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Ethicists and Economists for Ethical Donation Practices

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26 July 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 in opposition to Bill S-252, introduced by Independent Senator Pamela Wallin. The letter argues that both from an ethical and economic perspective, compensation for blood plasma donations should not be made illegal.

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, and clotting factors.

Given “the weakness of the economic and ethical arguments thus far presented against the compensatory model,” the letter, available at www.donationethics.com and addressed to Senators, reads, “we conclude that the present Bill is not justified in its current extreme form. A broader and deeper discussion should be had before we implement a complete prohibition.”

Medicine made with paid plasma donations is just as safe and effective as medicine made with unpaid plasma donations. But proponents of the Bill, including Senator Wallin, fail to recognize this fact, a fact that Health Canada, Canadian Blood Services, the Network for Rare Blood Disorders, the Canadian Hemophilia Society, the European Medicines Association, and others, have repeated numerous times.

“To suggest that plasma from paid donors is less safe than plasma from unpaid donors is to ignore the current scientific consensus,” said Aaron Ancell, signatory and Fellow at Harvard University’s Edmond J. Safra Center for Ethics. “It's akin to suggesting that climate change isn't real.”

“The proposal for a federal ban on compensation for plasma donors is not supported by evidence concerning, for example, the safety of plasma from compensated donors or the level of social support for compensation in the country,” said economist Nicola Lacetera, Associate Professor at the University of Toronto Mississauga.

Lacetera, along with frequent co-author Mario Macis, Associate Professor of economics at Johns Hopkins University, surveyed Canadians for an academic paper. They found that a significant majority (over 70%) of Canadians were in favour of compensation for plasma donations, with most saying it is “morally appropriate.”

Canada is almost entirely dependent on the United States for its supply of plasma-derived medicinal products. 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 paid donor plasma from the U.S.

“If Canadians truly believe it is unethical to compensate people for their plasma, then our entire system of supplying plasma is unethical,” said Jeremy C. Snyder, Associate Professor in the Faculty of Health Sciences at Simon Fraser University, whose primary research focus is on our moral obligations towards vulnerable populations. “Banning Canadian compensation won't change this and leaves us hypocritically encouraging ever more paid U.S. plasma.”

Ethicist Chris MacDonald from Ryerson University echoed Snyder’s comments. "Bill S-252 is well-intentioned but ultimately misguided,” he said. “It's hypocritical for us to pay everyone in the plasma process except donors, and hypocritical for us to ban paid donation here while importing plasma sourced from paid donors in the U.S.A."

The government of Ontario hastily banned compensation in 2014, as did the government of Alberta in 2017, and the government of British Columbia in 2018. The Province of Quebec had banned compensation in the Civil Code in 1994.

“At the very least, the proponents should inform the public of why they support this outright ban,” Lacetera added. “Canadians deserve to receive proper information about the costs and benefits of prohibiting compensation to plasma donors.”

The letter is signed by more than a dozen professional ethicists and economists. All signatories are Canadian or work at Canadian institutions, with the exception of ethicist David Faraci who signs on as co-founder of Donation Ethics.

The complete list of signatories:
Aaron Ancell, Edmond J. Safra Center for Ethics, Harvard University
David Faraci, Department of Philosophy, Durham University
Glenn Fox, Department of Food, Agricultural and Resource Economics, University of Guelph
Vincent Geloso, Department of Economics, Bates College
David R. Henderson, Hoover Institution, Stanford University; Graduate School of Business and Public Policy (emeritus), Naval Postgraduate School
Peter M. Jaworski, Georgetown Institute for the Study of Markets and Ethics, Georgetown University
Nicholas King, Department of the Social Studies of Medicine, McGill University
Nicola Lacetera, Department of Management, University of Toronto Mississauga
Chris MacDonald, Ted Rogers School of Management, Ryerson University
Douglas MacKay, Department of Public Policy, Center for Bioethics, University of North Carolina at Chapel Hill
Vida Panitch, Department of Philosophy, Carleton University
Jeremy C. Snyder, Department of Philosophy, Simon Fraser University
Alex Tabarrok, Department of Economics, George Mason University
Nancy Walton, Daphne Cockwell School of Nursing, Ryerson University

Additional quotes:
Vida Panitch: “Wallin’s proposed Bill misses the point. We are already buying plasma from paid American donors. So the issue shouldn’t be about whether to pay donors, but about who should be paying them. If we don’t want a for-profit model, we need a system of public sector compensation."

Alex Tabarrok: “Everyone who donates blood plasma helps someone else to live a better, longer life. Condemning donors who are encouraged by compensation is a dangerous and false morality of motives that harms Canadian patients.”

Douglas MacKay: “Bill S-252, the Voluntary Blood Donations Act, would prohibit compensation for plasma donations used in the development of plasma-derived medicinal products (PDMPs). The arguments in support of this Bill are weak. Canada currently relies heavily on plasma collected from compensated donors in the U.S. to meet the needs of Canadians for PDMPs and is highly unlikely to be self-sufficient in this regard through reliance n uncompensated, voluntary donations. Compensated plasma donations have proven to be safe and the use of compensation need not involve unfair treatment of donors. In my view, this Bill is not justified.”