The Boxer (Musings on lies & jests in the blood industry)

Updated: 23 Oct. 2016

This blog, takes its theme from items in October's 'New on TraQ' and posts on my @transfusionnews Twitter account.

The title is from a 1969 ditty by Simon and Garfunkel.

For readers who choose not to read the full blog and to peak your curiosity, here is the executive version. The blog focuses on blood donor plasma, but not in the usual way I've blogged about plasma in the past. October's blog aims to

• Showcase hypocrisy in the USA's not-for-profit blood industry, specifically the approach of community blood centers to blood donation;
• Stimulate you to think about how your country's blood donor system operates and why national differences exist;
• Interest you in reading at least the 'juicier tidbits' in Canadian Blood Services' 2015-16 Annual Report.

PLASMA DONATION in USA
In the USA you can donate plasma twice a week. The FDA allows 2 donations within a 7-day period, with at least 2 days between donations.

The main ways to donate plasma include

• Commercial paid-plasma centers like  Biotest, CSL, Grifols (Canadian Blood Services plasma protein products supplier), OctaPharma, and more. 
• They tell donors they are saving lives as opposed to admitting, 'We're exploiting you poor folks who need extra cash so we can make mega-bucks'.
• 600 America's Blood Centers (ABC), who collect nearly 50% of the blood supply, of which the sole non-US member is Canada's Héma-Québec (where paying for plasma is illegal);
• American Red Cross (ARC), which collects and processes about 40% of the USA's blood supply.

So far as I can tell (please correct me if I'm wrong), plasma collection in the USA is roughly as follows:

1. Paid-plasma centers offer donors varying amounts of money, but not directly (no direct cash payments, which might make it seem like 'filthy lucre' for selling a body tissue). 

Payment is via a card similar to a debit card. And some have cutesy loyalty programs. Examples:

• Australia's CSL (prepaid Visa debit card and iGive Rewards)
• Biolife (No loyalty program, prepaid Visa debit card)
• Grifols (No loyalty program, prepaid Visa debit card)
• OctaPharma (Visa debit card and OPI Rewards)
• See Plasma Donation FAQ

2. ABC non-profit community blood centers like Blood Centers of the Pacific stress that volunteer blood donors provide a safer blood supply. 

Unsaid is that volunteers are safer than paid donors only for blood components such as red cells, platelets, and plasma (not plasma protein products, which, besides donor screening and testing, undergo many steps to make them safer, e.g., plasma quarantine, technology to inactivate viruses, and purification steps).  At least that's the theory based on evidence to date.

But all such centers offer an incredible amount of what they call 'swag' (products given away free, typically for promotional purposes). For example, Blood Centers of the Pacific's 'swag' for donating plasma. 

So what can Hero Reward Points get you? Quite a bit (and they apply to all donation types, not just plasma).

• For example 1,600 Points for your first plasma donation earns a $25 Shopping eGift Card. 
• Each successive donation earns 600 points. At two/week potential earnings can amount to 4800 pts/month or three $25 eGift cards. 

Admittedly $75/mth doesn't compare to the money donors could earn at paid-plasma centers. But donating is not exactly unpaid as it is in many countries.

3. American Red Cross offers a true voluntary blood donor system. No money or similar for donating red cells, plasma, platelets, whatever.

PLASMA DONATION in CANADA
When you donate plasma in Canada at CBS or H-Q  you get what all voluntary blood donors get. 

In Edmonton, that's 'Cookies by George' and maybe some juice. And I mean to munch away on, post-donation, and on-site.

CBS's 2015-16 ANNUAL REPORT
So how does CBS's Annual Report (begin on p. 39) fit with this blog's theme of donating plasma for payment (no matter how defined) vs donating voluntarily?

First, consider that the plasma protein product market, including intravenous immune globulin (IVIG), stood at US$18.5b in 2015 and will continue to grow.

CBS reports that from 2013-14 to 2015-16 Plasma Protein Products (PPP)  (bought in $US) increased from $459,120,000 (45% of total costs) to $623,198,000 (53% of total costs), an increase of 36%. 

Besides IVIG utilization, the exchange rate affected CBS's PPP costs, because the CDN$ decreased 29% v $US during this time. In Jan 2013 Canada's dollar vs USA dollar was $1.01 vs 0.72 cents in Jan. 2016.

For 2016-17 CBS is trying to mitigate being captive to the exchange rate with the US$ by using a forward currency contract with its PPP supplier, Grifols.

LEARNING POINTS
1. Are USA's non-profit centers hypocritical in saying they offer a voluntary blood donor system? As a Canadian, I find the USA's debit card and cutesy loyalty programs cringeworthy. You decide.

2. By relying on the USA's paid plasma system for most of its plasma protein products like IVIG, CBS is captive to the exchange rate with the US dollar. Why doesn't CBS challenge Canadians to donate more plasma?

CBS makes decisions assuming outsourcing is always cheaper. And it often is in the short-term. But in the long-term, who knows? Plus, relying so heavily on poorer Americans who donate a body tissue (plasma) for money is not admirable, especially when you give up on promoting voluntary plasma donation to Canadians because it costs more. See

• Blood collection in Thunder Bay too costly, CBS official says (27 Mar. 2015)
• While my guitar gently weeps (8 Apr. 2012) 
• Broken links are now fixed.

CBS leaders have decided that Canadians cannot donate anywhere near enough plasma without even trying to challenge us.

3. CBS: How about challenging Canadians to donate plasma by being transparent (something you tout post-Krever) about the grim facts of what relying on USA's paid plasma costs tax payers?

Give young Canadian donors, those in community colleges, technical institutes universities, the chance to be voluntary plasma-donating heroes. Give long-standing oldster donors a chance to shine.

Don't cave and assume sufficient plasma donation in Canada is an impossible task, without even trying. Give our youngsters and oldsters a chance to prove you wrong. Or at least to increase plasma donation significantly. If a donate-plasma campaign falls short, so be it.

You haven't even tried, CBS. Despite all your 'leading edge' innovation rhetoric, you lack a vision for Canadian blood donors being special.

FOR FUN
To me Simon and Garfunkel's 'The Boxer' lyrics resonate with this blog.

• The Boxer (Simon and Garfunkel, Live in NYC Central Park, 1981)

Such are promises
All lies and jest
Still, a man hears what he wants to hear
And disregards the rest.

As always, comments are most welcome.

FURTHER READING

The twisted business of donating plasma (28 May 2014)

All about blood banks.  A multibillion-dollar business in a nonprofit world (1991)