Canadian Plasma Resources, having failed miserably with its plan to pay plasma donors in Toronto, has now set up shop in Saskatoon.
Why Saskatchewan – or any other province, for that matter – would align itself with a company that has a controversial history and business plan is odd, especially given Canada's painful history with tainted blood.
And it is doubly puzzling because the provinces own Canadian Blood Services (CBS), the not-for-profit agency that collects blood and plasma (from volunteer, non-remunerated donors) in Canada, and whose efforts are undermined by the private company's tactics. It's as if the right hand doesn't know what the left hand is doing.
Regardless, the festering presence of Canadian Plasma Resources has forced us to come to grips with the pros and cons of paid plasma. The Krever Inquiry – an exhaustive examination of the debacle that left more than 30,000 Canadians infected with HIV-AIDS and hepatitis C from tainted blood and blood products – said that donors should not be paid, "except in rare circumstances."
The World Health Organization also says countries should aspire to 100-per-cent voluntary blood and plasma donations by 2020. But the stark reality is that blood (and plasma in particular) is a big and profitable business with an expanding market.
In Canada, we collect all the blood and plasma we need, but we purchase virtually all our blood products – more than $600-million a year – and the vast majority are made with the plasma of paid U.S. donors.
Ethically, the notion of paying for bodily fluids and body parts makes us uncomfortable. In Canada, we have banned the sale of sperm, eggs and organs, in large part due to fears the poor and vulnerable could be exploited. But only two provinces, Quebec and Ontario, have banned the sale of blood and plasma.
There is also a safety issue. While there is evidence that paying for blood attracts higher-risk donors, it doesn't necessarily mean the end product is less safe – even if companies such as Canadian Plasma Resources set-up shop next door to homeless shelters.
In the bad old days of the 1970s and 80s, blood and plasma was collected on skid rows, in prisons and in the slums of Haiti, and there was very little screening and testing, all of which contributed to the deadly legacy of tainted blood. But one of the biggest contributing factors to the unfettered use of tainted blood was the jingoistic (and utterly false) belief that donations from volunteer, non-remunerated, red-blooded Canadian donors were magically free of pathogens.
Today, screening of donors, paid and unpaid, is much more rigorous, and testing is more sophisticated and accurate. As a result, there hasn't been a single case of a blood-borne infection from blood products in 25 years. So let's be careful to avoid the simplistic meme that paid blood is unsafe blood.
Regardless of source, it's important to ensure the safety and security of supply for patients who need blood and blood products. Currently, CBS collects about 200,000 litres of plasma annually. That is enough to produce only about 22 per cent of blood products such as intravenous immunoglobulin, which is used to treat a growing number of immune disorders. That product is purchased from the United States and Switzerland.
Currently, there are no manufacturers of blood products in Canada. However, both Green Cross Biotherapeutics and Therapure Biopharma are getting into the business. Within five years, CBS hopes to increase collection markedly to about 500,000 litres a year, with the use of dedicated plasma collection centres. But CBS has no plans to pay donors, other than the traditional cookies and juice. Nor does it plan to buy plasma from other providers, such as Canadian Plasma Resources.
In fact, what Canadian Plasma Resources plans to do with the plasma it has collected is unclear as it does not have license from the U.S. Food and Drug Administration, which means it essentially can't sell its plasma in the United States. What is clear, however, is that there is a lot of action in the blood business; as opportunities arise, we must be careful to not repeat the errors at the root of the tainted-blood debacle. What policy makers need to do now is come up with a clear, coherent position on issues such as paying for plasma and domestic production of blood products rather than grasping at every shiny bauble that comes along.