By Suzanne King

Michael Mullen donates blood plasma every Tuesday and Thursday. He has for 12 years.

The money it brings in — a little over $100 a week — augments what he makes as a chef. He’s come to rely on it.

“It helps supplement bill paying,” he said recently, smoking a cigarette outside the Biomat USA donation center on East 63rd Street where he’d just spent an hour and a half in the donation chair. “If I didn’t have it, I don’t know. I don’t know what would happen.”

Kelcey Gordon is out of work and said he’d struggle without the money he makes donating twice a week. Standing outside the same for-profit plasma donation center, one of 11 in the Kansas City area, he said he is grateful for the extra cash it represents.

In the $35 billion plasma pharmaceutical industry, Mullen, Gordon and some 3 million other U.S. adults supply the raw material the industry counts on.

The plasma they deposit every week is tested, processed and separated into protein parts that become medicine to treat rare, chronic conditions like immune deficiencies, autoimmune diseases and bleeding disorders.

Their plasma, collected at a storefront that shares a shopping center with a Thriftway and lies just a block east of Cash America Pawn, will end up in medicines sold for hundreds or thousands of dollars a dose. It will likely treat patients on the other side of the world.

Thanks to regulations that make the United States one of the few countries to let companies pay for plasma, and because people here can donate as often as twice a week, the U.S. supplies about 70% of the world’s plasma.

“This is the world basket of plasma,” said Peter Jaworski, a Georgetown University professor who studies the plasma economy.

The industry — with the enthusiastic backing of organizations that advocate for people suffering from the diseases that plasma therapies treat — says the system works. If people weren’t paid to donate, they argue demand could not be met. That would mean thousands of people would die or be unable to live normal lives.

The plasma centers, most of them owned and operated by pharmaceutical companies based overseas, say their business models also inject money into local communities.

Donation centers employ phlebotomists, security guards and screeners. And the payments made to donors — which vary based on how often someone donates and, in some cases, how much a donor weighs — go back into the local economy.

But doctors and public health experts caution that no one really knows what frequent plasma donations over many years could mean for donors’ health.

And they worry that poor people provide a bulk of U.S. donations at plasma centers. Plasma centers tend to set up in disadvantaged neighborhoods and rely on incentive programs designed to make donors give again and again.

Plasma centers push people to give as often as possible, but they don’t disclose the unknown risks of frequently extracting plasma from their blood for many years.

“People perceive it as a better alternative than high-cost loans that lead to debt,” said Emily A. Gallagher, an assistant professor of finance at the University of Colorado. She co-authored a study about the intersection between plasma donors and payday loan customers.

“Without knowing the longer-term health consequences,” she said, “it’s analogous to a loan against your future house with an unknown interest rate.”

Therapies from donated plasma

The blood running through your veins includes red blood cells, white blood cells, platelets and plasma. Plasma — a yellow-tinged liquid — accounts for more than half of your blood.

It is 90% water, but also contains proteins vital to living a normal life. When someone has plasma that lacks  — or is short on — certain proteins, they end up with rare and chronic diseases. Medicines made from healthy human plasma treat those diseases by supplementing the lacking plasma.

For someone with primary immune deficiency, a condition in which a person’s immune system doesn’t function properly, it takes 130 donations to cover a year’s worth of treatment. For a person with alpha-1 antitrypsin deficiency, a potentially fatal disease that can lead to organ damage, that number jumps to 900 donations a year. And for someone with hemophilia, a blood clotting disorder, it takes 1,200 donations of plasma to make a year’s worth of medicine.

Scientists have known about blood circulation since 1628, and blood transfusions began almost that long ago. In 1665, a British doctor figured out how to keep a dog alive by transfusing blood from other dogs.

At the beginning of the 20th century, scientists began to figure out that different people had different blood types. And by World War II the value of blood plasma was well understood.

In 1940, researchers developed a process to break plasma down into individual components to treat patients. That’s essentially what happens to plasma donated today.

Wild west of plasma collection

Donated plasma goes through a process known as fractionation, which separates plasma into various protein parts. Once it is tested and cleaned — a process that can take up to a year — those proteins are pooled with other donors’ plasma and made into therapies.

Plasma therapies for patients on the receiving end are considered extremely safe today. Tests designed to find plasma tainted by disease are highly effective. And plasma pharmaceutical makers won’t use plasma until a donor has given at least twice and the donor has passed a health screening. In addition, plasma is treated to kill any lingering virus before it is used in medicine.

But in the 1980s, before it was understood that viruses like HIV could be transmitted through blood, plasma transfusions proved deadly.

In the United States, 63% of hemophiliacs contracted HIV after receiving plasma from infected donors. Others contracted hepatitis B and hepatitis C, diseases that are also transmitted through blood.

After those “wild west days of plasma collection,” Jaworski said, the industry underwent drastic changes. That included pharmaceutical companies taking over independent donation centers. In recent years, those centers have multiplied.

Pharmaceutical companies operate a combined 1,000 collection centers in the United States. That’s compared to 300 in 2005.

The business of taking human plasma and turning it into medicine is worth about $35 billion this year. And that could nearly double by 2032, according to Fortune Business Insights, a market research firm.

Growing demand for plasma donations

Kansas City-area donation centers are all owned directly by the companies that make the plasma-derived drugs.

They include the Biomat on 63rd Street, owned by Grifols S.A., a Spanish company. Other Kansas City donation centers are owned by CSL Ltd., based in Australia, Takeda Pharmaceuticals from Japan and Octapharma Plasma, out of Switzerland.

Experts say the influx of new donation centers in recent years follows growing demand for plasma therapies. That’s because scientists are figuring out that more diseases can benefit from plasma medicines. During the COVID pandemic, plasma transfusions from previously infected donors were tried as a treatment, but its effectiveness isn’t understood because scientific testing was lacking.

Demand for plasma therapies is also up because more people are being diagnosed with diseases that could benefit from them.

For example, improved newborn screenings mean more people know they have primary immune deficiency, diseases that affect an estimated 500,000 people. But according to the Immune Deficiency Foundation, “tens of thousands” of others remain undiagnosed.

Only the United States, Germany, the Czech Republic and a few other countries allow payments for plasma donations. The countries that restrict payments have to rely on imports, primarily from the U.S. There is no synthetic alternative to human plasma.

That’s why Jaworski wants more countries to allow paid plasma.

“There isn’t a single country in the world that collects enough plasma to meet demand unless they compensate donors,” he said. “The most important moral mission for a system of blood and plasma collection is to meet the needs of patients.”

By that standard, he said, the American system is unquestionably succeeding.

“America not only collects enough for its own citizens,” he said, “it also collects enough for the rest of the world.”

Is donating plasma twice a week safe?

Through a process known as plasmapheresis, the plasma collected at for-profit centers is taken out of a donor’s arm as whole blood, pumped into a machine that separates out plasma and returns red blood cells and other components of blood to the donor.

That process, known as source plasma collection, is regulated by the U.S. Food and Drug Administration and also overseen by the countries that import the plasma. Donors spend about 90 minutes in the donation chair.

Nonprofit blood centers like the Community Blood Center of Greater Kansas City collect plasma through whole blood donations. Plasma is separated out once blood has been donated. But that process yields much less plasma.

Nonprofit blood banks don’t pay for donations. For one thing, hospitals won’t accept blood from a donor who has been compensated. And the World Health Organization advises against paying for donations. It’s considered risky because donors who give blood because they need money could be more likely to misrepresent their health history — essentially hiding the likelihood that they’re carrying blood-borne infections.

Because plasma used in pharmaceuticals is so thoroughly processed, the risk posed by paid donations is lower. Jaworski said it’s proved to be extraordinarily safe for 30 years. He argues that objections to paid plasma donations are unrealistic when so many people rely on plasma therapies.

He compared paying people for their plasma to hiring firefighters rather than relying on volunteers. The payment doesn’t diminish the good act, he said.

“At some point, you get too many fires and you have to pay people to put out the fires,” he said. “We hit that tipping point (for plasma) more than 20 years ago.”

People who rely on the therapies created from paid-for plasma are actively campaigning to be sure paid donations continue.

The Immune Deficiency Foundation has a program meant to recruit more paid donors. “Your work will encourage donors to continue donating and, in turn, encourage their friends and family to donate plasma as well,” the organization’s web page says.

But while plasma-derived therapies are critical for the patients relying on them to live a normal life, some doctors worry about what plasma donation could do to donors.

Plasma collection centers advise donors to drink lots of water, get sleep and have a healthy meal before donating. In the near term, donors are told to be prepared for certain temporary side effects like dehydration, dizziness and fatigue.

On its webpage, CSL Plasma also warns about the possibility that donating frequently for a long period of time can deplete immunoglobulin levels, which can lower a person’s ability to fight off infections.

What is the downside to donating plasma?

Dr. Morey A. Blinder, a hematologist at Washington University, said that’s definitely something frequent plasma donors should worry about. Long-term studies, looking at people who donate plasma twice a week, year after year, simply haven’t been done, he said.

“You’re depleting a person’s proteins in their bloodstream,” he said. “And it’s hard to know what the effect of that is.”

Proteins regenerate, he said, so in the short term, people can keep up. But it’s unclear what happens over time.

And while the plasma collection centers monitor donors’ health, their incentive isn’t to limit donations. It’s to collect as much plasma as possible.

“There are financial incentives to these donors to stay on schedule and keep donating,” Blinder said.

Many doctors would feel more comfortable, he said, if that pressure were reduced. Blinder also would like to see more frequent checks of donors’ blood levels, and a weekly, rather than twice weekly, donation limit.

“People in this field would say that would be an advantage,” he said.

Blinder also questions whether the pharmaceutical companies are paying donors fairly. Donors take home around $50 per donation, but the medicine it’s eventually turned into can cost $200 a gram, perhaps $16,000 per treatment dose, depending on the illness.

“We don’t have a good sense of the margins they earn on the plasma,” said Gallagher, the University of Colorado professor.

Right or wrong, the paid plasma business has become a reasonably big thread in the country’s social safety net. Gallagher found that people tend to donate plasma so they can get extra money and avoid taking out high-interest loans to make ends meet. Donors range from college students to single parents to low-wage earners who just need extra cash.

BioLife Plasma Services is promising new donors “up to $800.” And CSL Plasma advertises new donors “over $700 your first month.”

Whether or not donors are getting a fair payment, selling plasma is tempting a growing number of Americans. And, like Mullen and Gordon, they’re relying on the extra cash.

That’s why most mornings, before CSL Plasma’s donation center at 37th and Broadway opens for business at 6 a.m., a line of ready donors is already waiting outside.

This article first appeared on Beacon: Kansas City and is republished here under a Creative Commons license.

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This story was originally published by The Kansas City Beacon, an online news outlet focused on local, in-depth journalism in the public interest.

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