Is it ethical or advisable to pay for plasma?

In the 19th century, women would sell their hair for a little pocket money. For a time, hair shaved from prison inmates helped meet surging demand for wigs and hairpieces, according to Smithsonian magazine, as did the shorn locks of novices entering convents.

Today, there are dozens of online sites where people can sell their hair. On the plus side, it’s painless and it grows back. In the minus column, the slow- growing crop only can be harvested every year or two. Blood plasma, on the other hand, can be donated twice every seven days. Ka- ching!

Plasma — the yellow liquid in which blood cells are suspended — is used in transfusions and processed into immunoglobulin therapies to help people with weakened immune systems.

Donating plasma is a lucrative gig, where compensation is permitted. Canadian Plasma Resources ( CPR) will pay qualified plasma donors $ 30 for their first donation, and up to $ 65 for a second donation the same week. A complex rewards structure incentivizes frequent donation and ties compensation to the volume of plasma extracted. Donors undergo screening, including a health questionnaire and medical exam.

A new deal between Canadian Blood Services and Spanish pharmaceutical company Grifols to collect more plasma from domestic donors has revived the debate over whether it’s ethical or advisable to pay for plasma.

The safety of Canada’s blood supply is a federal responsibility, but the decision to compensate plasma donors lies with each province and territory. The result is a regulatory patchwork: In Ontario, Quebec and B. C., donations are strictly voluntary, while donors can be compensated at private clinics in Saskatchewan, Manitoba, Alberta and New Brunswick.

Ontario took steps to prohibit paying plasma donors in 2014, when CPR tried to enter the Toronto market. Tapping the student demographic, a pay- for- plasma clinic was planned near the University of Toronto’s downtown campus. It was also next door to a homeless shelter, raising concerns about targeting vulnerable populations, as well as public confidence in the integrity of health questionnaires completed by donors in financial need.

The Voluntary Blood Donations Act in Ontario formalized one of the key recommendations of the Krever Commission, which urged significant efforts to ensure blood products used in Canada are made from blood and plasma collected from unpaid donors.

The lessons of Canada’s worst public health crisis were fresh in the minds of Canadians. Some 2,000 people contracted HIV from insufficiently screened blood products in the 1980s; another 30,000 were exposed to hepatitis C.

The Krever Commission identified shocking systemic failures contributing to the tainted blood tragedy. They included meeting the demand for plasma by importing it from U. S. prisons and paid donations in highrisk areas, at the height of the AIDS epidemic.

Voluntary donation helps preserve the safety and integrity of Canadian blood products. The same sensible principle governs organ donations, and donor eggs for in- vitro fertilization. Demand for these life- giving donations chronically exceeds supply. Nevertheless, procurement remains voluntary; they cannot be bought. In Canada, compensation for egg donors is limited to reimbursement for expenses.

Being paid for donating plasma is not like selling a kidney, but neither is it quite like selling your hair. Lives are at stake if the supply is vulnerable to compromise — or if there’s not enough.

Plasma donations in Canada currently do not meet domestic need. According to CPR, about 80 per cent of immunoglobulin therapies used in Canada are currently made with plasma from paid donors in the U. S.

Voluntary donation helps safeguard our plasma supply, but if it leaves us dependent on plasma from paid donors in other jurisdictions, it’s not clear we’re any further ahead.