Cover: Exploring the business, stigma and life-saving benefits of plasma donation
Last summer, the house Ohio State art student Madeline Conway rented foreclosed.
Forced into a sudden move, Conway couldn't cover the additional security deposit by relying on freelance gigs, and the unexpected financial hardship left them scrambling.
That's when Conway noticed the sign on the large crimson and tan CSL Plasma building on North High Street: “Earn up to $400 this month.”
“I was like, ‘Damn, I need money,'” Conway recalled in a mid-January interview. “Let's do it.”
Armed with their I.D. (donors must be at least 18), proof of address and social security number, Conway entered the Old North center to donate plasma, the straw-colored liquid that, combined with cells and platelets, comprises our blood.
After completing a questionnaire and passing a physical, Conway was cleared. Conway then entered a room with rows upon rows of people relaxing in donor beds, watching TV or using electronic devices. It was a “human blood farm,” they said.
During the 45- to 90-minuteplasmapheresis process, a machine separated Conway's plasma from the rest of their blood. (Red blood cells and platelets were returned.) Conway was bandaged and sent on their way with money loaded on a card.
After seven total visits in August, Conway made $350, which allowed them to pay for rent and gas.
“And then I went back to school and I got my loan money and I stopped going,” they said.
Gabrielle Benton has a similar story. She graduated from OSU last May and donated at CSL Plasma all summer, making more than $800 to help pay for unforeseen dental expenses. By the fall, she was done and off to France, where she now teaches English to elementary students.
But Conway and Benton's brief stints donating plasma did not come without criticism.
“The stigma is very real,” Benton said in a Skype interview. “My parents, when they found out I was doing this on a regular basis, were like, ‘Please stop. You don't know what this will do to your health.'”
Her parents also felt that, as a college graduate with savings, she shouldn't be taking advantage of an opportunity seen by many as a last resort.
“It just isn't something that's respected and seen as a normal thing to do,” Benton said.
“My roommates were like, ‘You don't have to do this,'” Conway said. “And it's like, ‘I know I don't have to. It's really not much different from donating [whole] blood. I know y'all would not be worried about me if I was donating blood.”
Like Conway and Benton, millions of people donate plasma each year at more than 700 centers across the U.S., Canada and Europe,according to the Plasma Protein Therapeutics Association. In the U.S. alone, thePPTA reports that plasma collections totaled approximately 42 million in 2017 — up from approximately 15 million in 2007.
Those plasma collections, rich in protein, are used by pharmaceutical companies to develop products that treat myriad conditions, some life-threatening, including hemophilia, immune deficiencies and shock or trauma. Andaccording to market research, plasma protein therapy is a growing, billion-dollar market.
Despite the life-saving aspect, a shadow looms over plasma donation; many believe the donation centers are relying on and exploiting the poorest communities. A recentstudy by former Case Western Reserve University researcher Heather Olsen found that plasma donation centers are commonly in low-income neighborhoods, and money earned from donating is mostly used to pay for food and other basic necessities.
And despite being regulated by the U.S. Food & Drug Administration, there is concern that, unlike whole blood donation at American Red Cross facilities, plasma donation compromises safety. Some argue that because the latter includes a financial incentive, donors may be more willing to lie during the screening process, and centers may be prioritizing volume of collections over quality control.
Some of those concerns are shared in Columbus. Donors visiting plasma centers in economically disadvantaged neighborhoods, and even CSL Plasma in Old North, admitted they observed people relying on donations to make ends meet. But there is also a contingent of donors primarily motivated by benevolence.
“I normally work two jobs anyway,” said Anthony Jackson, who donates at Octapharma Plasma in the Northern Lights Shopping Center in Linden. “Hopefully, I'll help somebody.”
Standing outside of a plasma donation center on a frigid February morning is not the best time for engaging in conversation. But I'd bet that even in summer months, most donors are not interested in chatting. I watch person after person hurry in and out of Talecris Plasma Resources, sandwiched in between a production and manufacturing staffing company and a Subway in Hilltop.
It became clear really quickly that people just wanted to get in, get out and get on to their jobs or families. Their time was about money.
One woman with whom I was able to make eye contact confirmed as much. “I have to go,” she said. But before she hopped in her car, she spun around and added, “My experience was really good. It helps me feed my kids.”
Both The Atlantic and The New York Times ran critical articles within the last year headlined “How Blood-Plasma Companies Target the Poorest Americans” and “What Is the Blood of a Poor Person Worth?,” respectively. Both questioned whether the plasma industry was dependent on people desperate for cash for basic necessities, and if donors were being paid enough, considering that the market was booming.
The PPTA responded to the latter, claiming it “lacked balance.”
“While people's reasons for donating their plasma are as varied as the diseases treated by access to plasma protein therapies, some do so to lessen financial stress or to earn some extra income to help friends or loved ones,” the PPTA stated. “A letter published last year by more than two dozen ethicists and economists explains that compensating donors is ethical and is intended to recognize their time and inconvenience.”
In Columbus, plasma donation centers are concentrated in low-income areas like Linden, Hilltop and Whitehall; on High Street near campus; or outside of the city in Obetz and Reynoldsburg.
CSL Plasma, Talecris Plasma and Octapharma Plasma's rates per donation are generally consistent with the standard $30-$50 range across the country. However, each location varies when it comes to bonuses and incentives. (Pay may also be adjusted based on weight; donors are required to weigh at least 110 pounds and heavier donors yield more plasma.)
For example, a new donor at CSL Plasma receives $75 on their first and second visits. Regular donors who come twice per week receive $20 or $25 on their first visit and $22 or $45 on their second visit, depending on weight. If they can make it to an eighth donation in one month, they'll receive $100 for that collection. And an incentive is offered to college students.
“I can't speak specifically to Columbus, but we tend to put our centers in densely populated areas because, obviously, there's more people to donate,” said Mary Coates, head of corporate communications at CSL Plasma. “We also very frequently put the centers near colleges and universities for two reasons. One, the college students tend to be great donors, but also they are potential employee pools.”
Vlasta Hakes, director of public affairs at Grifols pharmaceutical company — which owns Talecris Plasma Resources — said donors represent a “cross-section of the local community, including college students, military personnel, homemakers, professionals and workers.”
“I think that there should be [centers] scattered all over the place in higher-end areas and middle-class areas and in low-income areas,” said Jennifer Gonzales, a DoorDash driver who donates at Talecris Plasma. “I'm pretty sure that they would have a lot more donors that are going to be eager to help. … [And] some feel a little bit funny about coming to the lower-income areas.”
Though Gonzales started donating during a period of unemployment, she said she is motivated by helping people. She visits twice a week and proudly claimed to have donated more than 100 times in 2018.
“I just figured I'm saving lives and I get a little bit of extra money for it,” she said. “I don't touch [the money]. … [I'm] just saving up for my daughter's college.”
Coates said she recognized money as an important motivator for plasma donors.
“The other thing that we're finding is there is a certain percent of donors that are donating purely based on philanthropic motives,” she said. “And those are people who typically know somebody who has a disease.”
While Gonzales builds her savings and younger donors like Madeline Conway and Gabrielle Benton collected temporary supplemental income, others see plasma donation as a consistent, necessary financial source.
“This economy is worse than what Donald Trump says it is,” said donor Anthony Jackson, who relocated to Columbus from Cleveland in search of better job opportunities. He cited the recent closing of Toys “R” Us, the Kroger bakery in Columbus and businesses along High Street as contributing factors to economic distress.
According to Jackson, the predominantly African-American donors at Octapharma Plasma in Linden need bus money, especially since the Northern Lights Kroger closed. “You can put a little bit more in your refrigerator,” he said. “You can do a little bit more with your family. You can go a little further on vacation.”
Since African-Americans and other people of color disproportionately populate low-income neighborhoods, they may comprise most of the plasma donor base by default. For example, in Olsen's study, 84 percent of participants were African-American.
“I will say that at CSL [Plasma], I was in the vast minority, being Caucasian,” Benton said. “Out of like 30 or 40 people donating at one time, the vast majority were black, Latino or other [people of color].”
Though race- or class-based marketing is difficult to prove without further quantitative analysis, Conway mentioned the black woman featured in the ad on the CSL Plasma building, along with the ads on COTA buses made them think about the potential for bias, especially given the financial bonuses for college-educated donors.
And current rates for plasma donation are questioned by some local donors.
“I think that a lot of people would want to be paid more,” said Gonzales, adding that donors have searched online to determine how much companies make from selling their plasma. “They think, ‘Well, if they're getting paid $1,000 for a bottle of plasma, why are they only paying us this much?'”
“I know they can't pay us a million dollars but I would like an increase,” said Jackson, sharing that each week, he receives $25 for his first visit and $45 for his second visit. (Octapharma Plasma in Linden did not respond to repeated interview requests.)
Jackson said $50 per donation would be fair. And even though the center offers a monthly bonus for hitting a certain number of visits, it's often difficult for donors to keep up.
“That puts a lot of pressure on a person trying to get that bonus,” he said. And charging donors a small fee to use their payment cards is a standard practice at plasma donation centers.
CSL Plasma and Talecris Plasma did not disclose specifics about company profits from plasma collections. But both stressed the significant cost of collection, testing and manufacturing — a process that takes several months.
“The cost of collecting the plasma is the single-largest production cost of producing life-saving plasma medicines,” Grifols Director of Public Affairs Vlasta Hakes said.
“But, like any business, there would be some degree of profit,” Coates said. “The plasma that we collect goes to our parent [biopharmaceutical company CSL Behring] and then it's manufactured into medicine. In terms of pricing, that's their domain.”
Payment isn't the only benefit people receive from donating plasma.
“They use us almost as a health clinic to test their blood pressure and make sure that everything is going well for them, so they don't have to go into a doctor,” Coates said.
It's possible that unemployed or underemployed donors can't afford to go to the doctor. And, according to Olsen's research, “significant numbers of donors who live in states without expanded medical coverage would not be able to afford the lifesaving therapies created by their own plasma contributions.”
But those larger questions may not weigh on donors who are just trying to get by each day.
“[It's] a win-win,” plasma donor Jackson said. “You're getting a free health screening and you're getting paid, at the end of the day.”
Stigma and fear surrounding plasma donation may be residual effects of the mass contamination of plasma-based pharmaceuticals during the HIV/AIDS epidemic. Additionally, thousands of Chinese donors became infected with both AIDS and Hepatitis C due to inefficient sterilization in the 1990s.
But the industry is much safer today. In addition to being regulated by the FDA, many centers are further certified by the International Quality Plasma Program, a voluntary standards program initiated by PPTA. Facilities like CSL Plasma provide information on the rigorous testing of collections, as well as emphasize the use of sterile equipment. And certified, medically trained personnel are always on staff.
But some are calling for a more restrictive screening process. For example, some donors may lie about tattoos and diseases, put on extra clothes or ankle weights to meet weight requirements or use other “tricks” to pass protein checks — as reported in The Atlantic.
Though U.S. citizens are legally permitted to donate twice per week with at least two days between collections, some worry about the long-term effects of that frequency. In all other countries, people must wait two weeks between donations. And some donors have reported side effects including fatigue, dehydration and blackouts.
Donors interviewed for this article said they haven't experienced any serious health problems; they made sure to drink plenty of water and eat beforehand, and rest afterward.
But there are environmental stressors.
“It can be very anxiety-inducing because you are waiting in so many lines,” Conway said of the centers, which can get crowded. “You are being corralled.”
Donors also said staff members aren't always gentle and efficient.
“I've been stuck poorly,” Benton said. “Like they really can't find a vein. I have had someone fish around. That was the worst. … I've been stuck in both arms one time, and then you're bandaged on both sides. That doesn't look good at all.”
On the other hand, plasma donations centers can be arguably too careful. Under FDA regulations, gay men are not permitted to donate plasma or whole blood unless they have abstained from sex for 12 months. This restriction, labeled MSM (men who have sex with men), was enacted in 2015 after the FDA lifted the blood ban for gay men.
"Epidemiologic studies at the time indicated that a history of male-to-male sexual contact was associated with a 62-fold increased risk for being HIV positive, whereas the increase in risk for a history of multiple sexual partners of the opposite sex in the last year was 2.3-fold," the federal agency stated in an email to Alive. "The recommended deferral period in the final guidance is 12 months because a 12-month deferral has been well studied and found, among other things, to maintain the safety of the blood supply in Australia, a country with HIV epidemiology and blood screening systems similar to the United States. That being said, the FDA is committed to reevaluating its blood donor deferral policies as new scientific information becomes available."
Columbus activist Erick Bellomy came face to face with those limitations in 2014 when he attempted to donate at CSL Plasma shortly after graduating high school.
“[I asked,] ‘How invasive is the physical?'” Bellomy recalled in a mid-January interview. “‘When I was a kid, I was molested. Sometimes I just don't trust people.' And they said, ‘Let's get more information about what happened to you when you were a kid.'”
According to Bellomy, who is openly gay, when the staff learned he had been molested by another male, they permanently deferred him from donating.
“I don't really see that as sex,” he said. “I don't really see that as consensual. … I felt discriminated against.”
Bellomy shared his story with 10TV and launched an online campaign to bring awareness about the FDA's then-lifetime ban for gay men.
Alive reached out to Mary Coates at CSL Plasma for comment on Bellomy's experience.
“I believe what he says. I have no reason to dispute him at this point,” Coates said. “The people who were there at that time aren't anymore. So I don't even have the ability to say, ‘What happened in this case?' … I will say that whatever the policy was at that time, it's still the same today.”
Despite the lift of the blood ban, CSL Plasma's lifetime ban on MSM remains. Because CSL Plasma and its parent company are global, they have to adhere not only to the FDA, but to international quality agencies. And some of those agencies are less progressive.
“They have deemed MSM as a potentially higher risk for transmitting disease,” she said. “We have to defer them. We don't take a stand at all on sexual preference. That is not what it's about. It's really following some quality standards that exist in order for us to produce the medicine.”
Unaware of this exception for plasma donation centers, Bellomy said he returned to CSL Plasma to donate after the ban and was denied again.
“I have a lot of resentment towards them,” he said. “These places aren't best for the LGBTQ community if they want to feel empowered and feel as if they matter. … And now we have all these preventative measures [like] PrEP. … We're so advanced now. It just doesn't make sense to me that it's 40 years after the AIDS epidemic and we're still treating people as if they're a disease.”
Depending on one's perspective, the ends of plasma collection may not justify the means, but they still matter. According to the Global Genes organization, there are approximately 7,000 different types of rare diseases, and 350 million people who live with them worldwide.
Plasma collections are needed consistently at high volumes. According to the Plasma Protein Therapeutics Association, it takes 1,200 plasma donations for the annual treatment of one hemophilia patient.
There are many groups advocating for patients worldwide, and multiple testimonials about the life-changing impact of plasma-based therapies can be found online.
“My grandfather recently became ill,” donor Gabrielle Benton said. “He had developed an autoimmune disease and he had to get plasma transfusions. … You cannot just come up with real, authentic plasma. People donate it and it's used in hospitals. I'm really glad that he was able to receive that treatment.”
Some argue that, ethically, concerns about plasma donation should be directed at those in charge of regulation, not donors who are exercising their legal right to make a living.
“We, as a society, must openly recognize and thank our donors for taking the time to donate and the crucial role they have in helping save lives,” said Vlasta Hakes at Grifols.
“I can swallow my pride,” said donor Anthony Jackson. “I know where I've been. I know where I can go. And I most definitely know who I am.”