The clinic was clean but cold, especially for the plasma donors. As they sat for an hour, blood was pumped from their arms into a centrifuge machine that spun their yellow, protein-rich plasma away from the heavier red blood cells. The plasma would be bagged, tagged, and flash-frozen, while remaining blood cells — now room-temperature, colder than when they left — were pumped back into their body, along with a chemical coagulant to prevent clotting. An impossible-to-ignore odor permeated the building — a mix of the iron-rich scent of blood and the acrid smell of the chemical. Unlike donating blood, when you donate plasma, your blood is returned to you — you get something back. But it’s a little different: colder, and a touch unnatural. And the process can wear on the body. Repeat donors have learned to bring their own blankets.
Kathleen McLaughlin was interviewing for a job. This plasma clinic was in need of another phlebotomist, someone to help administer the roughly 1,200 donations that came in weekly. Only McLaughlin didn’t have any medical training. She’s a journalist who was finally getting a behind-the-scenes tour of a plasma clinic for her book Blood Money: The Story of Life, Death, and Profit Inside America’s Blood Industry, published earlier this year, asking nonstop questions and hoping she wouldn’t be found out.
Ultimately, her medical background wasn’t that important. Instead, the managers were more interested in her customer service experience. Having a steady hand to puncture a vein is important, but a bedside manner is perhaps more so when your industry depends on new and returning customers to fill the clinic’s recliners seven days a week.
McLaughlin was in Michigan’s rust belt, speculating on the absence of the American auto industry and the seeming abundance of plasma centers that had sprung up in its place. Unable to donate plasma herself for health reasons, she hovered in parking lots, interviewing donors outside clinics in Flint, in a Mormon college town in Idaho, and along the US-Mexico border to learn more about the ins and outs of a nebulous industry operating at a deceptively large scale.
McLaughlin began her research assuming that hundreds of thousands of Americans donated plasma. Instead, she learned that roughly twenty million people donate plasma annually in the United States. (To be clear, this number is derived from working backward from the number of plasma units sold each year. The industry, which is run by private companies, does not readily release data.)
A Global Industry
The United States is one of five countries in the world where it’s legal to sell your plasma for money. And out of those five countries, the United States has the most generous policy around frequency. Germany allows people to give plasma fifty times per year, with intensive health checkups after every four visits; in the United States, people can donate 104 times, and clinic payments incentivize them to do so as frequently as possible.
In 2005, there were three hundred plasma clinics in the country. Today that number has almost tripled. Knowing these numbers, it’s no surprise that the United States is the largest exporter of human plasma, supplying two-thirds of the world’s supply. In fact, according to Blood Money, blood products accounted for nearly 3 percent of US global exports overall in 2021. Medicine derived from plasma is distributed around the globe and used for research, in surgery, and to treat immune deficiencies, hemophilia, blood disorders, and neurological disorders. McLaughlin is a beneficiary — she has a rare chronic illness that is treated with medicine made from plasma, and sitting for five-hour transfusions every six months gave her lots of time to ponder questions about the origins of her medication.
Questions like, “If my insurance is paying $12,000 per dosage for this medicine, how much are the people supplying plasma getting?” Payment for plasma donation, given on prepaid debit cards, varies from clinic to clinic but averages out to around $40 per visit. First-time donors can earn a higher rate to get them in the door, and returning donors can progressively earn more, provided they come consistently. Miss an appointment, and they have to start at the bottom again. But donate twice a week, or sign up for the right promotions and coupons, and you could take home an extra $800 to $1,200 each month.
There’s a careful calculation each donor must make, though. They’re paid for their donation, but not for the time it takes to get to the clinic or the downtime afterward, when the fatigue sets in and they can’t work. They have to hydrate and eat a healthy, protein-rich diet prior to donating. If their protein levels aren’t up to snuff, they could be turned away, with nothing to show for it but wasted time and gas money. One donor tells McLaughlin that about 5 percent of his earnings go toward the special diet regular plasma donation requires, and notes that if clinics provided light snacks, a little would go a long way. At least at a blood drive, you get free cookies.
Altruism and Income
Alongside her interviews and ethnography, McLaughlin provides small historic detours to build a bigger picture of blood and plasma giving. (It turns out that there is no proof Peter Thiel ever invested in blood boy technology. The Gawker defunder remains just a metaphorical vampire, not a real one.) We learn about Dr Charles Drew, the African American doctor who, despite intense racism, pioneered blood storage and transportation in the 1940s, a critical asset for Allied forces in World War II. And McLaughlin takes us to the bustling plasma economy in China’s Henan province in the 1990s that led to a massive HIV infection — which the government then covered up.
Blood Money sees traces of this crisis in the modern United States. Not the infection, thankfully — technological advances have ensured that all blood is heat-treated before usage. “What’s happening here is different,” writes McLaughlin. “It’s quieter, less deadly, but perhaps more insidious because of how successfully it’s been hidden and allowed to grow.” The industry’s brisk expansion, heavy churn of donors, and intentional placement of clinics in low-income areas all ring alarm bells. “It is an industry that exploits the United States’ lack of protections for the poor and the working class, in the service of global medicine and profit.”
Part of this exploitation seems to be tied to an inherent tension between altruism and income in the industry. From the moment they walk in the door, donors are reminded of the service their plasma donation provides. Marketing photos of smiling adults and children represent the faceless strangers who benefit from lifesaving drugs made from human plasma.
After all, in theory, donating plasma is like donating blood at your local Red Cross drive: you’re giving up a vital bodily substance for the greater good. However, because donating plasma takes at least an hour, whereas giving blood is much faster and less taxing, people are paid — ostensibly for their time. In addition, groups like the World Health Organization discourage paying for blood for “safety” reasons. When money’s involved, they say, people could lie about their health.
As a beneficiary of these drugs, McLaughlin is an effective ambassador for discussing the issue — and she finds the blood vs plasma payment a “wholly arbitrary distinction.” Both plasma and blood are tested before being used, so safety isn’t really an issue.
The monetary transaction over plasma donation “relies on a myth that most people are selling their plasma as a way to help people like me, not primarily for the money they get by doing it,” writes McLaughlin. But after speaking with more than one hundred donors, it’s clear to McLaughlin that no one is donating plasma for the warm fuzzies — they need cash. The money — not enough for a full income, at least in the United States — can supplement rent and student loans, but also go toward small luxuries people couldn’t afford otherwise, like a vacation or tickets to the Eras Tour.
Despite the industry’s insistence that donating plasma is primarily an altruistic act, there’s one very specific, recent example where plasma donation was treated as labor. And it happened at the US-Mexico border, another location where McLaughlin conducted her research.
Prior to the COVID-19 pandemic, roughly one thousand Mexican nationals crossed the US border every week to donate plasma at the fifty or so clinics in the El Paso, Texas, area. If the border guards didn’t hassle you, you could leave and return to Juárez in four hours. The money earned in the United States went further in Mexico, where — like most countries in the world — you can’t sell your plasma for money.
In June 2021, US Customs and Border Protection issued a statement saying that, effective immediately, donating plasma was considered “labor for hire,” meaning that the thousands of Mexican plasma donors who crossed into the United States temporarily on a visitor visa would now need a work visa. (The news that plasma donation was considered labor did not extend to the hundreds of other plasma centers around the country.)
Donations along the border, already slow due to the pandemic, dried up. The following year, the two largest plasma corporations — Spain-based Grifols and Australia-based CSL — teamed up to get the faucet spurting again, challenging the work visa requirement with a lawsuit.
Data behind the plasma industry, usually hidden behind the veil of private enterprise, came out in court filings. While most plasma clinics in the United States received one thousand donations a week, those at the border had been receiving 2,300. Out of more than one thousand US clinics, the fifty-two along the border provided up to 10 percent of the total US plasma supply.
That’s right — international companies sued in 2021 for their right to continue to collect the blood plasma of Mexican nationals at the border, who were contributing an outsize amount of plasma to the US national pool. This is just one of the stories from Blood Money that, in other contexts, might sound like an unhinged conspiracy theory. (I won’t get into the internationally exported, HIV-positive plasma harvested from Arkansas prisoners that the Clinton administration doesn’t want you to know about.)
Based on those numbers alone, it’s clear that the work visa requirement hurt these companies’ bottom lines. But the argument that helped sway a federal district judge to help overturn the decision? The human, altruistic side of plasma giving. Per Pro Publica, the judge said that “her decision to grant a preliminary injunction reflected the crucial need for blood plasma in manufacturing lifesaving medications.” The requirement was waived later that year.
A Priceless Commodity
To be clear, plasma does contribute to lifesaving medications. No one, including McLaughlin, is saying we should stop plasma donations, paid or not. But donors should be compensated fairly — not just for their time, but for providing a priceless commodity mined from their bodies (the long-term effects of which deserve more research). With a standard, just wage, donors wouldn’t have to gamify their trips to the clinic or sign up for promos and coupons like they’re going to a car wash.
To imagine a model for what could be, McLaughlin looked at a short-lived labor union of blood donors in 1930s New York City. Prior to the advent of Dr Drew’s blood banks, donors were needed immediately and on-site when blood was required for transfusions. Through the Blood Givers’ Union (chartered through the American Federation of Labor), blood donors organized for well-compensated minimum rates for every one hundred cubic centimeters of blood given. The union fizzled out with World War II and the advent of blood banks, which no doubt weakened the donors’ bargaining power.
If plasma donation was considered work today, McLaughlin notes, its union membership would number in the millions. A union could set a fair minimum payment for plasma and establish sustainable donation periods rather than rushing people in every two weeks, allowing people’s bodies time to recover from losing essential protein. And who knows — maybe they could bargain for some free cookies at the clinic too.
“Paid plasma extraction is, I have come to believe, low-paid, exploited labor,” writes McLaughlin near the end of Blood Money.
Thinking of plasma donation as work might feel uncomfortable for some. We may not like to admit that we live in a country where it’s completely legal, and even encouraged, to sell body parts for extra cash. But is it more uncomfortable than witnessing GoFundMes for insulin, fourteen-year-olds working factory night shifts, public schools in debt to private banks, and other current economic realities?
In a society where our basic needs were taken care of, donating plasma could be wholly altruistic. But we don’t live in that society. In the United States, a quarter of parents struggled with food and housing last year, and millions of people — people with kids, full-time jobs, and college degrees — sell one of their most precious bodily fluids for gas money.
And patients around the world, including McLaughlin, rely on critical medication made from plasma. But these faceless patients are used as justification for the obfuscation — and some would say exploitation — of donors’ rights. If we’re motivated by the health and well-being of others, Blood Money says, let’s start with the health and well-being of plasma donors in the United States.