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Blood and Blood Components

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Baylis, F., Downie, J., & Herder, M. (2013). Round table discussion on payment of plasma donors in Canada - Summary report [PDF - 29.5KB]. Submitted to: Office of Policy and International Collaboration (BGDT).

Recent News

In February 2016, Canadian Plasma Resources a private, for-profit plasma collection company, opened a clinic in Saskatoon. A little more than a year later, it opened a second clinic in Moncton. Initially compensation was set at $25.00 per “donation.” Currently, compensation is $50.00 per “donation”.  This money is credited to a Donor Value Card (a non-transferable VISA card) and qualified donors are limited to one “donation” per week.

The company has reported that it hopes to open additional for-profit clinics in other provinces including British Columbia, and Nova Scotia. Meanwhile, there are laws in Ontario, Québec, and Alberta that ban the sale of plasma.

On February 25th, 2018 CBC Radio One program The Sunday Edition hosted a debate about financial compensation (cash payment) for plasma providers. On the program it was explained that at the moment, plasma collected from Canadian volunteers is far short of the country’s needs and some suggested addressing the shortage by allowing payment for plasma. The public response to the broadcast was so intense that an unscheduled session was added the following week where host Michael Enwright read a sample of the mail correspondence and Dr. Graham Sher (CEO, Canadian Blood Services) responded in turn.

In general, most correspondents were quite critical of Canadian Blood Services and expressed concerns about problems of access and inconveniences now attached to donation. Dr. Sher affirmed those concerns and explained that Canadian Blood Services’ plans to improve access, rather than incentivize participation through financial compensation. In his words, “the question is not should we or should we not rely on remunerated donors. We do today. Eighty-five per cent of the supply comes from the United States, where they pay their plasma donors. The issue in Canada is, how do we want to solve the domestic security of supply concern? …Do we want a public sector solution which guarantees security of supply for Canadians, or do we welcome private sector players into the Canadian market who will sell the plasma anywhere on the international market to the highest bidder?”

Enwright asked Sher whether he was surprised that “people are so concerned about this?” Sher responded, saying: “This sends the opposite message to me. It indicates the very high level of support and commitment that Canadians have for their national blood service …this to me actually demonstrates how important Canadians view their blood system and I’m very, very proud that this many people would be interested in writing to you and saying we either have concerns, questions or ideas.”

Overview

In the 1980s, tainted blood products – many of which came from paid at-risk populations in the United States – infected thousands of Canadians with HIV and Hepatitis C. At the time, the federal government appointed a Royal Commission (known as the Krever Commission). In 1997, the Krever Commission recommended that Canada only accept payment for blood in rare circumstances. On this basis, Canadian Blood Services and Héma-Québec were created as arms-length agencies to administer the donation and provision of blood and blood components. Since then, blood donation within Canadian borders has been heavily screened.  With the exception of the Cangene Corporation (1984-2014) facility  in Winnipeg, which paid “donors” with the extremely rare Rh-negative blood type, blood donation in Canada remained altruistic.

Recent developments, however, have put Canada’s non-profit system under stress. In February 2013, Canadian Plasma Resources announced plans to open three clinics in Ontario – two in Toronto and one in Hamilton – at which it would pay “donors” for their plasma. One of these facilities was located next to a homeless shelter and another next to a drug-treatment facility. This raised concerns about the exploitation of at-risk individuals and about increased safety risks for recipients of paid-for blood.

In March 2013, the Ontario Minister of Health wrote to the federal Minister of Health [PDF - 89 KB] expressing concerns about the integrity of the altruistic blood donor system. A month later, Health Canada chaired a roundtable followed by a public consultation process (to which Matthew Herder, Françoise Baylis, and Jocelyn Downie contributed [PDF - 26 KB]). Notably, in announcing the consultation process, Health Canada overstated the scope of payment for blood in Canada by incorrectly asserting that “the practice of payment for donations of plasma for the creation of plasma-derived pharmaceuticals has occurred in Canada for 30 years.” In point of fact, at that time, payment for plasma donations only occurred for Rh-negative blood at the Cangene Corporation clinic in Winnipeg.

About a year later, in February 2014, Matthew Herder, Françoise Baylis, and Jocelyn Downie wrote to the Ontario Health Minister Deb Matthews [PDF - 2.9 MB], urging the government to amend section 10 of the Trillium Gift of Life Network Act in order to ban payment for blood and blood components. In due course, the

 Ontario government announced that it would ban payment for blood and plasma in the province. On December 11, 2014, Bill 21, the Safeguarding Health Care Integrity Act, received Royal Assent. This legislation empowers the Ontario government to control licensing for labs and specimen collection centers. It also distinguishes between plasma donations used in drug manufacturing and fresh blood and plasma used in transfusions. Schedule 1 includes provisions from Bill 178 (the Voluntary Blood Donations Act) that prohibit direct or indirect payment as well as receipt of payment for blood or blood components.

Meeting patients' needs for plasma-derivatives is an ongoing challenge. Canada is currently 100% self-sufficient in supply of whole-blood and fresh frozen plasma for transfusions, whereas altruistic donations of plasma for manufacturing of plasma-derivatives (that are used in treatment of patients with immunodeficiency and autoimmune diseases, bleeding disorders and other rare diseases) meet 17% of the demand. The remainder of plasma products used in Canada are imported from commercial companies who use paid donors.

The World Health Organization recommends the elimination of paid donations to ensure blood safety and availability. With limited research on the Canadian context, deciding how best to ensure a safe and sufficient supply that, at the same time, avoids the harms of exploitation means that policy choices must be made under conditions of uncertainty.

Post-Krever Commission, the altruistic blood donor system appears to have served Canadians well. But neither federal nor provincial legislation (outside of Québec, Ontario, Alberta and most recently Britisch Columbia) actually bans compensation for blood or blood components (including plasma). Health Canada is reported by the CBC to have claimed that "its mandate is to regulate the safety and quality of the plasma that is collected for the purposes of transfusion or use in the manufacture of a human drug, which does not extend to corporate or operational decisions such as compensation to donors." Thus, there is little to prohibit private for-profit companies in Canada from attempting to incentivize donation of blood or blood components through financial reimbursement schemes in those jurisdictions that lack relevant law and policy.

For more in depth coverage of many of these issues, consult the work of Anne Kingston in: "Should we pay for blood?" (Macleans Magazine, 15 Apr 2013), "What a blood plasma-for-profit clinic means for public health care" (Macleans Magazine, 14 Jan 2107), and "A bloody mess: the story behind paid plasma in Canada" (Macleans Magazine, 22 Nov 2017) as well as a response to the latter in the "Letter to the editor" by Graham Sher, Executive Director, Canadian Blood Services.

Last  updated  Spring 2018