric Crampton
The Post
24 June, 2023

At the start of National Blood Donor Week, the New Zealand Blood Service warned that it will need more donors.

According to the Blood Service’s Asuke Burge, “If we can’t meet demand, it means we are going to be forced to compete in the global market, for particularly plasma products. We don’t want to do that.”

The Blood Service may not want to compete in global markets for plasma markets, but that horse has long since bolted. The detail is in the fine print on page 79 of the 2021-22 Blood Service Annual Report – the most recent available. Some 86.2 percent of the country’s demand for immunoglobulin, a blood plasma product, is met by domestic production. The rest is imported.

And the figure last year was similar.

The root cause is obvious.

New Zealand relies on uncompensated blood and plasma donation. Compensation, in New Zealand, is prohibited.

Professor Peter Jaworski, an expert in the ethics and economics of blood plasma donation, released an international report during blood donor week with the hard numbers; the New Zealand Initiative was one of the report’s global release partners.

As Jaworski explains, “Every country that permits the commercial model to operate within its borders has surplus plasma. …Every country that prohibits the commercial model or donor compensation has plasma collection deficits which have only grown over the past decade. There are no exceptions.”

More than seventy percent of the plasma for the world’s plasma for manufactured therapies comes from the United States. Other countries that allow compensation, like Germany, Austria, Hungary and the Czech Republic, together with the United States, provide plasma for close to ninety percent of global demand.

Because America allows compensation, its donors fill gaps in other countries’ supplies. New Zealand simply is not pulling its weight, for the most dubious of constructed ethical concerns.

Bioethicists sometimes worry about compensation. But it seems strange, at best, to ban compensation here while relying on imported plasma from paid donors. Whatever worries you have about compensation seem worsened by relying on imported compensated product.

If you worry that poorer people are exploited by having the option to donate plasma for compensation, isn’t New Zealand’s social safety net better than America’s? Plasma collection is safe and does not put donor health at risk, so the concern seems misguided. But if you think there is somehow a problem, isn’t it worse to rely on compensated donations from the US?

If you worry that compensated product is less safe than uncompensated donations, remember that the world relies on blood product imported from compensated American donors. If there were a safety issue, wouldn’t someone have noticed?

There is a bigger real concern that seems to have slipped past the ethicists who object to donor compensation.

If New Zealand comes to rely more heavily on imported products, we will be contributing to a global problem. Not all countries are able to manufacture their own blood plasma products. They must rely on imports.

Failing to compensate donors here can mean fewer of these products are available in poorer countries.

New Zealand claimed to have worried a lot about these kinds of global equity issues when the government put us at the back of the global Covid vaccination queue. But we seem happy to consider ourselves more moral than countries that allow compensation while pushing poorer countries out of the queue for products like immunoglobulin.

Should we maintain the status quo and rely ever more heavily on imported plasma products? Or should we follow the example set by places like Alberta, Canada?

In late 2020, Alberta repealed its ban on compensated donations. Since then, three commercial collection centres have opened. By 2024, the province of some 4.4 million people is likely to be the only Canadian province approaching self-reliance, rather than importing product from elsewhere.

Commercial plasma collection centres, paying donors, operate alongside traditional unpaid collection systems. It does not have to be one or the other. Both can coexist successfully, as they do in Alberta and many other countries.

Banning compensation of plasma donors does not prevent compensation. It just changes where that compensation happens, while worsening global shortages of critical medical supplies.

New Zealand needs to rethink this prohibition on compensation, as well as a few others.

Earlier this month, Amber Older wrote in The Spinoff about the effects of New Zealand’s ban on compensation for sperm donors. Everyone involved in assisted reproductive therapies is allowed to be compensated – except for the donors. The result is entirely predictable to any economist, or really to anyone able to think coherently.

Older reports a two-and-a-half to three year wait for IVF. All because Parliament decided to prohibit compensation of sperm donors.

Prohibitions on voluntary transactions among consenting adults should always be viewed with deep scepticism. These two prohibitions should be lifted immediately. Their cost is simply too high.

Read here

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