Donating 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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  • The reason they don’t pay for blood is because they don’t want people donating blood for the wrong reasons. Seriously, you didn’t know this? In Australia no one gets paid for blood or plasma. It’s the same in all civilized countries. Thank you and happy New year.

    • Kevin,
      you seem very full of yourself. The USA is the “civilized world” that’s why if you need complicated surgical or medical procedures done the best place in the world to come is here. the profit motive has fueled more research, and technological advances than all of your tired taxpayer financed single payer systems put together. that is why when I travel abroad UK, Canada, Germany etc. the people I speak to always say not to fall ill while traveling in their country because you may not get to see a doctor before complications arise and or death occurs. I don’t make this up that is what I am told. Here if I am sick I can see a doctor within hours sometimes quicker. I too have had multiple surgeries but have never had a need for a transfusion. so stick to your side of the border and keep your “civilized” opinions to yourself. because the insinuation that this bastion of free enterprise we citizens of the USA cherish is uncivilized is NOT lost on me.

    • Paul it’s not an insinuation. It’s a statement of the bleeding obvious. The best cancer treatment in the world is in Switzerland by the way. And the best neurosurgeons are in Australia. The US has the WORST costs and the WORST outcomes for basic procedures in the western world. The second major cause of death in the US is medical mistakes. Feel great if you like. It won’t help if you get sick.

    • No one cares about reasons. It is about safety and donor prevalence. Like the article says, people are less likely to donate blood if people are paying for it, and people who are ineligible to donate blood will not attempt blood donation if there is no payment for doing so.

      No one cares “where your hearth is”. Decisions are made to save money and lives.

  • It’s b.s they don’t wanna pay you for it but a trip to the doctor for breathing problem for an inhaler 1300$ plus 75$ for the generic inhaler it’s crap.

  • “Even though it’s legal, it’s still considered not totally moral or ethical to pay cash to blood donors.”

    This “culture” is why I don’t give blood. BS statements like that while they sure don’t have a “moral or ethical” problem to charge big money to receive said blood.
    That, and I get badgered way too much having AB-. In short, you want my blood, pay for it. Like anything else in life wanted.

    • Guarantee ur charged when u need said blood. This whole country is founded on corporations. And medical big pharm companies take a huge portion of that blame

  • Blood donations should be paid for. The hospital charges for the blood when patients need it!
    Plasma donations do not seem safe to me due to your blood going through a machine.

    • No one pays for blood?
      Look it up on Google you really need to learn how this works bud. They average cost to patient is 219 for a blood trans. I would post the screenshot but won’t let me . Look up on Google how much it costs it’s literally all the info there waiting for you. Hospital is money they pay u 50 for ur blood but if u needed it back ur taxes and it will cost on average 219 to buy it back.

  • I tried to donate plasma today only to be told I am to old. Then they turned around and told me I could donate blood though. That don’t make any sense! That is discrimination on the old! Wake up not all of is as old as everybody thinks! We can still work and is still good health why not be able to help out in both centers?

    • Probably because of how much plasma is taken out vs a blood donation (those plasma containers are pretty big, at least as much if not more than a bag of blood which contains other things besides plasma). Plasma helps fight off infections and diseases, something older people are more prone to. They probably want to make sure you have all the plasma you can get.

    • Yes u do pay for blood as in my previous response maybe not if u are covered by health insurance but unless it’s state u pay for that too so yes in a “civilized” world you do pay for it because of big corps that would charge you for the air u breathe if they find a way to do that.

  • Good article. I am about to become a plasma donor. The “stipend” you receive makes it worth the time and expense for retired folks like myself. In my area it is about $40.00 for plasma.

    I have made donations to the Red Cross most of my life and have lost count how many times I was unable to donate due to their gross inefficiency in personnel not showing up, computer malfunctions, equipment no working or never brought to the site.

  • Just started doing plasma “selling” recently. I am older and had trouble donating blood but did it anyway to get the “I’m doing some good feeling”, however, getting compensated for it, like with the plasma, would be much better. What they are giving for plasma now, $20 to $60, per 880 mL is nothing compared to how much they resell the pharmaceutical products made out of it. Come on, hospitals pay hundreds for a pint of blood and you pay nearly a thousand for it through your insurance or your pocket, if you need it in the hospital. The Red Cross needs to get off its high horse and offer some renumeration for a blood donation to ease our continual shortage. The testing now is great and there should be few to no contaminated blood getting in the supply chain. This is a no brainer!

    • Agreeeee. Thats Y I dont bother donating to RC. I am very healthy and capable but why should other gets rich and you get nothing

    • Imagine. They could rent the building, buy and maintain all the equipment and pay the staff…keep all the regulations, do mandatory education, and support their donors through the whole process for NOTHING! So, who is greedy, really. You, or the plasma center?

    • Did you read the article? It clearly states that the World Health Organization discourages payment for whole blood products because there is evidence to suggest that donors would omit important information used during the screening process. Because whole blood donations are given directly to patients and only screened for a few things like HIV, it is imperative that the donor not omit any information as this can make a recipient very ill. The reason this does not apply to plasma is because plasma is highly processed and any potential contamination or issue is significantly lower risk for the recipient. It has nothing to do with Red Cross being on their “high horse”. Red Cross does offer non-cash rewards for regular donations.

    • Hospitals make NOTHING? Are you that far brainwashed? Hospital CEO are very wealthy as well as the doctors. It’s a corporation same with big pharm. Why make a cure when they make more money off keeping you sick? If there was a cure you probably couldn’t afford it just like so many other medical things. People are paid 75 in my area for blood but on average a transfusion costs 219 dollars Google it if u don’t believe me and yes they pay u for blood donation not just plasma. That’s just 219$ for the transfusion If u don’t have insurance u pay for it all if u do unless it’s state ur still paying that monthly bill that you rarely actually need. One trip to doctor for being sick just making sure it’s not serious. 1300$ bill sent out the door with advice to buy some DayQuil. This country is not right with big pharma taxing for sick people . Now let’s say you did need more my friend fell down the stairs and had to stay in hospital for three days head injury his bill was over 50,000$ just to babysit him if he didn’t have state insurance he would be so far in debt for a life threatening injury that’s just adding insult to injury salt on the wound what the hell is this turning into? That hospital has many of those constantly so tell me their not making money? Lol you may not pay out of pocket but ur insurance is either way these bills are way higher than they should be and unless u see ur own bill u wouldn’t know which only happened to him because he didn’t have his papers on him he fell coming home from work when the railing broke in our hallway falling backwards and smacking his head dead on the floor really badly.

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