Unlike the donation of whole blood, which is voluntary, blood plasma donors in China are compensated in much-needed cash, a practice that is causing growing health problems among the rural poor.
A new study by a Yale School of Public Health researcher published in the journal Health Economics Review reveals how members of farming families in western China who use commercial blood plasma donation to supplement their income suffer from an increased risk of infectious disease and general poor health.
“Overall, the poor often treat their blood as fluid labor. They extract this resource when greatly needed,” said Dr. Xi Chen, assistant professor in the department of health policy and management. “Some need cash to send children to school. Some need money to build fancy houses to attract potential brides, as the marriage market is tightening.”
Because privatized blood banks fall outside the scope of much government regulation, oversight of the process is spotty. As a result, the blood banks do not consistently follow standardized, hygienic procedures. Often, according to Dr. Chen, they ignore sterilization, and share centrifuge machines and needles amongst patients without checking for viruses, which has caused an increase in infectious diseases such as HIV/AIDS and hepatitis C. The same nonstandard procedure to collect plasma resulted in the deaths of more than one million people in central China’s Henan province, Dr. Chen said. With tightening regulations, the blood banks have been moving to more impoverished areas.
In addition, many people are given incentives to donate frequently, as often as twice monthly. Without proper compensation in their diets for the loss of plasma, some are left weak and more prone to illness. This has had a profound economic effect on communities as well. In some villages, much of the farmland is left uncultivated, said Dr. Chen, because of the negative health effects that frequent plasma donation has on farm workers.
Though some donors are aware that donating blood plasma is dangerous, the financial incentive for many is too great to ignore. There is high demand for blood plasma, which is sold to pharmaceutical companies who use it in the production of blood products and medications.
Dr. Chen plans to continue this study, as more questions have arisen from its results. Most of the plasma donors he encountered were women and Dr. Chen said he wants to find out why that is the case.
“How does a poor household decide which family members should donate?” he asked. “This is very important to women’s well-being.”
In the meantime, the plasmapheresis industry and blood donation centers in China should learn from their counterparts in the United States. After problems with paid donation operating procedures occurred in the United States decades ago, the FDA has been effectively regulating the sector. Donors are screened before every donation, databases of donors are shared between centers to ensure that donors are not “plasma shopping,” and all equipment that touches a donor’s blood is made up of disposable tubing that is used only once, said Chen.
Dr. Chen is confident that changing the system in China is not impossible. “Commercial plasma collection does not have to be a danger to the donors,” he said
The study was funded by two grants from the China Natural Science Foundation (CNSF approval numbers 70525003 and 70828002), and a doctoral research award in the theme project, titled Persistent Poverty and Upward Mobility, from the Institute for Social Sciences at Cornell University.