Ethicists and Economists for Ethical Donation-Compensation Practices

January 16, 2018

Ethicists and economists express concerns about banning compensation for plasma donations

Ottawa, Ontario and Washington, D.C. – A group of professional ethicists and economists published an open letter urging provincial governments to reconsider proposals to ban compensation for blood plasma donations. The letter is signed by 26 ethicists and economists, including two Nobel Prize winners (Alvin Roth and Vernon Smith), a recipient of the Order of Canada (Jan Narveson), amongst others.

Blood plasma, the yellow liquid within which white and red blood cells as well as platelets are suspended, is used for transfusions as well as to manufacture plasma-derived medicinal products like immune globulin, albumin, clotting factors, amongst other medicines.

Health Canada, the U.S. Food and Drug Association, Canadian Blood Services, the Canadian Hemophilia Society, and the European Medicines Association have all said that plasma medicines are equally safe and effective whether they are made with paid or unpaid plasma donations.

“In our view,” the letter, available at and addressed to the Health Canada Expert Panel on Immune Globulin Product Supply and Related Impacts in Canada, reads, “none of the moral objections to the compensatory model are persuasive. Furthermore, there is a strong moral presumption against standing in the way of a model that is the most likely to promote security not only of Canada’s supply of [plasma-derived medicinal products], including [Immune Globulin], but also of the global supply.”

Canada is almost entirely dependent on the United States for its supply of plasma-derived medicinal products, like immune globulin, albumin, and clotting factor. Canada is fully self-sufficient when it comes to plasma for purposes of transfusion, but Canadian Blood Services collects only enough additional blood plasma to satisfy 17% of the domestic need for immune globulin alone, with the remainder imported overwhelmingly from the U.S.

The United States has over 600 private, for-profit plasma clinics where donors are paid between $30-50 per donation.

“The fact that we’re buying plasma products from south of the border rather undermines our rationale for not paying donors here, because it suggests we don’t actually believe that payment is unsafe, commodifying, or exploitative, and shows just how badly these products are needed,” said ethicist Vida Panitch, Associate Professor at Carleton University and a signatory to the letter.

The letter is motivated by the sometimes fierce opposition to offering compensation for blood plasma donations for the manufacture of plasma medicines. The government of Ontario hastily banned compensation in 2014, as did the government of Alberta in 2017. The Province of Quebec had banned compensation in the Civil Code in 1994.

Economist and signatory Nicola Lacetera, Associate Professor at the University of Toronto, thinks there hasn’t been sufficient debate and discussion of the issue. “Whatever the final decisions about compensation will be,” he said, “a broader debate on these questions, and more comprehensive information to the public are warranted. The objective of this letter is precisely to encourage this debate and fully inform the public about it.”

Lacetera, along with frequent co-author Mario Macis—also a signatory to the letter and Associate Professor of economics at Johns Hopkins University—surveyed Canadians for a forthcoming academic paper. They found that a significant majority of Canadians considered compensation for plasma donations acceptable.

Ethicist Chris MacDonald, a signatory and Associate Professor in the Ted Rogers School of Management at Ryerson University, echoed Lacetera’s comments: “This issue is far too important—lives are quite literally at stake. We need to rely on the very best arguments, grounded in the very best evidence.”

“And the best evidence and best arguments support leaving compensation on the table, as one among many options,” MacDonald added.

The complete list of signatories: Alvin E. Roth (Stanford University, Nobel Prize), Vernon L. Smith (Chapman University, Nobel Prize), Jan Narveson (University of Waterloo, Emeritus, Order of Canada), Chris MacDonald (Ryerson University), Vida Panitch (Carleton University), Nicola Lacetera (University of Toronto), Mario Macis (Johns Hopkins University), Aaron Ancell (University of Toronto), Mark Fedyk (Mount Allison University), Glenn Fox (University of Guelph), Matthew Mitchell (University of Toronto), Vincent Geloso (Texas Tech University), Peter M. Jaworski (Georgetown University), Alex Tabarrok (George Mason University), David R. Henderson (Naval Postgraduate School, Emeritus), Jason Brennan (Georgetown University), Gerald B. Dworkin (University of California, Davis), William English (Georgetown University), David Faraci (Georgetown University), Jessica Flanigan (University of Richmond), Kimberly D. Krawiec (Duke University), Jonathan Miles (Quincy University), Jeffrey Moriarty (Bentley University), Jacob Sparks (John Jay College), James Stacey Taylor (The College of New Jersey), and Daniel Waxman (Oxford University).