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Banking on blood

Critics of Saskatoon’s pay for plasma donation clinic aren’t seeing the big picture
By Barbara von Tigerstrom
April 15 2016 issue

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The recent announcement that a private plasma donation clinic had opened in Saskatoon has reignited the controversy surrounding paid donation of blood products, with opponents invoking memories of the tainted blood scandal to argue against the practice.

Canadian Blood Services (CBS) operates plasma collection clinics on a not-for-profit basis in six provinces and Héma-Québec in Quebec. Collecting plasma using plasmapheresis (which separates plasma from other blood components) takes longer than a regular blood donation and must be done at a specialized centre; some plasma is also recovered from donated whole blood. All CBS and Héma-Québec blood and plasma collection is from unpaid voluntary donations.

The Saskatoon clinic is operated by Canadian Plasma Resources and reportedly will compensate donors with a $25 gift card. When the company previously tried to open clinics in Ontario, the provincial government passed legislation banning paid donation of blood products (Voluntary Blood Donations Act, S.O. 2014, c. 14, sch. 1). There is no sign of a similar move in Saskatchewan, despite opposition from critics who have called on the provincial and federal governments to stop the clinic’s operation. This is planned to be the first of several collection sites for this company, although contrary to some reports, it will not be the first of its kind in Canada; in fact a plasma collection facility that compensates donors has been operating in Manitoba for many years.

Notwithstanding the common misconception that payment for donating blood products is not allowed in Canada, that is true only in Quebec and, since 2014, Ontario. Provincial and territorial laws that prohibit paying for human organs or tissues don’t apply to blood products, and federal legislation only bans the purchase of gametes or embryos (Assisted Human Reproduction Act, S.C. 2004, c. 2, s. 7). Regulations under the federal Food and Drugs Act (R.S.C. 1985, c. F-27) govern safety matters like donor screening and testing and the licensing of establishments that collect, process, or distribute plasma and plasma products. After a review and consultation in 2013, Health Canada maintained its position that banning compensated plasma donation was not justified on safety grounds, leaving the matter to provincial/territorial legislation.

The most common argument made in favour of a ban is that paid donation compromises the safety of blood products, since payment and for-profit operation could create incentives to conceal risks and cut corners. The report of the Krever Commission (Commission of Inquiry on the Blood System in Canada, 1997) recommended against payment of blood and plasma donors for safety reasons. This recommendation is frequently cited by opponents of private plasma donation clinics, but much has changed in the 20 years since the inquiry, including stronger federal regulation and improved techniques for processing blood products. Even Krever’s report concluded that screening and treatment methods had “almost eliminated” the risk of HIV and hepatitis transmission from plasma derivatives.

Another argument is that allowing paid plasma donation will undermine the current system of voluntary donation in Canada. This doesn’t seem to be an immediate practical concern given that there is no CBS plasma donation clinic in Saskatchewan, though some also worry that compensation erodes the spirit of altruism that voluntary donation represents. Donors might prefer the paid donation option if it becomes more widely available, potentially threatening the viability of CBS plasma donation sites. However, it’s possible — though as yet uncertain — that introducing paid donation could benefit the supply of plasma products for Canadian patients. According to some sources, plasma collected at the Saskatoon clinic is intended to supply plasma products for use in Canada. Assurance of this could alleviate concerns previously raised in Ontario that donations would be diverted away from the Canadian system altogether.

A recent CBS statement rejects safety concerns about paid plasma donations and suggests that voluntary blood donations and paid plasma donations can coexist, as they do in the United States and other countries. In fact, the majority of plasma products used in Canada are made from plasma donated in the United States, where compensation for plasma donation is the norm. Although the World Health Organization advocates voluntary non-remunerated donation, experts in its global consultation cautioned that this may not be feasible for plasma products, given the current supply.

Finally, some raise moral objections, saying that compensation leads to exploitation or commodifies human biological material, though these objections may have more force in relation to organs or reproductive material. The fact that we rely on plasma products sourced from paid foreign donations makes it awkward to insist too strongly that compensated donation is inherently immoral or unsafe. It is only right that we respect the legacy of the Krever inquiry and the tragedy that prompted it, but it’s not obvious that banning paid plasma donation is the best way to do that. The current controversy presents the opportunity for an informed conversation about how to ensure a safe and reliable supply of blood products for all who need them.

Barbara von Tigerstrom is a professor at the University of Saskatchewan College of Law.

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