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Ryan Meili is an expert advisor with EvidenceNetwork.ca, assistant professor in the Department of Community Health and Epidemiology at the College of Medicine, University of Saskatchewan, and a family doctor. @ryanmeili

Monika Dutt is the Medical Officer of Health for Cape Breton District Health Authority a and chair of Canadian Doctors for Medicare. @Monika_Dutt

In the early 1980s, more than 2,000 Canadians who received blood transfusions were infected with HIV and as many as 30,000 contracted Hepatitis C. This tragic scandal, and the Krever Inquiry that followed, resulted in the overhaul of our blood donation system to ensure the safety of any blood products. This made Canada one of the safest countries for blood transfusion in the world.

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Among the recommendations from Justice Horace Krever was that Canada should not pay donors for blood or plasma, except in rare circumstances. This is in line with the World Health Organization's recommendation that all governments should strive for the safest process: using unpaid, voluntary blood and plasma donors.

Unfortunately, we are moving towards doing exactly that in Canada: paying cash for blood products.

In recent months, a private, for-profit company called Canadian Plasma Resources (CPR) has announced its intention to begin paying donors for plasma. They've opened three clinics in Ontario and begun to collect plasma, despite new legislation introduced by the Ontario government to prevent paid blood product donation.

How is this possible? Despite being urged by several medical organizations to deny regulatory approval of CPR and halt the sale of blood, Federal Minister of Health Rona Ambrose has remained silent on the issue. In the meantime, the company has simply moved forward with operations in the absence of federal regulation and despite provincial disapproval.

The ethical concerns around paying donors are significant. Those who tend to donate blood products for payment are often the poorest citizens, a fact underlined by the establishment of CPR's clinics in impoverished neighbourhoods. Should we really be allowing a company to take advantage of social inequalities for profit, and in the process overturn long-standing evidence-based policies around safe use of blood products?

During his tenure as president of the International Federation of Blood Donor Organizations, Niels Mikkelsen cautioned that ministries of health, blood centres and voluntary donor associations must "continuously monitor the implementation of the blood legislation closely." Failing to do so, he warned, would result in nothing less than a disaster. Such a policy failure is precisely what CPR's operation represents.

The threat that paid blood donations pose to our healthcare system extends beyond questions of safe collection and processing. Dr. Neelam Dhingra of the World Health Organization contends that blood donation by voluntary unpaid donors is the "cornerstone of an adequate and safe blood supply." Why? For two reasons.

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Firstly, WHO research has found that unpaid volunteers provide the safest blood donations. Among donors, this group consistently has the lowest prevalence of blood borne infections. Secondly, reliance on unpaid donations also plays a critical role in maintaining the supply of blood products. The WHO cautions that when a country permits paid blood donations, the number of voluntary donors actually decreases, threatening supply.

Allowing CPR to operate with its paid donation model would be a distinct change from Canada's voluntary blood donation system, posing significant ethical, safety and public health concerns.

All of which makes it difficult to understand why the federal government continues to hold out the prospect of granting CPR a licence. Health Minister Rona Ambrose and Health Canada should heed the advice of international experts, the Governments of Ontario and Quebec, and the landmark Krever report and move quickly to deny companies the opportunity to pay for plasma.

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