Plasma Donation: A Response to The Guardian’s Recent Article Condemning the Plasma Industry

Arwa Mahdawi, a friend just sent me your opinion piece about the evils of the plasma industry. Quite frankly, I would have preferred to send you a response directly, but The Guardian requires that a complaint about content be limited to no more than 500 words. This topic, in which you scratched just the surface of the issue, is far too complex for anyone to explain in 500 words or less. I found your opinion piece to be, at best, under-researched, and in the worst case scenario, outright dangerous to those of us who rely on plasma-based therapies to live. It is not just you, though. You are certainly not the first columnist to demonize the plasma collection process in the US, and I am sure you will not be the last. The one thing that these articles have in common is that they are often woefully and negligently under-researched, and they completely ignore the very patients who rely on these donations. These articles are typically full of one-sided criticism, but none of them offer alternative solutions to ensure a continuous, adequate plasma supply. My biggest fear is that one of these articles will some day go viral, and the fall-out will threaten my life and well-being. Perhaps it is the collective privilege of columnists like you, who are likely relatively healthy and have never needed a plasma product to just survive, that prevents you from seeing the whole picture.

First, I would like to point out that the only use for plasma that you mentioned in your entire article is for the treatment of severely ill COVID-19 patients. While this is a great use of plasma, you failed to research and mention a single other use for plasma therapies. This is important, because it is such a big reason for why plasma companies have to pay for it in countries where it is legal to do so. Did you know that plasma based therapies are used to treat a variety of extremely rare and incurable diseases? In some of these conditions, it takes over 1,000 plasma donations per year to treat just ONE patient. In contrast, donation centers commonly say that one whole blood donation treats an average of 3 different patients. Those plasma therapies that require such high amounts of donation are also life-long, regular treatments, and without the treatments, the patients would die. Those conditions include various forms of primary immunodeficiency (genetic diseases similar to “Bubble Boy Disease”), hemophilia and other bleeding disorders, alpha-1 antitrypsin deficiency, and so many more. These are just some of the life-long conditions where plasma is life-giving. There are also a variety of others treated by plasma, in which the patients benefit from a drastically improved quality of life for their incurable illness, including several very debilitating neurological conditions. It was a disservice to patients like myself for you to completely ignore the desperate health needs of all of us in your article.

Second, did you know that plasma-based therapies regularly face threats of shortage? Some plasma-based therapies, such as immunoglobulin, take 7-12 months to become usable products after collection, so shortages cannot be addressed in a timely manner when they happen. It takes intricate planning to prevent a shortage, and even that still doesn’t always work. What does that mean for us when there is a shortage? It means that patients like myself can be denied refills of medication and be at serious risk for life-threatening complications, even after missing just one dose. It means that if I were denied treatment due to a shortage, any infection I contract could become very serious or even fatal due to the fact that my immune system doesn’t function properly even against common illnesses. It means that a child with a bleeding disorder that has to miss treatment could fall on the playground and bleed to death. How does the plasma industry ensure a steady supply? They pay for plasma where it is safe and legal to do so. Payment for plasma ensures the vital, regular stream of donations. You even mentioned in your article that the US supplies 70% of the global plasma supply, but you never expanded on why that is or why it is vital that we do.

You also failed to mention the time commitment difference in the process of donating blood and platelets compared to plasma. The actual procedure time for blood donation is around 15 minutes. The procedure time for donating platelets is roughly 30 minutes. You did, however, accurately mention that it takes roughly 90 minutes to donate plasma. That is a far greater strain on someone’s time than blood or platelet donation. How easy do you think it is to convince someone to sit for 90 minutes with a needle in their arm to donate plasma? If someone is giving up 90 minutes of their time to sit in a chair with a needle in their arm, I think that we have to find a way to prove to them that their time is valuable. Right now, we do that by paying them for the time that they could be using to do many other, more pleasant things. The plasma industry certainly wouldn’t be spending so much money to pay donors if they could keep the same level of donations for free, so if you can think of a better way to show donors that we value their time, please feel free to enlighten the rest of us. You seem to offer plenty of criticism but no solutions.

I will agree with you that it is regrettable that young adults are intentionally trying to get infected with COVID-19 in order to get paid for their plasma that is rich in antibodies. However, how is that the plasma industry’s fault? These people are over 18 years old - legal adults who are fully capable of understanding the risks of such decisions. At some point, we have to start holding adults accountable for their own decisions, because intentionally exposing themselves to COVID-19 for a small bonus in compensation is a result of their own poor decision-making. The same collection centers paying small COVID-19 bonuses are also still paying for regular plasma, so the students could have still donated for cash without contracting COVID-19. Just like you, I wish that there were more financial safety nets for the most destitute. Many of the rare disease patients that plasma therapies treat worldwide also fall into the category that needs more social safety nets. However, the plasma industry is not responsible for that lack of a safety net. A number of other societal and policy issues are responsible for that. It is a problem far too large for a few drug companies to solve. I am not naïve. I know that many donors do it for the money, but desperate people also do far worse things for extra money than donating plasma. The plasma companies aren’t stealing it from donors’ arms. Just like any other medical procedure, it requires informed patient consent after receiving an explanation of the risks.

The plasma industry isn’t the only medical industry that pays donors for pieces of their body and attracts mostly young, low-income participants; yet they are the only one regularly vilified in the press for it. People get paid to participate in clinical trials, with far less research proving the safety of those procedures or sometimes no knowledge of the safety at all. Men can sell their sperm for a profit. Young women can get paid quite a bit of money to donate their eggs, a risky and invasive procedure that can lead to serious complications or even death. Women can get paid a significant sum to become surrogates for families that cannot carry their own children, a task that can also be very dangerous and even potentially fatal. In your own article, you mentioned that complications from regular plasma donation include migraines, numbness and fainting. Perhaps you have never donated blood or platelets, but these are some of the exact same side effects of unpaid blood and platelet donation. Is it more unethical to pay someone for their eggs or surrogacy so that a couple can conceive a child (both beautiful and life-giving sacrifices to make for another human being), or is it more unethical to pay someone to donate plasma so that patients with rare diseases can literally just survive? They are all life-giving donations, some far more risky than others, so why only focus on the plasma industry?

Next time you write an article on such a complex topic with real-world, life and death consequences, please do more thorough research. Speak with the patients that are heavily affected by the impacts of your words, the paid donors who feel villainized and embarrassed as a result of your judgmental and mightier-than-thou attitude, the highly-reputable patient organizations that fight tooth and nail every day for adequate patient care, and the plasma industry leaders who are desperately trying to avoid another shortage that could be fatal to their patients. The issue of payment for plasma donation is not as black and white as you would like to think. It is many more shades of grey, and your refusal to allow for that possibility in your article will unfairly taint the practice of plasma-donation and keep people from donating to life-saving therapies. I am not saying that paid plasma is a perfect system; however, rare disease patients cannot afford to throw the current system in the trash until there is a viable alternative. You have a platform with a level of readership that I dream of advocating to, and this week, you chose to use that platform to ignore and further hurt the future of rare disease patients like myself, rather than lift us up.

Chronically yours,

Jen