Impact Ethics

Blood and Blood Components

SELECT MEDIA ARTICLES

Smarsh, S. (Summer 2017). Blood brother: Blood is donated, pla$sma is purcha$ed. VQR: A National Journal of Literature & Discussion, 93(3).

Bissett, K. (17 Jun 2016). Plans for paid-plasma donation clinic in New Brunswick raises ethical debate.The Brandon Sun.

Picard, A. (10 May 2016). It's beyond time for a clear policy on paying donors for plasma.The Globe and Mail.

Mallick, H. (26 Apr 2016). Blood agency would turn us into stop ‘n’ shops: Mallick.Toronto Star.

Crowe, K. (26 Apr 2016). Canadian Blood Services won't rule out paying plasma donors. CBC News.

McMillan, E. (5 Apr 2016). Canadian plasma resources pays for donations, eyes Maritime expansion. CBC News.

Brend, Y. (21 Mar 2016). Pay-for-plasma system looming in B.C. CBC News.

Boon, J. (11 Mar 2016). For-profit plasma clinics exploit blood for profit say NDP. The Coast.

Anonymous. (9 Mar 2016). Pay-for-plasma clinic may head to Nova Scotia. The Chronicle Herald.

Crowe, K. (9 Mar 2016). Paid plasma in Canada: 10 things to know about the business of blood. CBC News.

Graig, M. (18 Feb 2016). Controversial plasma collection clinic now open in SaskatoonGlobal News.

Grant, K. (24 Nov 2014). Company gives up on plan to open plasma clinics in Ontario. Globe & Mail.

Babbage, M. (22 Jul 2014). Ontario bill proposes ban on paying for blood, blood plasma. The Canadian Press.

Dala, M., Doig, C., & Laupacis, A. (17 Apr 1014). Paying for plasma – Canada’s double standard? Healthy Debate.

Anonymous. (19 Mar 2014). Ontario is right to ban paid donation of blood plasma: Editorial.Toronto Star.

Rae, B. (7 Feb 2014). Why is it taking governments so long to say no to "pay for plasma"? www.bobrae.ca.

Blackwell, R. (12 Dec 2013). Cangene bought by US rival for $236 million, latest Canadian biotech taken private. The Globe and Mail.

Anonymous. (20 Jun 2013). 28 Organizations call for public policy review on for-profit plasma collection. Diablogue.

Kingston, A. (15 Apr 2013). Should we pay for blood? Maclean's.

Teotonio, I. (12 Apr 2013). Should federal and provincial regulators allow plasma-for-profit clinics to operate in Canada? The Star.

SELECT BLOGS

Nielsen, L.W. (22 Apr 2016). Got plasma? Impact Ethics.

Herder, M. (20 Apr 2016). Talking plasma and markets with my mothers.Impact Ethics

Behrmann, J., & Ravitsky, V. (30 Oct 2014). After plasma: Are blood stem cells next? Impact Ethics.

Lanteigne, K. (21 Mar 2014). Blood money. Impact Ethics.

Haw, J. (17 Oct 2013). Canada's national public cord blood bank opens its doors.Impact Ethics.

Herder, M., & Baylis, F. (6 Aug 2013). Policy laundering and payment-for-plasma.Impact Ethics.

Dutt, M. (31 Jul 2013). For-profit plasma clinics are risky business. Impact Ethics.

SELECT PUBLICATIONS

WHO. (1975 onwards). Resolutions relating to blood safety adopted by WHO governing bodies. World Health Organization.

WHO. (Jun. 2015). Blood and blood safety availability. Fact sheet N°279. World Health Organization.

Health Canada. (27 Jun. 2013). Backgrounder paper – plasma donations in Canada. Drugs and Health Products.

Canadian Blood Services. (18 Feb 2016). Statement from Canadian Blood Services: Payment for Plasma Donation.

Glauser, W. (28 Jul 2015). Payment for plasma raises ethical issues. Canadian Medical Association Journal, doi: 10.1503/cmaj.109-4855.  

Health Canada. (May 2014). Plasma Donation in Canada—Fact Sheet.

WHO & IFRCRCS. (2010). Towards 100% voluntary blood donation: A global framework for action [PDF 7.79 MB]. World Health Organization & International Federation of Red Cross and Red Crescent Socieities.  

SELECT POLICY CONTRIBUTIONS

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 for-profit plasma collection company, opened a clinic in Saskatoon. Approved plasma donors receive a $25 gift card per collection. It is reported that the company plans to open another for-profit plasma collection clinic in British Columbia, and is exploring the possibility of opening additional clinics in other provinces, including in Nova Scotia.

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. And, except for the Cangene facility in Winnipeg which pays “donors” with the extremely rare Rh-negative blood type, blood donation has 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 Plasma Resources 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. Legislation to prohibit financial compensation for blood and blood constituents was introduced in July 2014. On December 11, 2014, Bill 21, the Safeguarding Health Care Integrity Act, received Royal Assent. This legislation empowers the Ontario government to control licencing for labs and specimen collection centres. 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 25% of the demand. The remaining 75% 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 and Ontario) 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.

Last updated April 2016.