You just have to go early, says a visitor in a Detroit blood bank review. “Then it is less busy,” she writes between all critical comments on Google. Blood Bank visitors complain that the local CSL Plasma is dirty, with unprofessional staff and so popular that you always have to wait two to three hours before giving plasma. It is quite normal that you have to wait in line for a few hours before you as a donor spend another hour giving blood plasma. But the fees are sought after.
Also read: Big alarm at the blood bank: another bag full of black particles
„Donate now and earn up to $ 400 a month! We reward all our donors with a rechargeable prepaid credit card”Advertises the local blood bank. A satisfied, somewhat older donor: “I love this tent. A second job can be stolen from me. ” He receives about 50 dollars (44 euros) per visit, for which he donates a small liter. He does that twice a week.
Wednesday revealed NRC after a joint investigation with international media connected to the whistleblowing platform The Signals Network that unidentified black particles are released in one of the most used plasma donation machines worldwide. These particles can enter the body of donors and patients. The health effects have not been properly investigated – not by the American manufacturer Haemonetics, not by blood banks and not by the inspectorate.
Human plasma is highly sought after, demand is exploding. Proteins from plasma are an important raw material for more and more medicines. Doctors now prescribe medicines from blood to treat about a hundred different diseases. Financial and economic interests are high.
Who is used to the Dutch blood banks can hardly imagine what a fully privatized blood market looks like. In the United States, commercial blood banks compete with each other. They pay for the decreased blood plasma, which is traded worldwide as a raw material for many medicines.
In the Netherlands it is prohibited by law to pay. That lowers the risk of people gambling about their health or that only underprivileged people donate blood. In the US, addicts and homeless people often turn out to be suppliers. Volunteering is central in the Netherlands: the donor of blood plasma is only given a pink cake and Sanquin must not strive for profit. The blood bank will receive a monopoly in return.
Only it takes the greatest effort to be self-sufficient in the Netherlands. Sanquin guarantees that sufficient tapped body fluid is available for every patient who needs a transfusion of blood or blood plasma in the Netherlands. And the organization can amply meet that. However, there is a shortage of plasma as a raw material for medicines.
Commercial and utility function
Just like energy company Shell, Sanquin has a sort of division ‘upstream’ (the blood banks) and a division ‘downstream’ (the medicine manufacturer). The organization considers itself of great importance for public health. “We save 25,000 lives a year,” Sanquin writes in his annual report.
The non-profit-oriented utility function for the Dutch blood supply is at odds with the commercial world market for medicines. Sanquin wins the blood plasma in a foundation, but uses around 90 percent of this in a separate, profit-oriented company. It has been extremely successful in recent years.
The demand for antibodies (immunoglobulins) from the plasma has been growing at around 6 percent per year for years. The blood bank annually supplies more than 300,000 kilos of plasma to Sanquin Plasma Products BV. Sanquin extracts the plasma from donated blood and receives it directly through donation of blood plasma. The plasma leg accounts for more than half of Sanquin’s turnover of half a billion euros. And plasma is even more important for profitability. Three quarters of the operating result, 45 of the 60 million euros, comes from this.
Politicians built in a few safety valves. To prevent abuse, the House of Representatives enforced a strict legal separation between the blood banks and Sanquin’s commercial arm. The Ministry of Health determines the price at which Sanquin’s commercial division purchases the free plasma from donors from Sanquin’s blood banks.
Because a liter of plasma is worth a lot on the world market: 100 to 120 euros. The Americans have become purveyors of the world. Initially, detainees were major blood plasma donors. Today, it is mainly the poorest Americans who donate their blood plasma in large quantities. There is also massive ‘day donation tourism’ along the border with Mexico. On temporary visas, Mexicans cross the border to donate plasma and return the same day. Paying for plasma is prohibited in their home country, while Mexicans can earn a full income with their donations in the US.
But how often can plasma be drawn from humans without harm to them? It is not uncommon for a donor to pass out after a plasma donation. That is easy to explain: the donation causes a temporary shortage of substances that the body replenishes itself.
Also read: Suspicious plasma found at blood banks worldwide, ten to twenty incidents in the Netherlands
In plasma donation, the machine often adds sodium citrate to the blood which flows back to the donor to prevent lump formation. That binds with calcium in the body, causing the donor to have a temporary calcium deficiency. This has been cited as one of the causes for unconsciousness or extreme fatigue after the donation. But in the vast majority of cases, donors do not experience a problem.
Donating too frequently can affect the immune system. In the Netherlands, you may donate plasma a maximum of 12 times a year, a maximum of 25 liters. On average, a donor does not give plasma to Sanquin six times a year.
But in the US, those boundaries are stretched far. There you can donate plasma twice a week and a maximum of 84 liters per year (1.6 liters per week). The Americans go much further than what the World Health Organization (WHO) recommends. For medical reasons, they recommend an interval of at least two weeks before a donor donates plasma again.
Too much social safety net
On balance, there is a large shortage of plasma in Europe, which is mainly imported from the US. One of the explanations: there is too little underclass in Europe. “A strong economy, low unemployment, a higher minimum wage and a generous social safety net”, a director of plasma machine manufacturer Haemonetics mentions as disadvantages in an internal presentation. According to him, these are the main reasons why it is difficult to find enough donors in Germany, even though it is allowed to pay for plasma donation there. This logic also explains why the American blood banks are so busy at the end of the month: the money from donors has run out. “Very good place if you need cash quickly,” writes visitor Ron of the Detroit blood bank.
A mysterious phenomenon are the deaths that sometimes fall after a plasma donation. Where Haemonetics has to report such an incident in the US to the FDA regulator, the company in Europe is not obliged to report deaths. For example, data from the US regulator shows that in 2010 a woman was found after donation in her car with cardiac arrest. Another donor was already sick during the donation, and died shortly afterwards. However, most donors who died shortly after donation still seemed to be feeling well when they left the blood bank. Usually reports concern a death within 24 hours after donation, and occasionally a death is registered five days after donation.
It is not clear whether the deaths are related to the problematic black particles in the plasma. Certainly, given the appeal to addicts to donate, it can be a coincidence if someone collapses after donation in the parking lot.
Haemonetics did not take reporting seriously for years and reported no deaths at all after donation between 2010 and 2017. Six deaths were reported in subsequent years. In 2020, Haemonetics suddenly reported 33 more deaths, also over previous years. When asked about this sudden increase, Haemonetics first reports that due to a technical error, reports were not reached by the regulator on time. Haemonetics later states that the increase is due to the fact that the company started to count in a different way.
In Europe, donors can only be paid in four countries: Germany, Austria, the Czech Republic and Hungary. Those four countries also supply the most plasma, according to figures from Haemonetics. Europe does not collect enough blood plasma. The result: Europe imports three-quarters of its needs from the US. According to Haemonetics, in addition to the 5.4 million liters of self-harvested plasma, about 16 million liters of frozen plasma cross the ocean every year. There is $ 26 billion annually in the market for plasma products worldwide, estimates BCC Research, a research firm.
Within that field of influence, Sanquin is looking for ways to satisfy its plasma hunger. Sanquin raised the maximum age for donors by ten years in April 2018, to 79. “The age limit had long been set at 69 because the assumption was that after that age the risk of unwanted effects from a donation becomes too great,” it says. company in a statement. “But after literature research and exchange of experiences with blood banks in other western countries with a higher maximum age, it turned out that giving blood, plasma or platelets [bloedplaatjes] is responsible and safe for the donor even after the age of 69. “
In doing so, Sanquin deliberately deviates from the advice of the WHO, which sets a maximum age of 65. Sanquin does not discuss the reason why it deviates from those recommendations, but says it is safe. Sanquin has also set up a separate department that specializes in purchasing plasma abroad, not for transfusion to patients, but for its medicine production.
The quantities purchased are competition sensitive information. Sanquin recently found a Hungarian strategic cooperation partner. Sanquin does not want to say who this is, what is paid and whether there is a specific donation for Sanquin in Hungary.
A version of this article also appeared in the NRC Handelsblad of 3 July 2020
A version of this article also appeared in nrc.next dated July 3, 2020