Plasmadonoren betalen voor hun gift? Het kan ook anders!

Vorige maand publiceerde The Economist een artikel waarin het financieel vergoeden van plasmadonoren werd verdedigd. Onze gedelegeerd bestuurder Philippe Vandekerckhove  is het echter niet helemaal eens met deze these en stuurde onderstaand antwoord door naar het Britse magazine in kwestie.

Dear Madam, Dear Sir:

You are right that something needs to be done about the dependency on American plasma, if only because President Trump’s wall, if finished, could stop the significant numbers of Mexicans who cross the border to donate plasma for money in the US. But you are wrong to claim that the issue is not being dealt with, and that only paid donorship can resolve it.

You cite Belgium as an example to support your thesis, but it is actually an example of the opposite. First of all, Belgium is one of the EU countries that collects most plasma as a percentage of its own needs (60 % this year) and it does so in a completely non-paid way. Secondly, at the request of the government two years ago, plasma collections increase by 5% yearly and we will be self-sufficient by 2026. (The Dutch even do better, yet you fail to mention them at all). 

Increasing unpaid donations thus is not an impossible goal, but takes some time as it requires building up donor tradition. In contrast to chemically-derived drugs for which the raw materials can easily be up- or downscaled, the donor base cannot be switched on or off as readily. This is precisely why a long term perspective towards plasmapheresis is essential, and where it has gone wrong (at least in Europe). It is true that national governments within the EU could have taken action faster when the decline of plasma from whole blood started. But their inaction is at least partly explained by the unclear context they were in. The EU – apparently without deliberate intention – created an open market for blood products with its “blood directive” (2003) and the interpretation thereof by the EU Court of Justice (2011). This allowed certain, but not all, plasma firms to sue national governments and blood services alike on covering their needs of plasma.

It is only normal that governments consider all options, including improving a system that has proven its value over decades, before jumping to paid donation, especially as this is likely to make their population increasingly dependent for life-saving drugs on multinational firms in terms of supply and pricing. Crowding-out, in contrast to what you write, most definitely exists, but in a form you failed to mention. Where payment for plasmapheresis is introduced, the pool of people willing to donate for free evaporates fast. Even the Red Cross in those countries ends up paying its plasma donors. This is a one-way street: once people regard plasma donation as an economic transaction rather than civic duty, they are no longer willing to donate for free. The only question is whether this crowding out-effect also spills over into other donations such as whole blood. In Hungary for instance, the government had to force plasma donors to also become blood donor because of shortages. The scientific evidence is conflicting so more research is necessary before ruling this out. 

Besides the ethics of using poorer people as donors, collecting more frequent high volume donations for payment is not without risks, as plasma donation is in essence a protein and not a water donation as you suggest. It takes time to replenish protein stores, and the effect of very frequent high volume donations on donor safety has not been studied well enough. With regards to patient safety, it is interesting to note that you consider this a non-issue because of the processing used, at a time when the US still does not accept European plasma due to the perceived risk of vCJD (“mad cows disease”).

American plasma is considered a “strategic” resource by the US and can be prioritised for domestic use by decision of the US President. What needs to be done is for Europe to take back control of its plasma supply by correcting the unintended consequences of its “blood directive”, and for national governments to create the long term context in which blood services can build their plasma donor base, as the Belgian government has done.