“Foreigner.” I find it a harsh word that I hate seeing applied to others. Yet applied to myself, it’s the only word that half conveys how baffling I find this country at times. I’d like to apologise ahead of this article, for I will be telling you some things you already know.
The first time that I ceded reason and dear sense to this country was during my fourth week experiencing pneumonia, at a point where my body could no longer stay awake during the day. I’d finally managed to see a doctor, a miracle to even make it; you couldn’t imagine my horror when I realised that I wouldn’t be given medication if I couldn’t pay for it. I don’t know if Americans themselves are still struck by the insidious price of keeping healthy and alive, or if it just blends in as a feature of the reality you’ve grown up with. This provokes my apology for what you all know and are used to. There’s been little to gain from shock or horror at a reality that is now mine too.
I have since become a little more desensitized to the price of being alive in America. But walking back to my dorm, I didn’t feel like one of the “lucky ones” because my insurance had taken a $200 prescription down to $30, for half of what I needed to recover. I only thought of whether or not I’d make it back to my dorm, and that I wouldn’t have been able to wake up the next day had I not had that $30 on me.
Now let’s discuss plasma. There has been a recent rise in companies compensating donors for their plasma. In RI, CSL Plasma and Grifols each have multiple locations, and more options are available over the border in Mass.
A Grifols donor makes around $50 a donation; enough to cover three doses of paracetamol a day, on top of prescribed pneumonia medication (for me, at least). Another fifty dollars could cover a brief grocery run, maybe some gas, maybe a few new clothes. Maybe it could treat you to a light dinner out; maybe it’s been a while.
A study conducted by James and Cameron Mustard in 2004 found that commercial plasma centres were overrepresented in neighbourhoods with households where average incomes are often below half the poverty threshold, where regular, untaxed stipends of $50 or $100 dollars could be the difference between a month’s heating or cold. In the absence of data about the donors themselves, a look into who has the most proximity to and opportunity for plasma donation indicates what commercial plasma companies are appealing to: desperation.
The process of donating sucks. I tried it myself; it completely sucks. I have never had a needle so large injected in me, I have never experienced such a painful needle for so long. Never once have I experienced a needle vibrating inside me indicating some sort of bodily failure on my part, as though a sports coach telling me that I’m not performing well enough. It’s oddly violating to experience performance criticism through a vibration in your pained vein like an alert on your phone. It’s even more aggravating after the third time when, figuratively and literally drained, you might just not be good enough. And if you’re not good enough, then you cannot finish your donation and receive the full amount of money. What ensues is an infuriating battle with your body against your body to keep it performing against… its will? And of course, surely, if your body cannot keep up then you should stop, both for safety and general decency, as long as you could accept $22.50 instead of $45. A significant difference after your travel time spent, physicality given, and fatigue accepted. The participation award might not be worth the race, you might just keep pumping your fist and praying that the machine doesn’t stop again.
“No one’s here because they want to be. This is the first thing that you give up,” I was told by a young woman who had been on the bed opposite me. When I saw her having her vitals checked, I’d noticed how she’d hidden her bag on the scale to pass the weight threshold. Her hematocrit had been 38. She’d just made it. This was my second biweekly donation for the third week in a row. A general, constant exhaustion had been catching up to me for weeks now. When my hematocrit was 38 and I was accepted, with piteous looks and advice to eat spinach, I was surprised by how quickly my body had withered.
It’s unusual to see young adults and even more so to see young women. I’m sure that the young woman I’d seen had been met with much of the same surprise that I had: the shock at your age, the pity for why you must be here so young, the pity that you are. From the staff to the people beside you in the same situation, there’s this sense as a young woman that you’re not supposed to be there, you shouldn’t be doing this. But that’s the irony isn’t it? Nobody should be doing it. People should be donating plasma because they want to be, not because it’s crucial to their financial wellbeing, and yet as a young woman, your regularity stokes this perception of injustice, that something is wrong if you’re there. The myth of the completely voluntary donor unravels itself with introspection. The people there don’t believe it themselves.
You’re told ahead of time that you might faint, your body might ache, you might bruise, you will scar. Depending on your centre, you accept that the staff injecting you may be unlicensed. You sign liability for any accident that might occur, whether it’s an allergic reaction or a missed needle striking your artery instead. These aren’t deterrents to people whose primary sources of income cannot afford the ever-rising cost of living.
This is not to say that people cannot or do not donate plasma out of desire, or that donors who are financially incentivised do not feel any goodwill. The centre locations and in effect, business model of plasma centres, reflect that this isn’t the primary motivator for plasma donation in the US. A range of ethnographic research and journalistic accounts suggest that the key, motivating factor for plasma donation is monetary compensation. Looking into the census tracts in which donation centres are placed further evidences the intentionality of the businesses.
A study conducted by the University of Michigan in 2021 found that census tracts with higher levels of individuals just above the poverty line, as well as higher levels of individuals in poverty and deep poverty, were most likely to have a plasma center. They found that the rate of residents between 50 and 100% of poverty was 51% higher in tracts with a plasma center than in tracts without plasma centers. These factors are not a result of the existence of the plasma donation centres, but rather the intentionality on the part of the businesses of choosing areas with lower economic mobility and support to place their centres. It isn’t random that donation centres pop up in deprived areas, it’s a business model. And tomorrow, if the average donor no longer needed the money, these companies would go out of business.
The first time that I’d donated, they were offering $125 dollars on your first four donations. I donated because I wanted 500 dollars.
Perhaps it’s that the labour that I’m paid for is the capacity of my own body. I don’t know exactly what, but something muddy and blurred evokes this sort of shame and concealment about the whole ordeal. I keep returning to the smiling posters and Arial-font quotes. I’m doing a good deed, why do I feel bad about it? The idea is that anyone should donate for an extra buck, and yet a college student in a cashmere trench coat stands out and wonders if she looks like the asshole she feels like. It felt wrong to choose to be there and to choose to subject myself to a horrible experience when other people were there because it was their only option. Yay spring break, yay clothes. “No one comes here because they want to,” replays over and over in my mind.
A study conducted in Spain (where paying for plasma is not legal – only five countries, including the US, currently allow pay-for-plasma. In other countries, it is strictly an act of volunteerism) in 1989, showed that, in order to give, voluntary donors required the certainty that their blood would not become merchandise. This addresses the risk that voluntary donors could feel less encouraged to donate plasma, seeing their contribution as not only less necessary, but also commercial, rather than altruistic. Despite being a Spanish company, Grifols’ business model defies Spain’s Catholic-influenced ethos towards donation. In Spain, blood is seen as a “special gift” to be held responsible by the community, rather than to be exchanged for money or goods. An employee can take time off work to donate, and it would be their employer’s responsibility to fill in the gap made by their absence, recognising their labour in contributing to the community.
Comparatively, in their essay, “The Market For Blood,” Robert, Wang, and Garbarino explore the sense of shame regarding donation that I couldn’t quite put a name to. They discussed how another form of exploitation for donors can be the “repugnant” idea of being paid for plasma donation, as if some lower form of physically selling yourself. This stigma, shame, and embarrassment around it doubly applies to a more desperate crowd that needs the money, regardless of this feeling. The perception of donation being reserved for the poor and vulnerable can devalue it in the eyes of many people, seeing it solely as means to quick compensation rather than also a lifesaving contribution. Plasma donation’s association with the poorest citizens can put a lot of people off, thinking that their contribution either wouldn’t be necessary or that it is not something which anyone could do.
Pablo Rodriguez del Pozo, a professor of medical ethics at Cornell (and formerly in Spain), says: “The ethical conflict arises only when lower socio-economic groups, out of urgent financial need, give blood in exchange for low sums of money, or when they unknowingly or even knowingly jeopardize their health. These groups are exploited if, under different financial circumstances or with full information, they would have refused to donate.”
This can be most clearly seen through the strategic placement of Grifols’ centres in Texas along the Mexican border. In 2021, US Customs and Border Protection enforced a policy that disallowed Mexicans entering the USA on day-visas from donating plasma in exchange for money, arguing that Grifols were reliant on exploiting low-income Mexicans in border towns. Exploitation, or a smart business model? Both. What’s worse in this case is that the average American donor at least feeds into a system that could one day benefit them, should they need it. The Mexican donor supplies their plasma to a medical system that will never feed back into their lives, and to a country that shows little respect to them.
Of course, all plasma is marked up and sold for far more than the donor receives. As with anything, the full value of one’s product and labour is decided through the business’ profit incentive, which is exploitation in itself. Grifols, and other plasma donation companies, are businesses first and foremost that aim to cut costs and maximise profits above all else, changing the value of your plasma with it. It’s a trusty model, because there will always be someone who needs it. Last year, your plasma was worth $55, this year they know that you’ll accept $45.
This is the crux of any capitalistic industry, yet it feels far more sinister when the exploitation is against people who will never have the chance to benefit from it. Federal Judge Tanya Chutkan, who overturned the Texas ruling, said that CBP officials had “failed to consider” the extent to which blood plasma companies were relying on Mexican donors. “A person is more than just a shopping cart of biological products to be bought and sold at a later date,” she’d said. I struggle to understand how her metaphor actually humanizes these Mexican plasma donors in tandem with her ruling. She said that her decision to grant a preliminary injunction reflected the crucial need for blood plasma in manufacturing lifesaving medications. I believe that, and I also believe that these Mexican citizens are not spending their free time driving across dangerous border crossings biweekly out of a desire to support American communities. Considering del Pozo’s criteria, relying on Mexican citizens who would not donate with more financial freedom and ability, is exploitation.
This highlights a fundamental separation of class when you consider that the poorest, and most vulnerable people are debilitating themselves for money, and that the people benefitting are the rich companies that are targeting them, and people, perhaps unfortunate, who are more likely to be able to afford health care than the average donor. Should we put our hands up and say, well the donors are getting a good deal too? Exploitation is exploitation, it’s not more or less acceptable for any group of people because they don’t have other options.
This was the leading argument when Grifols planned to open the first paid-plasma centre in Canada, finding more opposition as Canada has universal healthcare, and has previously not authorised commercial donation. Natalie Mehra, executive director of the Ontario Health Coalition, said at a protest against the opening, that blood is a critical part of the human body and that body parts should not be bought and sold for profit. JP Hornick, president of OPSEU, which represents Canadian Blood Services workers, had said that using the human body for profit preys upon the vulnerable, who may feel the need to sell body products to survive.
Though this sentiment, like Judge Chutkan’s, criticizes the commercialisation of the human body and its reduction to body parts, they come to different conclusions. How can it be that both quotes criticise the same thing and yet divert completely in conclusion? Or better yet, is it naive to see no commercial value in the human body? Our time is valued, our mental energy is valued, our physical capacity is valued in manual work. How does one value our plasma as a transmission of labour and resource? If I hadn’t been compensated, my plasma would’ve still been used to the same ends. Does the donor being paid make the transmission fairer?
An answer to those questions would need to evaluate different forms of compensation. In Europe, where there is no paid compensation for the most part, one may only derive satisfaction from their donation, but at the same time there is no pressure on low income people to subject themselves to the unpleasantness of donation as a way out of financial difficulty. Whether or not other options are found, nothing else being available should be a critique of a system that has left vulnerable people with no means out of their situation, rather than an endorsement of an exploitative option.
Del Pozo makes a crucial point: that even in an all volunteer donor system, someone still has to pay for the blood. Importing plasma from around the world means dealing with an entirely new fabric of regulations regarding the collection of that blood. He states that, “The moral misgivings surrounding paid donors, particularly the possible exploitation of the destitute, are transferred across national borders but by no means resolved.”
In an entirely commercial healthcare system, like the USA’s, it becomes difficult to ask for the goodwill of people to exhaust themselves for free when they’d have to pay themselves if the same system ever met them on the other side. However, one could also argue that the amount of plasma donation it would take to equate the cost of a healthcare procedure that would require it, would never balance out.
It is completely true though, that all-volunteer systems still have blood on their hands through importing from other countries where plasma is commercially collected. Grifols attributes their closure of 29 centres across the United States to “[enhancing] productivity per center, improve plasma collection efficiency and overall yield across the network,” which conveniently coincides with approval from the European Medicines Agency to use less expensive plasma from Egypt, reducing reliance on US plasma.
Perhaps everything becomes messy when you look too close. The closing of select Grifols’ centres across the United States removes an unpleasant financial incentive, but also a reliable source of income for many people. Desperation doesn’t disappear and money at physical cost is still money = money that now fewer people across America have access to.
Note: Not all donors suffer the same negative effects, and compensation varies significantly at different donation centers, in different states, and often for different donors.