Weekend Reads | Blood Money

by Kevin Schofield

This weekend's read looks at a side hustle that might be more common than you think: getting paid to donate blood plasma.

Plasma donation involves going to a donation center and being hooked up to a machine for up to two hours. The machine separates and extracts plasma from your blood while returning the other components, including red blood cells and platelets, to your body. Because our bodies regenerate plasma quickly (faster than red blood cells), one can donate plasma up to twice a week. And while some organizations, such as Bloodworks Northwest and the American Red Cross, do not pay donors for their plasma, there are several for-profit pharmaceutical companies that run chains of plasma-donation centers that do: on average about $50 per donation, and up to $200 when there is a critical shortage of plasma supply.

Plasma is used by pharma companies to create lifesaving medicinal treatments for several diseases. Many of those patients need regular, ongoing plasma treatments, most likely for the rest of their lives. Over the past decade, the plasma-related collection and treatment business has grown dramatically: In 2019, over 53 million donations were collected. The value of the treatments was estimated at over $26 billion in 2021, and it is expected to grow to $60 billion by 2032.

One of the reasons why it's such a big business here is because the United States supplies the majority of plasma for medical treatments to the rest of the world — including 80% of Canada's. This is in large part because the U.S. allows donors to be compensated, while most countries do not. The World Health Organization explicitly discourages countries from allowing compensation for the donation of "human materials" such as plasma out of concern that the money will create an environment where low-income persons are exploited because of their financial stresses. And as this weekend's read explains, what is happening in the United States lends credence to that concern. It's a paper by researchers at Washington University and the University of Colorado, Boulder, analyzing the financial status of those who donate plasma in the United States.

Who donates plasma? According to surveys, donors are more likely to be:

• Individuals with income under $20,000 per year.
• Individuals under age 35.
• Individuals with children.
• Individuals who identify as Black.

When asked why they donate, 64% of donors said their primary reason was to cover emergency or day-to-day expenses. So why do they choose plasma donation instead of a "gig" job like driving for Uber or DoorDash? According to the researchers, plasma donors are twice as likely to say that gig work is too costly to enter: For instance, they don't have a reliable car or other means of transportation that would be required to do gig work.

As it turns out, plasma donors have very similar demographics to "payday loan" customers — and here is where the researchers' analysis gets very thought-provoking. In fact, payday loan centers and plasma donation centers tend to target the same neighborhoods: low-income areas with plenty of people experiencing either short-term or chronic financial pressures. And the researchers discovered that plasma donation is often a substitute for high-interest payday loans: When a plasma center opens up in a neighborhood, the likelihood of an individual taking out a payday loan declines by 18%.

Payday loans can often be debt traps: With annual interest rates up to 400%, the interest and fees associated with them can often be much more than the amount borrowed — especially if the loans are renewed, as they commonly are (80% of payday loans are renewed, and half are in a sequence at least 10 loans long). The researchers do the math for us: an average two-week payday loan, $304 at 400% interest, that is renewed 10 times. After 20 weeks, the borrower owes $1,272, which includes $967 in interest and fees. Contrast that with donating plasma and getting paid $300: you are debt-free and you save $967 in interest and fees. For people in economic distress, donating plasma is clearly a better financial outcome than taking out a payday loan.

Plus, the researchers point out, the money the donors receive largely goes toward consumption, plowed back into the local economy, rather than into loan fees and interest. To back this up, they note that after a plasma center opens up in a neighborhood, foot traffic to local businesses increases.

So there seems to be a strong argument that donating plasma is a much better alternative to high-interest payday loans that can land someone in an inescapable debt trap. It's better for the individual, and it's probably better for the local economy. But there are some big caveats to that. The World Health Organization's concern seems to hold true: the plasma industry very much targets low income communities as a source of human materials. Whether doing so "exploits" them depends on whether donating is voluntary or a result of donors' financial desperation, and on whether the compensation is a "fair deal" for the donors.

And to understand whether it's a fair deal, we also need to understand what the long-term health effects are for someone donating plasma up to twice a week. Unlike organ donation, plasma seems to be "renewable": Our bodies make more of it, quickly, but can we do that indefinitely without doing harm to our bodies or our health? The researchers note that at this time we simply don't know: The question hasn't been studied in-depth, which is strange given how many people donate plasma regularly. Though perhaps it's not so strange, given that the people who donate frequently are often those who are underrepresented by our political systems (and our public health infrastructure).

In most countries that do not allow compensation for plasma donations, there are not enough plasma donations to satisfy the domestic demand for health care treatments. Because of that, the United States provides much of the world's supply of plasma. So, as the researchers say, "a subset of predominantly low-income adults in the U.S. — under 1% of the world's population — are providing the majority of the world's plasma supply."

This raises serious issues of medical ethics. In a close-up view, this system of plasma donation to supplement one's income has significant advantages over payday loans. It's better than the current alternative, but that doesn't mean it's good; it might just be the lesser of two evils. If we zoom out, it's clear that the greater injustice is the social, political, and economic system that keeps poor people poor. Donating plasma twice a week — assuming it doesn't compromise long-term health — can provide essential supplemental income, but it's not a living wage. The researchers observe that four companies — all owned by global for-profit pharmaceutical companies — operate 85% of the plasma centers in the United States. Those companies have some perverse incentives to maintain the status quo: the U.S.'s lax rules on compensation for plasma donations; other countries' tighter rules that create a global demand for American plasma products; and a population of low-income Americans, disproportionately People of Color, who regularly experience financial distress. It's deeply unsettling — though not at all surprising — that a system like this exists that makes things marginally better for low-income individuals, earns billions of dollars for multinational corporations, and not only does nothing to relieve but ultimately relies upon the economic inequities in our society.

Blood Money: Selling Plasma to Avoid High-Interest Loans

Featured image via SeventyFour/Shutterstock.com.