Safe, Legal, Ethical: The Case for and Against Selling Blood Plasma

If I asked you to name a quintessentially American side hustle, what would you say?

Delivering pizza, maybe. Or delivering newspapers. Or maybe just picking up a couple shifts at a local restaurant, bringing diners hamburgers and slices of all-American apple pie.

You almost certainly wouldn’t say selling plasma, which is interesting, because in the past few decades, that has quietly become one of the major sources of secondary income in this country. On any given day, tens of thousands of people file into collection centers across the US, present their arms, and have the plasma extracted from their blood for a few dozen bucks a pop.

Selling plasma is illegal in almost every other country in the world, but it’s perfectly legal in America. “What’s up with that?” is a very interesting question, as are the two obvious follow-ups: “Is this ethical?” and “Is this safe?”

What is blood plasma, and why does anyone want to buy it?

Plasma is the liquid part of your blood, constituting about 55% of its volume. It has nothing to do with the “plasma” that you’ll find in glowing neon signs and the northern lights, which is electrically charged gas. The two substances just share a name.

By itself, with the red blood cells removed, plasma is a runny, yellow substance. If you saw it in a collection bag, you could easily mistake it for another, rather more familiar bodily fluid, but it’s considerably more useful.

Plasma is mostly composed of water, but about 10% of it consists of solids, including proteins with names like immunoglobulin, albumin, and—stay with me here—coagulation factor VIII. These proteins have vital functions. They clot your blood when you get injured, help your immune system fight off disease, and generally work very hard to keep you alive.

Plasmapheresis and fractionation

Your plasma can keep other people alive, too.

Plasma is a medically useful substance. It can be directly given to people in transfusions, but it’s also possible to process it and extract its component proteins, turning them into medications for people with blood clotting disorders, dysfunctional immune systems, and so on.

Plasma can be collected in several ways, but one of the most common is a process called plasmapheresis. This usually involves drawing your blood and placing it in a machine—a centrifuge—which spins rapidly, separating it into layers. The layer of plasma is skimmed off, and the rest is injected back into you (often after being supplemented with saline to replace the fluid you lost).

Plasma has many potential uses, but if you “donate” it at a paid plasma center, it has only one possible fate. It will undergo another process, fractionation, to further separate it into its base components, especially those key proteins.

These will continue on their journey and, in many cases, will eventually be injected into somebody else, quite possibly saving their life and almost certainly making it much more pleasant and livable.

The controversial status of the blood plasma industry

You’re probably getting why blood plasma is important. It’s an immensely valuable substance, and in many places, there isn’t enough of it to go around.

That’s why there are companies that will pay you for yours. In particular, three dominate the US plasma industry:

• BioLife (a subsidiary of Takeda)
• CSL Plasma
• Grifols

Together, these harvest upwards of two thirds of the paid plasma that’s collected in the US, which, again, is one of the only countries that allows them to do this.

Depending on how you count, there are anywhere between 193 and 237 countries in the world today. In the vast majority of those, all of the plasma that’s collected is genuinely donated. Compensated plasma collection is legal in just five.

Even in the countries where it’s allowed, the practice is controversial. The most prominent organization that has taken a stance against it—there are many—is the World Health Organization (WHO), which advocates for a plasma collection model that relies on “100% voluntary non-remunerated blood donation.” 1

In the view of many people, blood plasma belongs in the class of things that should only be freely given, never sold.

Why do people oppose the paid plasma industry?

There are many arguments against paying for plasma, but the most common include:

• It’s exploitative: Paying people to tap their veins and sell their blood is, shockingly enough, something that a lot of people believe is morally wrong, especially given that many sellers are, like CJ, financially struggling and lack other options.
• It’s unhealthy: Some people believe that frequently donating plasma is rough on the body and could cause long-term health problems.
• It’s dangerous: Still others are concerned that paying for plasma may incentivize people to donate even if they have bloodborne illnesses, risking incidents like the tainted blood scandal of the 70s–80s, in which tens of thousands of people were given blood products that were contaminated with HIV and hepatitis C.

So how reasonable are these objections?

The short answer: donating plasma is broadly safe

We can (mostly) dispense with the latter two arguments very quickly.

First off, you can’t get HIV from selling your plasma. You just can’t. You also can’t get hepatitis B or C or whatever other terrifying disease you have rattling around in your head, nor can paid donors transmit those diseases to others.

The clinics that collect plasma screen all of their donors, both for health conditions that could make the process dangerous and for communicable diseases. They draw blood using sterile, one-use-only instruments, and test the plasma itself after extracting it. They then subject it to a barrage of viral inactivation treatments, which may include (but aren’t necessarily limited to):

• Heat-treating or pasteurizing it
• Bathing it in solvent-detergents
• Nanofiltration (straining it through filters with microscopic holes that catch many viruses)
• Blasting it with UV light

There was a time, back when pathogens like HIV weren’t as thoroughly understood as they are today, that there was a risk of them getting into the plasma supply, but that just isn’t going to happen today. Not in the US, anyway.

What about the health impact of giving plasma? Is it hard on your body, even if you can’t catch (or transmit) anything scary?

Here, things get a bit trickier, but as far as we know, plasmapheresis is safe. The medical literature on this is surprisingly scanty (more on that below), but millions of people regularly sell their plasma, and they mostly seem fine.

In the course of researching this article, I spoke to several plasma sellers. CJ was one. Another, Jordan Scribner, told me that when he first signed up, he had to watch several videos that listed the potential side effects he might experience.

If you’re ever undergone a medical procedure or even watched a drug commercial on TV, you probably have some idea of what these are like: “Side effects may include dizziness, bruising, fainting, spontaneous combustion, or suddenly turning into a speckled toad. Sign here to promise you won’t sue us if that happens.”

If you sell your plasma, there’s certainly a chance that you’ll bruise or feel dizzy. You might faint, although it’s unlikely. If you search the web, you can find lists of other, more serious side effects you could experience, such as an adverse reaction to the citrate anticoagulant that’s used in the collection process. That does happen, but it’s even rarer, and it also won’t kill you.

The bottom line is that, at least when it comes to short- and mid-term effects, giving plasma seems to be safe. When it comes to the potential for long-term health impacts, not everyone is convinced, but that’s getting into speculative territory.

Don’t worry, we’ll come back to that later.

Let’s accept for the moment that selling plasma is, in fact, safe.

Even so, many people still disapprove of it. If you dig into this, sooner or later—probably sooner—you’ll encounter the 2023 book Blood Money by the journalist Kathleen McLaughlin. It’s a deep dive into the American plasma industry, and it isn’t particularly complimentary.

McLaughlin does not, of course, speak for all the critics of compensated plasma donation, but she’s one of the only people to write a popular book on the subject, and you’ll see hers referenced in discussions across the internet. “Should I try selling plasma?” “I’m not a fan. You should read Blood Money.”

From beneficiary to critic

McLaughlin has an interesting story. She has chronic inflammatory demyelinating polyneuropathy (yes, I know), a serious autoimmune condition that causes the body to attack its own nerves. The disease is usually nonfatal, but “usually” isn’t the same as “always,” and even when it doesn’t kill, it can cripple. Fortunately, it can be treated with regular doses of plasma-derived medication.

MacLaughlin received these for decades before growing curious about the industry that supplies the substance that allows her to live a mostly normal life. She decided to investigate it, and what followed was her book.

Blood Money is a good read. It also contains a number of passages that are remarkably disturbing, and examining them is instructive, because they’re emblematic of the tenor of the debate around paid plasma.

McLaughlin spent much of her career in China, and instead of opening her book with a description of the American plasma industry, she tells an eerie story about Henan, a Chinese province that was left behind by China’s “warp-speed growth” in the 90s.

To drum up income, Henan’s officials opened “blood stations” across the province, and its residents—who were mostly poor farmers—sold plasma in staggering quantities. At the height of the craze, the air in most of the region’s towns and villages was heavy with the iron-rich smell of blood.

Unfortunately, in the growth-at-all-costs environment that pervaded China at the time, safety wasn’t a priority. The nurses and technicians who staffed the plasma clinics didn’t so much cut corners as shred them with a wood chipper. They failed to properly screen donors, reused tools, and violated other basic sanitation protocols. Whistleblowers tried to sound the alarm, and the Chinese Communist Party silenced them.

In 1995, HIV first showed up in Henan’s pool of blood plasma, and it quickly spread. No one knows how many people were infected before the Chinese government shut down the industry, but it was almost certainly north of one million. Today, most of those people are dead; the few survivors, who were left impoverished by the collapse of the plasma scheme, eke by on meager payouts from the government.

As an example of how the plasma industry can go wrong, this story is chillingly effective. But.

But but but. These events happened in China in the 90s. Nothing like that is going to happen in modern-day America, where plasma collection is much more tightly regulated. There is an argument to be made that by opening with this, McLaughlin is being more than a little unfair, priming the reader to judge the American industry guilty for a horror story that took place nearly three decades ago and a world away.

“Predatory,” “exploitative,” and other fun words

That said, McLaughlin also gives plenty of details about the US plasma industry, and even if you think she’s stacking the decks, it’s worth reading her book for them.

Within the first few chapters, you’ll learn that most of the plasma collected in the US is, indeed, harvested from people with relatively low incomes. There’s no secret about this; you can tell by looking at a map. Extraction centers tend to cluster in poorer areas.

Take Flint, Michigan, a town so infamous that it requires no introduction. Flint, with a population of around 79,000, is host to no fewer than five clinics, or one per every 16,000 people. McLaughlin’s hometown of Missoula, Montana, which is significantly richer but has nearly the same population (76,000), is host to exactly one.

Similarly, there are more than 40 extraction centers along the US-Mexico border. A significant portion of the plasma collected in America actually comes from Mexican citizens, who cross over on short-term visas to sell it. The payouts they earn go much further in Mexico than they would in the United States.

(In 2021, US Customs and Border Protection tried to shut this down. The plasma collection companies fought them in court, and at present, appear to be winning.)

There’s no way around it: the plasma industry largely subsists on the blood of the less well-off. Many of these people probably would not donate if their circumstances didn’t force them to do so. Plasma companies are clearly well aware of this.

McLaughlin doesn’t think much of this. Words like “predatory,” “exploitative,” and even ”vampire” appear more than a few times in her book, both in reference to the plasma industry and to America’s economic system, which drives people to participate in it.

The profit motive and the global plasma market

In many plasma centers, when you sign up, you’ll be shown videos that explain how wonderful giving plasma is and how much it helps people. These feature diverse casts of attractive people who would, of course, all be desperately ill if not for your plasma.

“Are those as cringe as they sound?” I asked CJ (which, admittedly, was a rather leading question).

“Yeah, absolutely,” he said. “They felt like stock videos.” He added that he wondered whether the people in them were real patients or just paid models and actors.

I asked him if the videos ever said where most of these beneficiaries were located.

“They definitely didn’t mention that.”

Plasma companies don’t publicize it, but much of what they collect isn’t meant for domestic use. It’s exported.

That’s because the US is one of just a few countries that actually produce more plasma than they need. As McLaughlin reports:

• In 2021, the US earned more than $24 billion from the worldwide sales of its blood products.
• These accounted for 2.69% of its total exports, a higher percentage than soybeans (and soy is, itself, the US’s single biggest agricultural export).

In other words, plasma makes up a significant portion of the US’s export economy, and a much bigger slice of the pie than most people realize.

It’s true that when you give plasma for money, you’re genuinely helping people. But it’s also true that you probably aren’t directly helping your friends and neighbors, who are lucky enough to live in a country that already has a surplus. Instead, your plasma is being sold on the global market for a hefty profit.

I’ll lay my cards on the table: when I learned these facts, they struck me as pretty unsavory. McLaughlin certainly seems to take it as a given that they make the industry “exploitative,” and reading her book, it’s hard not to nod along and agree.

But, in fact, there’s a logical leap there. The mere fact of money changing hands doesn’t make something wrong, and while I can’t say I relish the thought of plasma clinics springing up in staggering numbers in some of our country’s most disadvantaged communities … in the end, can you really blame them? Aren’t they just going where the demand is?

And paid plasma does have its champions. One of its most ardent—and most prolific—is Peter Jaworski, an ethicist and professor at Georgetown University, who’s built his career on defending this industry.

I contacted Jaworski, and he agreed to sit for an interview. Over the course of an hour, he walked me through the arguments in favor of the compensated model. There are many, and if you want to read all of them, you can read his treatise, Bloody Well Pay Them.

To my mind, the strongest argument he put forth was: there is no other way.

The not-quite-global shortage of blood plasma

Again, there are exactly five countries that allow people to sell plasma: Germany, Austria, Hungary, the Czech Republic, and the United States.

There are also exactly five countries that collect enough plasma to meet their medical needs: Germany, Austria, Hungary, the Czech Republic, and the United States.

“None of the countries that do not pay for plasma collect enough,” said Jaworski. “Not one. The last time a country collected enough plasma without paying donors was New Zealand in 2014. It’s been a decade. It’s been a decade since there was even one counter-example.”

There is one reason why patients are not dying en masse in places that ban compensated collection. They buy plasma in huge quantities from countries that don’t.

The US is by far the biggest player here, providing 65% to 68% percent of the global supply used to manufacture plasma therapies. This is despite the fact that plasma self-sufficiency is a policy goal for many countries. It’s not ideal when huge classes of vital medications are sourced from abroad—it approaches a national security concern, in fact, because it means that any disruption in the supply chain could turn deadly. But achieving self-sufficiency with a non-remunerated model seems to be very difficult.

In Canada, where Jaworski is a citizen (despite living and teaching in the US), there is a fierce debate over whether paying for plasma should be legalized. In 2020, the Legislative Assembly of Alberta heard dueling presentations from both pro- and anti-paid plasma figures. Jaworski presented, as did one of his opposite numbers, Kat Lanteigne, the founder of the activist group BloodWatch.

The transcript of Lanteigne’s presentation is blistering. In her words, it is “a studied fact that the paid-donor model targets poor and vulnerable populations … there’s nothing attractive about the American model right now.”

Jaworski’s response is that the moral argument against paying is “incoherent.” Countries that prohibit paid plasma still rely on the paid-donor model, however distasteful they find it. They just indirectly pay American sellers instead of their own citizens.

Nobody’s favorite thing to talk about

I asked Jaworski if, by and large, people know that no countries that prohibit paying donors are self-sufficient.

“No,” he said. “Sometimes when I go out and give talks at conferences, I’m surprised that people who work within this space are not really aware that there isn’t even one example.”

I said this issue seemed under-covered to me, academically and journalistically, and he agreed.

“I wish I could tell you why, but I’m not sure,” he said. “I wish more people would talk about it … I think it’s partly that people don’t want to think about it.”

He reflected for a second.

“I mean, I don’t know how you feel about blood, but if I didn’t have an academic interest in this, it’s not like I would want to think about it all the time. It’s gross, right? I have a fear of needles, and a lot of other people do too, so it falls through the cracks.”

Talking money: the math of blood plasma collection

Jaworski strongly pushed back against the idea that plasma companies exploit donors. There’s a persistent rumor that they make huge sums off of each donation. Sometimes the number is $1,000, sometimes it’s $5,000, but the implication is always that plasma clinics are cheating people and keeping the lion’s share of the profits.

This is not true.

When clinics extract plasma, they take between 700 and 800 milliliters (0.7–0.8 L), generally paying anywhere between $40 and $100 for it.

“The current price of a liter of plasma is about $200,” said Jaworski. He went on to rattle off the overhead expenses that clinics have to cover: rent, the cost of the machinery they use, their employees’ salaries, and so on. In the end, he told me, “the company gets something like $20 to $40 per liter.”

According to Jaworski, when you sell your plasma, it’s perfectly true that your split with the company isn’t 50-50. That’s because you actually take home substantially more than they do.

Do these numbers check out?

A skeptical reader might be inclined to be suspicious of Jaworski’s figures.

However, they check out. You can verify them yourself with a little research and some back-of-the-napkin math. In 2017, Canadian Plasma Resources, a formerly independent company that’s now owned by Grifols, made an offer to Canadian Blood Services to sell plasma for $125 USD per liter.

They also listed price estimates for several major plasma-derived products, which will give you an idea of what vertically integrated companies like CSL Plasma stand to make after selling your fractionated plasma:

• Intravenous immunoglobulin (IVIG): $225 for 4.5 grams (the estimated yield from 1 L of plasma)
• Albumin: $60 for 24 grams (ditto)

Inflation has yanked those prices higher since 2017, but not hugely, and they represent gross profits—what the companies stand to make before accounting for their expenses.

Any way you slice it, plasma companies aren’t pocketing thousands of dollars while paying donors pennies. Even if you pretend that they have no overhead at all, they simply aren’t bringing in that much to begin with.

In 2019, The New York Times published an article on the ethics of the plasma industry. In it, a donor named Kevin Hayway is quoted as saying, in reference to plasma companies, “I know they get a lot of money. I would say they should pay more, but that’s just my opinion.”

This is a common sentiment. Several interviewees in McLaughlin’s book echo it, and she seems to agree. But it isn’t clear where that money is supposed to come from.

It’s true that plasma companies are profitable, but that’s because they process tens of millions of donations per year, not because their profit margins are particularly high.

The origin of the rumor

It isn’t hard to figure out why people suspect that plasma companies are cheating them. Plasma-derived medication is expensive, far more so than the cost of the raw material demands.

McLauglin writes in her book that “each session at the infusion center costs my insurance company more than $10,000.” By the time plasma products reach people’s veins, their prices have been greatly inflated.

I contacted Roger Kobayashi, a clinical professor at the UCLA School of Medicine, and asked him about the perception that plasma companies are cheating donors.

Kobayashi has a fair amount to say about the price of plasma therapies. He was quoted in the NYT article I just linked, giving the then-price of immunoglobulin ($300), and in 2021, he gave a presentation to the Kansas State Legislature on the medicine’s sky-high costs. He’s a strong advocate for making these treatments more affordable and accessible.

“I don’t think the manufacturers are making exorbitant profits,” he told me via email. In his view, the punishing cost of plasma treatments, which he called a “travesty,” can be largely blamed on “distributors, hospitals, end dispensers, PBMs [pharmacy benefit managers], and others who have marked up the end price enormously.”

He went on to refer to these “middle men” as “villains” and, even more colorfully, as ”cockroaches.”

“The CSLs, the Grifols, et. al, have some blame,” he said. However, the bigger problem is the other people and organizations in the plasma “food chain.”

Put another way: Yes, American healthcare is broken. That’s news to no one. But it isn’t the plasma industry’s fault.

The hidden undercurrent to the blood plasma debate

There is something underlying the entire conversation around paid plasma collection. To date, I haven’t seen it explicitly acknowledged anywhere, but to one degree or another, it affects the discourse in every respect. It’s the specter of politics.

It’s no secret that we live in a fiercely polarized age, and medical issues are often particularly charged. Take these questions:

• Should the US move toward a universal healthcare system, even if it means some people will effectively be subsidizing other people’s treatments?
• Did the US go too far with COVID lockdowns or mask and vaccine mandates?
• A 13-year-old says they’re trans. Should they be put on puberty blockers or hormones?

Not only are these questions political, they are partisan. People respond to them based on what team they belong to. I have my own thoughts on them, and in all likelihood, so do you, and if I knew your answers, I’d be able to guess whether you usually vote for people with (R) or (D) by their name with a pretty high level of confidence. Assuming you vote.

So, too, with paid plasma donation. The conversation around it isn’t as venomous as around the issues I just mentioned, but it still breaks down fairly neatly along political fault lines.

I don’t know for a fact what Lanteigne or McLaughlin’s politics are (neither responded to my request for comment), but at least for McLaughlin, I can make a pretty good guess. She writes a Substack titled Notes on Class, and in Blood Money, she refers to Donald Trump as a “horrifying circus act.” Her book received a very credulous review in Jacobin, which is an explicitly socialist magazine. Draw your own conclusions.

As for Jaworski, his treatise, Bloody Well Pay Them, was published in the US by the Niskanen Center, a libertarian think tank, and he has been favorably covered by (and has written for) Reason, a magazine that describes itself as libertarian and is generally considered to lean right.

It makes sense, when you think about it. On one side, you have the erstwhile defenders of the exploited poor. On the other, you have the erstwhile defenders of the free market.

To be clear, I am not suggesting that the people on either “team” are partisan hacks. To the contrary, at least when it comes to McLaughlin and Jaworski, I believe both are good-faith actors doing what they believe is right.

But the specter of politics still clings to this whole issue, clouding it, making it so that when you discover a source of information, it’s just a little bit harder than it should be to tell if what you’re reading is credible or if it’s just the approved position of Team Red or Team Blue.

It also injects a bit of toxicity into the debate, and even—occasionally—a kernel of danger, albeit of a rather petty variety. Jaworski told me that once, an opposing activist (who he did not name) called his university, trying to get him fired.

“She was confused about how universities work,” he said. “She thought she could get me in trouble with my employer by picking up the phone and being like, are you okay with one of your employees running around saying it’s okay to pay for plasma?” He laughed. “Obviously, the university was like—what are they gonna do? I have academic freedom.”

The least worst option

Let’s circle back for a second and talk about the exploited poor—those unfortunate folks who the left-leaning critics of paid plasma are so concerned with defending.

There are truly predatory industries out there that exist to prey on them. Set aside the question of whether plasma collection is one of them for a moment and consider an example that’s even more controversial: the payday lending industry.

Payday loans are short-term loans with astronomically high interest rates. Their critics allege that they’re traps that pull people into never-ending whirlpools of bad debt.

Payday loans do have their defenders (hello again, Reason!), but even if you see them as a necessary evil, they are undeniably risky. You don’t ever want to visit a payday lender if you can help it.

What does this have to do with plasma?

A recent study published in The Review of Financial Studies attempts to address the question: does selling plasma ultimately help or hurt people? The authors, John Dooley of Washington University in St. Louis and Emily Gallagher of the University of Colorado Boulder, look at what happens to the demand for payday loans in a neighborhood when a new plasma center opens up.

Perhaps unsurprisingly, they conclude that selling plasma helps people avoid taking on unwanted debt. Specifically, they write that:

• On average, within 3 years of a plasma center opening, “payday loan transactions among young adults decline by 18%”
• Selling plasma allows people in the US to collectively avoid between $180 and $227 million in payday and installment debt every year (although they’re careful to note that this is a “back-of-the-envelope estimate”)

The upshot is that, even if it isn’t idyllic, for some people, selling plasma might be the last line of defense against something worse.

So is that it—have we solved it, then? Plasma companies meet a global need, pay people more or less fairly, and help them avoid debt … so that means that selling plasma is good, right?

Not so fast. There’s a line in Gallagher and Dooley’s paper that reads, “the potential health effects of regularly donating plasma are unknown but may take a long time to build.” This prevents them from concluding that it really is a net benefit to people.

I did say that we’d come back to the health impacts of selling plasma.

A surprising gap in our knowledge

Again, as far as we know, plasmapheresis is safe.

But that phrase, as far as we know, covers up a troubling reality. If you dive into the medical literature on this, you’ll find that we don’t know nearly as much as we’d like.

The practice appears to be safe in the short- and mid-term. But is it hard on the body when you do it frequently? Does it cause subtle damage that accumulates over time, only manifesting as health problems later in life?

We don’t know.

There simply haven’t been many long-term studies into this, and those that do exist are inconclusive. That’s not because researchers don’t care; it’s just difficult and expensive to study something like this.

Moreover, many studies are not applicable to very frequent donors. In Austria, for example, which allows paid plasma donation, you can do it up to 50 times per year. The American Red Cross allows you to donate (not sell) plasma once every 28 days, or just 13 times per year. Much of the research on plasmapheresis has been conducted on people who donate at roughly these frequencies.

However, in the US, you can sell plasma at a paid extraction center twice per week, or 104 times per year.

An invitation into uncharted territory

Plasma companies actively incentivize frequent donation by boosting their payouts if you go twice per week. CJ told me that when he was a donor, he received around $47 for the first donation he made each week, and $65 for the second. (This was in 2023, at a CSL Plasma center in Lansing, MI.)

CSL encouraged him to return with a loyalty system. By visiting frequently, he was able to advance through “tiers” with names like Bronze, Silver, Gold, and Platinum, earning rewards that he admitted he rarely paid much attention to.

It’s not surprising that plasma centers like it when donors return as often as they’re legally allowed to. However, if you donate that frequently, you’re in murky territory, scientifically speaking.

Further research is required

This is something that it would be easy to overstate for dramatic effect. It’s important not to do that.

If something’s been insufficiently studied, that means we can’t definitively state that it isn’t dangerous, but the flip side is also true. We can’t claim to know that it is.

In Blood Money, McLaughlin flirts with this, seeming to take it as an article of faith that giving plasma frequently may damage the body. “A practice that makes some people faint and feel ill, or need to sleep for hours—done twice a week for years on end—can’t be that innocuous.”

Grim pronouncements like that make for engaging reading, but most of the healthcare researchers I contacted were much more cautious. However, McLaughlin goes on to say something that few would disagree with: “It deserves more study.”

Literature reviews of the available evidence

There have, in fact, been several literature reviews of the science around plasmapheresis, including this 2023 review in Vox Sanguinis and this subsequent paper (which is upcoming and has not itself been peer-reviewed). However, neither review is dispositive. The authors bemoan the lack of conclusive research and advise donation centers to be careful, but stop well short of suggesting that twice-weekly donation hurts people.

I wrote to one of the authors of the first review, Veronica Hoad of Australian Red Cross Lifeblood, and asked her whether the science on this was as scanty as it seemed. Lifeblood’s spokesperson, Jemma Falkenmire, conveyed her response to me.

In Hoad’s view, “there is little evidence to date that there are donor health impacts” in the long term. She expressed more concern over the acute side effects that we know for a fact do occur (albeit rarely), such as citrate reactions. Ultimately, she also agreed that “the quality of the evidence is poor.”

She also deployed a phrase so infamous in academia that it has its own Wikipedia article. Say it with me, with feeling: further research is required.

Is your head hurting yet from the uncertainty? Then pop a pain pill, because there’s just a little more on the way.

That Canadian activist group I mentioned, BloodWatch, maintains a list of people who are against paid plasma. On it, you’ll find Jacalyn Duffin, a doctor and former professor at Queen’s University. She has enough awards and honors to her name that I’m not going to list them; this article is long enough already. She has a Wikipedia page, too. Check it out sometime.

Duffin knows a thing or two about blood. She’s a hematologist (a doctor who treats blood disorders), as well as a medical historian. In addition to signing her name to BloodWatch’s cause, she was featured in a 2018 CBC piece on the great plasma debate.

“I trained before we had AIDS, before we knew what Hepatitis C really was, and that experience made me very wary of the potential risks of this kind of collection,” she’s quoted as saying. “In the past, we saw that the contamination rate was influenced by people who were lured into selling their plasma, or their blood products, because they needed the money very badly … people on the streets, drug users, people who were short of money … these were people who had a higher rate of infection.”

In other words, Duffin is still concerned that the paid plasma model may lead to serious diseases getting into the plasma supply.

Is this a fair argument?

Let’s get one thing out of the way. Genuinely homeless people can’t legally sell plasma in the US. Neither can hard drug users. All clinics screen for that.

However, people have been known to lie on occasion. Let’s assume that the promise of easy money incentivizes some of them to try to bluff their way through the screening process, and for the sake of argument, let’s say that they occasionally succeed.

Is that a problem? After all, there are all of those safety measures we talked about. The tests. The solvent-detergents. The nanofilters.

That’s exactly what I asked Duffin about.

She wrote back to me and said that, while it’s true that plasma companies thoroughly test each batch they collect, they “can only test for pathogens that have already been identified.”

“As a historian, I know—and as a physician, I expect—that new communicable diseases will arise in the future,” she wrote. “And they will appear in blood.”

Any new bloodborne disease, she said, will “appear with greater frequency in people who are obliged to sell their blood because of their circumstances.”

None of the other physicians and researchers I got in touch with expressed similar fears, and in our conversation, Jaworski took pains to stress how seriously clinics take their sanitation and testing procedures. He pointed out that the main plasma companies are not American, and consequently, they’re doubly and often triply regulated.

CSL Plasma, for instance, is an Australian company. It operates in the United States, and often sells plasma to Canadian patients. This means that they have to comply with three sets of regulations and as many sets of inspectors (who fly in to check for compliance).

But it’s true that plasma centers cannot test for diseases that haven’t been identified and described yet. There’s no way to regulate your way out of that quandary.

Critics of Duffin’s argument might point out that if new bloodborne illnesses appear, that could happen in plasma that’s freely donated, too, so this isn’t a problem with the paid model so much as an inherent risk of the whole practice. Duffin’s response would probably be to reiterate that we’re more likely to see something scary in the blood of the relatively vulnerable people who donate for money.

That isn’t really something that can be proven or disproven; it will either happen or it won’t. And it appears we’ve reached something of an impasse.

I’ll admit that my own initial reaction to Duffin’s objection was skeptical. Which, of course, means precisely nothing; I have absolutely no medical training. At least one hematologist and scholar of the medical field with a host of very impressive-sounding letters after her name thinks there’s cause for concern. Take that as you will.

Maybe—just maybe—we’re biting off more than we can chew by trying to definitively establish whether paying for plasma is perfectly safe and perfectly ethical.

On the level of the individual donor, what is it like to do this regularly, week in and week out?

Is donating plasma painful?

Plasmapheresis doesn’t hurt, except for the part where you get stuck with a needle. Obviously, that part hurts a little.

In the course of researching this article, I talked to several people who’d frequently given plasma (none of them are current sellers). I’ve already mentioned two of their names: CJ and Jordan Scribner. They reported very different experiences.

“Apparently, I have weird veins,” said CJ. “They tell me that every time I donate blood or have to get blood drawn—they’re always like, oh, your veins are moving around. So sometimes I would go and it would take me like 30 minutes, and sometimes I would go and it would take an hour just for the blood draw.”

Believe me, CJ, as a fellow weird-vein-haver, I sympathize. By contrast, Scribner said he’d never had that problem.

“I’m a big guy,” he said. “I’ve got a lot of blood. They never had a hard time finding a vein. I never had any complications, and I was doing this once or twice a week for just shy of two years.”

Far from finding donating painful, Scribner actually enjoyed the experience. “Once the needle was in and taped down, I would just relax and read a book, or watch whatever movie they were playing on the screen there.”

Donating was Scribner’s “me time”—a biweekly period of 45 minutes to an hour when he had no responsibilities or obligations except to just sit there and let other people fuss over him.

What else will you experience when giving plasma?

When they inject your blood back into you after spinning off the plasma, it will be cold, which many people find uncomfortable. Bring a blanket or a jacket.

Aside from that, plasmapheresis just isn’t a painful process, assuming you aren’t unlucky enough to experience any of those rare-but-possible side effects, such as nausea or a vasovagal reaction (fainting).

Is giving plasma tiring?

Some people report feelings of extreme exhaustion after giving plasma. In McLaughlin’s words, this can “feel like draining the body almost to the bone.”

I can’t tell you how common this is, and as far as I know, there’s no actual data on that. It’s trivial to find anecdotes about it online, but none of the plasma donors I talked to on the record reported it, although CJ told me he knew people who’d experienced it.

“My roommate donated plasma, and they stopped after a few times, because they found that right afterwards, they would be exhausted and depressed for a few days. They didn’t like that feeling and said it wasn’t worth it. But I didn’t really experience that.”

As with other issues, a “healthy donor effect” makes this hard to investigate. People who find that selling plasma wipes them out tend to simply stop, which makes them less likely to show up in medical studies or even articles like this one.

If you do have this reaction, it probably won’t last more than a day or so, and you may be able to prevent it by taking common-sense measures to keep your body healthy, like hydrating well, getting plenty of sleep, and eating a protein-rich diet. That last point is particularly crucial. Giving plasma means draining your body of some of its vital proteins, and it’ll need to work hard to replenish them afterward.

Is there a stigma around selling plasma?

Selling plasma is stigmatized, and some people may judge you for it.

As a society, we’ve decided that donating blood is an almost heroic act. By contrast, many people see selling plasma as … dirty. Mercenary. Dangerous.

Much of this comes from its association with poverty and the unwashed masses. That doesn’t suggest great things about our culture, but the stigma exists nonetheless.

You’ll notice I’m only quoting two donors in this article. Funny thing—I know way more people who have sold plasma. I attended college at a state school where most of the students were from middle and working class families. There were three plasma centers just down the street from my old dormitory, and plenty of my peers went frequently, whether it was to survive or just for beer money. However, I was able to find just a few people who were willing to talk about it on the record, and even CJ asked me not to use his full name.

I asked CJ and Scribner whether they were at all worried people would judge them when they sold plasma. Again, they gave very different answers.

“Absolutely,” said CJ. “I definitely didn’t tell my parents. I would, like, turn the location off on my phone—my parents can see that because we mutually share it for safety reasons.” He shrugged. “After the first few times, I think I didn’t care as much. It’s like, if they find out, they find out. But I definitely didn’t tell anybody beyond my close friends.”

By contrast, Scribner said this didn’t really enter his head.

“If they judged me, I was fully oblivious to it. I’m the kind of person that—like with this interview—I will just talk proudly about my experiences. I don’t do shame in most cases. If you want to feel some sort of way about that, that’s more your problem than mine.”

Does selling plasma leave a scar?

Part of the stigma around selling plasma may also have something to do with the scar that it leaves. You’ll get one if you do it often enough, for long enough. It won’t form overnight, but in time, it will leave a mark on your inner elbow.

Plasma scars do not look anything like the track marks that appear on the arms of intravenous drug users, but not everyone knows the difference. The next time you wear short sleeves in a job interview and you catch the hiring manager’s eyes wandering toward your elbow, you are welcome to explain, “No, really. It’s from selling plasma.”

Here again, Scribner told me this didn’t bother him, but CJ said he was concerned about it when he donated regularly. He did this for about half a year in 2023, which wasn’t long enough for a permanent scar to form, but he had a temporary pockmark. I asked him if he ever worried people would get the wrong impression.

“I did,” he said. This was largely because he worked in a library, in a very public-facing role.

“I work in adult services, and so I’m gonna be working a lot with older folks, and I’m one of the younger people in my department. They see a younger kid with a bunch of tattoos and also scarring on my arm where drugs could go, so even if it’s not that, they don’t know the difference. … I was definitely self-conscious about it.”

How does it feel to help people?

In all this discussion of potential health problems and ethical controversies, we risk losing sight of one important fact.

Blood plasma helps people. It really does. We’ve written about hundreds of side hustles on this site, and this is one of the only ones that actually saves lives.

It’s up to you to decide how much that means to you. CJ said frankly that it wasn’t much of a selling point.

“I wouldn’t do it if there wasn’t at least a little bit of a guarantee that it was going to help people. I wouldn’t do it for sketchy reasons. But that was never really the consideration for me. It was always about the money.”

On the other hand, Scribner said altruism was a significant factor for him.

“I work mostly for nonprofits and educational positions,” he said. “Even when I’m freelancing, I tend to work for those kinds of causes. I really want to be able to do work that has at least some minute benefit to the world at large. If I can get paid and live in a capitalist system, that’s exactly the kind of thing I want. So I think that’s why I was immediately drawn to it.”

If you’ve read this far because you’ve been waiting for me to issue a final verdict on whether the paid plasma industry is good or bad, you’re about to be disappointed.

This is an issue that intelligent, well-intentioned people can disagree on. You’re going to have to decide how you feel about it for yourself.

And in the end, you might decide you feel conflicted. That’s fine. It’s possible to take issue with the specifics of how plasma companies incentivize frequent donation, for instance, without concluding that the industry at large is unethical, or that the paid plasma model should be banned. You might be persuaded by the argument that there’s no proven alternative while quietly wishing that we lived in a world where more people would donate just for altruism’s sake.

If every aspect of this was clear and one-sided, there wouldn’t be a controversy.

One final thought

I will tie things off with just one personal comment. This, incidentally, echoes something that Jaworski said near the end of our interview, which I wholeheartedly agree with.

However you ultimately decide you feel about this industry, the act of giving plasma isn’t dirty, and it isn’t anything to be ashamed of. To the contrary, it helps people, and it’s something you should take pride in, regardless of whether you’re selling plasma to make ends meet or freely donating it with the Red Cross.