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onating plasma and donating blood are essentially the same process: the entry questionnaire, getting hooked up to a machine, the cookie afterward. But in the US there’s a key difference: one is an act of charity, and the other an act of commerce. So why is it that you get paid to donate plasma, but not blood?

It’s a common misconception that the Food and Drug Administration bans paying for blood. In fact, it only says blood from paid donors has to be labeled that way. But hospitals won’t use it. In practice, nobody really pays for blood, said Mario Macis, an economist at the Johns Hopkins Carey Business School who has studied incentives for blood donation. “Even though it’s legal, it’s still considered not totally moral or ethical to pay cash to blood donors.”

Aside from the ickiness of handing out literal blood money, the FDA worries that paying donors would jeopardize the safety of the blood supply. No one with a blood-borne illness is eligible to donate, but the agency worries that if money were on the line, donors might lie about their health or their risk behaviors.

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The science there is far from settled. But the World Health Organization finds it convincing enough that they discourage countries from paying blood donors. “Evidence shows significantly lower prevalence of transfusion-transmissible infections among voluntary nonremunerated donors than among other types of donors,” their commentary in 2013 read.

Donated blood is tested for diseases, anyway, but the FDA says it intends those steps to be redundant security measures, “like layers of an onion.”

Plasma donation — in which blood is drawn, plasma separated out, and then blood cells and other components put back into you — is often compensated. The FDA doesn’t require paid plasma donations to be labeled. The reason is that plasma collected this way never goes straight into another person. It’s broken into many different protein products that will become pharmaceuticals. Along the way, these components are processed to remove or kill any virus stowaways. “The risk of infection is inherently much lower,” said Dr. Christopher Stowell, who recently chaired the FDA’s Blood Products Advisory Committee. Whole red blood cells are too fragile to undergo the same kind of processing as plasma.

And there’s some evidence that paying for plasma does, indeed, lead more people to conceal their disease status or risk behaviors. For instance, the Government Accountability Office looked at California’s blood versus plasma supply back in the 1990s and found that the plasma had much higher rates of HIV. There are reports of desperate donors lying about illnesses to donate for cash.

However, the type of compensation matters. In a 2013 Science paper, Macis and others found that rewards such as gift cards, coupons, and T-shirts almost always boosted donations, and they didn’t find any effects on blood safety. (The FDA doesn’t count rewards like this as payment, as long as they can’t be easily turned into cash.) “Nonmonetary incentives do work,” Macis said. He thinks using more of these motivators could help the United States manage seasonal blood shortages.

Were you hoping for more than a T-shirt? Don’t even think about selling a kidney. The National Organ Transplant Act of 1984 made it illegal to pay for organs. But in the 2011 case Flynn v. Holder, the US Court of Appeals for the Ninth Circuit ruled that a certain method of bone marrow donation could be compensated.

Traditionally, bone marrow was collected in a surgical procedure, with a hollow needle stuck straight into the pelvis. But in a more common method called peripheral blood stem cell apheresis, donors take drugs that release the stem cells from their marrow into their blood. Then they donate the cells through a needle in the arm and an apheresis machine — just like a plasma donation.

Centers that collect such cells pay up to $800, but they haven’t seen that much interest, the AP recently wrote. And the cells can’t be processed like plasma, so it’s unclear what the risk might be from paying donors in this nascent market.

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  • I generally agree with comments about concern over the unbalanced compensation, but when you’re paying “full price” to receive blood, part of what you’re paying for is the expensive testing the blood had to undergo, the special storage and transport, and the careers that require special training to be able to collect, test, and administer the blood. The difference is it’s free and requires no training for any body to make blood but to safely transfuse it costs a body lot more in terms of finances to get the special training/education.

  • I don’t get it. Did the commenters not read the article?

    NO ONE PAYS YOU FOR BLOOD DONATION!
    -They want your blood for FREE. Then, when someone else needs it, they charge them FULL-PRICE for blood they received for free!

    This is what is wrong with society. Learn to read, live a good life, skip school, well, than you’ve got financial troubles.

  • I used to donate blood all the time and so did my family.(we have 0-). I was in a accident and needed blood,they charged me full price even though my family donated for me. The only people that expect you to donate are the ones who make money off of it or the ones who scam others and donate to make them feel like they are doing something good, like the people that Bully people all week then go to church on Sunday thinking it makes it all OK.

    • I totally agree. Everybody makes money from the phlebotomist to the hospital, but not the guy whose blood it is. I kinda understand the theory but ya want my blood ya gotta pay. When everybody along the money trail donates their time I will donate mine. I understand they give you a debit card that even the bank makes money on by charging for the transactions.

  • I’m unemployed right now but babysit for others who can’t afford daycare. I am looking for ways to help me financially without leaving the people I help in a mess. Can you please send me some information in the Houston area. Thank you

  • I have a very bad financial situation I like to donate my blood for money so I can buy food for my kids,can you send me more information and prices please

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