"Bloody Well Pay" Blood Plasma Donors—and Organ Donors, too

Georgetown political philosopher Peter Jaworski makes the case for paying blood plasma donors. The same arguments also justify paying organ donors and participants in vaccine "challenge trials."


Blood plasma.


In a recent report co-published by the Adam Smith Institute, the Niskanen Center, and the Australian Taxpayers Alliance, Georgetown political philosopher Peter Jaworski argues that nations that currently ban paying blood plasma donors—including Canada, the UK, and Australia—should legalize it. As he puts it in the title of the report: "Just Bloody Well Pay Them." Here is a summary of his report, posted at the Niskanen Center website:

  • There are significant global shortages of blood plasma used to make plasma therapies. Demand is growing at a rate of 6-10% per year. Three-quarters of people do not have access to the appropriate plasma therapy, largely outside of developed countries.

  • Shortages are significantly exacerbated by the World Health Organisation's policy — adopted by the United Kingdom, Australia, New Zealand and some Canadian provinces — to rely exclusively on Voluntary Non-Remunerated Blood Donations (VNRBD).

  • The United Kingdom currently imports all (100%) of its supply of plasma therapies, Canada four-fifths (84%), Australia half (52%), and New Zealand one-tenth (13%). These countries are too increasingly dependent on imports of plasma therapies from countries that remunerate donors such as the United States and Germany. This inflates the global blood plasma price, making it unaffordable for low to middle income countries.

  • 5% of the world's population is responsible for more than half of all the plasma collected in the world.

  • In order to ensure a safe, secure, and sufficient supply of plasma therapies, the United Kingdom, Canada, Australia, and New Zealand should adopt Voluntary Remunerated Plasma Collections (VRPC).

As Jaworski explains, the US currently does allow payments to donors, and thereby provides a high percentage of the world's total supply of blood plasma. But shortages persist because so many other countries forbid it.

Jaworski provides excellent responses to a variety of standard arguments against paying donors, such as that it might lead to "exploitation" of the poor, or to "crowding out" of unpaid donations.

It is important to recognize that many of the issues raised here are similar to standard arguments against paying organ donors and paying participants in vaccine "challenge trials." In each of these cases, critics claim that allowing payment would exploit the poor, improperly "commodify" the body, and lead to deception and trickery at the expense of ill-informed donors. And, in each of them, policies banning these practices cost many lives, as well as inflicting other types of suffering. For example, the US ban on paying kidney donors leads to thousands of preventable deaths every year and consigns many thousands of other patients to years of painful kidney dialysis.

I criticized the "exploitation" and "commodification" arguments in the challenge trial context here, and in the organ transplant context here and here. I would add that legalizing these practices would also expand human freedom, and should be attractive to anyone who believes in the principle of "my body, my choice," and takes its implications seriously.

Last year, the Trump administration eased regulations restricting restricting the compensation of kidney donors for the expenses they incur as part of the donation process. This is an important step in the right direction. But much more can be achieved by also legalizing payments that go beyond simply compensating people for expenses. In most other cases, we don't expect to adequately meet the demand for any good or service simply by paying producers for some of the expenses they incur. We recognize that they also need to be able to make a profit—as in fact is allowed for every other participant in the kidney transplant process, including doctors, nurses, producers of medical supplies, and so on.

Allowing payment of organ donors, plasma donors, and participants in vaccine challenge trials is a great way to simultaneously save lives and expand human freedom. At this painful moment in history, it could also help put an early end to the coronavirus crisis, thereby limiting the enormous economic and social damage it causes.


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  1. Yes! The rich and the poor should be equally free to sell their kidneys!

    1. You’ve been using that a lot lately but I don’t think you really understand what it means. Let’s flip it about a bit.
      If you do allow people to sell their kidneys, then the rich and poor might finally be equally free to give them to others. Right now, the poor take far greater risks by donating a kidney. All donors incur significant risks. The poor have much less of a safety net when something goes wrong. Organ donation is almost exclusively a middle-to-upper class phenomenon. If, on the other hand, you compensate them at the right level, the poor will have the resources to respond to those risks.

      1. That’s a fair point (though not at all a rebuttal of the moral argument I was making – and making only for the 2nd time this decade). The problem is that it presupposes that the poor person in question lives in a country with a crappy health insurance and welfare system like the US. Otherwise, money wouldn’t be the limiting factor. The solution isn’t to incentivise poor people to undergo risky surgeries for money, but to make sure that rich and poor alike have an appropriate “safety net”.

    2. If your ethics leads to increased deaths, have you done anything good?

  2. The argument for the legalization of blood sales is made even more forcefully in Chapter 13 of “The Economics of the Undead” — available here (via SSRN):

  3. If the UK is importing 100% of its plasma, while not reimbursing its internal plasma generation a single shilling, it’s not “crowding out” anything.

    There are arguments about crowding out. But in this case, there’s nothing to crowd out. Apparently not a single person in the UK is donating plasma. (Nor are they getting reimbursed).

  4. The solution seems to be to figure out what New Zealand is doing to succeed without paying, and emulate that.

  5. There is a major problem in the countries where you can pay for live kidney donors of not actually securing proper consent–however, this kind of applies to any live kidney donors, as even in countries where you don’t get paid, you get an incredibly rosy picture of what it means for you. So there are serious ethical questions about live kidney donations even without the involvement of money. On the other hand, the life status of the donor should be utterly irrelevant to the question of if it’s ethical to pay. (Would you be more willing to donate your organs if it would help cover your final costs?)

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