holding hands in ad for paid plasma donation

Bioethics Forum Essay

Should Your Wedding Plans Include Plasma Donation?

When I said, “Yes!” to my partner’s proposal last spring and changed my Facebook relationship status to engaged, I expected targeted advertisements for wedding dresses, flowers, and photographers. What I did not expect were ads to donate my plasma to help pay for my wedding.

“Say ‘I do’ to donating plasma,” said the BioLife Plasma Services’ advertisement targeted to me, with a picture of a couple in a suit and wedding dress, “and get up to $900.” Despite our fear of needles, my partner and I briefly considered this as a viable option to help pay for our wedding. The average wedding in the United States costs $30,000 (although our low-key wedding will cost less). I mean, what could be more romantic than holding hands at the plasma donation center? But as I paused my scrolling to consider this option, my concerns as a bioethicist grew.

For one, the advertisements mention no risks. While plasma donation is relatively safe, risks include fatigue, bruising, bleeding, or dehydration and, though rare, fainting and serious infections. For people who do experience complications, it is unclear whether plasma companies would cover their medical expenses. Given that 49.8% of those who donate plasma earn less than 200% of the federal poverty level, medical risks could cause further financial hardship. Individuals in poverty are likely to be on Medicaid if they have insurance at all. And since Medicaid eligibility is income-linked, and being compensated for donating plasma is considered taxable income, donating plasma could bring a double risk to some people: increasing their tax burden and causing them to disqualify for Medicaid.

Compounding these risks, private plasma donation centers in the U.S.—which place these ads– have less stringent donation limits than are recommended by nonprofits and international organizations. For example, the American Red Cross (which does not compensate donors) only allows people to donate plasma every 28 days, or no more than 13 times in one calendar year. France and the Netherlands allow no more than 26 donations per year (one every two weeks). Yet the United States. permits donation up to two times a week and a maximum of 104 donations a year. Plasma donation companies in the U.S. entice people to donate frequently by offering financial incentives and referral bonuses and rewards programs.

The risks of frequent plasma donation are not limited to donors, but also extend to the patients who receive plasma. Plasma from frequent donors has been found to be of lower quality than plasma from less frequent donors.

However, around the world there is a substantial need for plasma that cannot be met without compensating donors. Someone who is seriously immunocompromised may need 130 plasma donations per year; someone with hemophilia, 1,200. Financial compensation is an effective way to increase donation. Some countries that rely on uncompensated donation must import plasma from countries that compensate their donors. The U.S. has become the largest exporter of plasma worldwide, responsible for two-thirds of the world’s supply. Export of blood products represents 3% of the U.S.’s global exports.

In addition to financial compensation, targeted advertising is an effective strategy for getting donors. So successful, in fact, that companies such as InceptSave, which calls itself “a blood donor recruitment partner,” have emerged to help donation centers grow their donor base. InceptSave hosted a panel discussion, How Do You Reactivate Blood Donors Using Social Media?, covering its strategies to help blood donation centers recruit new donors on social media including using “a multi-channel strategy that engages donors where they want to be engaged,” likely meaning targeted advertisements like the one I received.

However, targeted advertisements can be troubling when used for health-related procedures, products, and services. Hospitals and other medical entities subject to federal regulation are not permitted to use tracking technologies in a manner that would result in impermissible disclosures of personal health information  or other violations of the HIPAA rules. Yet, this happens. One study found that over 98% of hospital websites used third-party tracking.

In addition, the practice of geofencing, which is often used in targeted advertising, raises ethical concerns. This technique relies on a smartphone’s geolocation services to trigger the algorithm to deliver targeted ads when the device enters a specific geographic area, or geofence. Personal injury lawyers have used this technique to target ads to someone who has entered a hospital emergency room. In the case of plasma donation centers, my lack of recent visits to a medical facility may have been one of the data points that triggered the targeted ads for plasma donation, as these centers typically seek healthy, young donors.

Ultimately, the question of whether plasma donation centers should use targeted ads involves balancing the good of plasma donation and its medical necessity with the potential harms of exploiting the poor, increasing medical risks, and selling data (especially medical data) to advertisers. One way to reduce these harms is with better personal data protections, especially for health information, such as those instituted by the European Union. In addition, the U.S. should mandate less frequent donations to protect the safety of donors. The U.S. should also require plasma companies to cover medical expenses of donors should they suffer adverse effects.

So, will I say “I do” to plasma donation? Probably not, but with better regulations, maybe I’ll consider a first date.

Caroline S. Beit is a research coordinator at Baylor College of Medicine’s Medical Ethics and Health Policy Center and will begin medical school next year.

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  1. In the US, it is currently illegal to provide monetary incentives to donors for solid organs such as kidneys, livers, hearts and lungs, but the controversial dialogue continues as to whether or not donors should be paid for these organs. This article, although referencing plasma donation, provides a glimpse into how easily these same problems could transfer into the realm of solid organ transplantation, were compensation to be permitted. With the existence of sophisticated marketing practices, the ability to reach more vulnerable populations and lure them with money without informing them of the risks of organ donation can send them down a tempting rabbit hole without the proper protections in place. And the double financial whammy of losing Medicaid coverage due to the increased taxable income earned by selling the organ and the associated tax burden could quickly become financially and medically unsustainable for the donor. The frequency of plasma donation allowed in the US is suspicious in nature, with claims of harm to both the donor and the recipient. What is driving this need for such frequent donations? The US is the greatest exporter of plasma. What is it charging other countries? How are recipients in other countries faring when receiving less-than-optimal plasma due to frequent donors as the source, those who are eager to accrue additional income through multiple donations. While there is little possibility of ‘multiple donations’ with solid organs, would the promise of compensation potentially lead to a large increase of sub-optimal organs on the market? Would the stringent regulations that provide protections to both donors and donees become lax as the commercial market for organs picks up and supply levels approach those of demand? Would the transplant centers, which currently have to maintain such high thresholds of successful outcomes in order to stay in business, have greater access to funding once this charitable practice turns capitalistic? Also, potential low-income donors could make unethical claims about the health of their organs, placing themselves and the recipient in grave danger.
    As plasma is more readily obtained and available, with relatively minimal risk, perhaps it makes sense that it can be bought and sold in a dynamic market place. Even there, we can see that the benefits versus harms must be reassessed. This industry, however, provides us with a helpful lens with which to gauge the merits and/or detriments of shifting solid organ transplantation into a financially-driven institution. Attention must be paid.

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