Commodifying Blood Donation Could Solve Canada's Shortfall

10/08/2015 06:04 EDT | Updated 10/08/2016 05:12 EDT
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Many people think blood is special in a way that means it shouldn't be "commodified," or bought and sold on a market. It is a basic human need. It's not like the latest gadget or a pair of shoes; it is to be revered, not remunerated.

I'm glad we don't think food is special in this way. If we did, imagine how many people would die of starvation, or would suffer from hunger.

This past December, the Ontario legislature preserved the sanctity of the exchange of blood through Bill 21, entitled the "Safeguarding Health Care Integrity Act." Schedule 1 included provisions from Bill 178, the Voluntary Blood Donations Act", which prohibits paying and receiving payment for blood, either directly or indirectly. With this bill, the legislature has made the giving and receiving of blood a sacrament.

Canadian Blood Services does not have to kneel before the Act, by the way, since they are exempt from the requirements of holy sanguinity. Subsection 3 of Schedule 1 exempts them, and only them, from the subsections that make it a heresy to buy and sell blood. So they could, without being subject to an inquisition, engage in blood simony.

Is this way of describing the Act unfair? It would be, if the provisions of the Act were not based on magical thinking and were consistent with contemporary studies about the relationship between compensating donors and the quantity and quality of the blood supply. But the Act is not.

Opponents of a blood market cite worries about the safety and quantity of the blood supply. They also claim that selling blood "expresses" the wrong attitude to something sacred.

The latter worries I wrote about with Jason Brennan in a recent issue of Ethics, and explore at length in our book Markets without Limits. In short, no symbolic arguments against markets work. The right response to worries like, "if we buy and sell blood, doesn't that mean that we have the wrong attitude towards blood?" is, first, to point out that attitudes are independent of markets. We buy and sell cats and dogs, for example, but think of them as members of our family, not "commodities." And, second, that if a market in blood would save lives, as it would, then we should criticize the social practice of attaching these symbolic meanings to these kinds of exchanges. We don't have to think that the buying and selling of blood is profane, we could, instead, think it a wonderful thing. And we should.

The former worries about the safety and quantity of blood were most prominently raised by Richard Titmuss in his groundbreaking 1971 book, "The Gift Relationship." Titmuss argued that we can expect poorer quality blood, and maybe even fewer donations, if we compensate donors in cash. He thought that many of us donate blood out of altruistic concern for others. But no one will think you've done a good deed out of the goodness of your heart if they know you pocketed a few Wilfrid Lauriers in the process, and this will turn many of us off of donating blood. And who will give blood? People who need money, people whose blood is a little bit more dangerous.

Indeed, Ontario and the rest of Canada had a significant problem in the 1970s and 1980s. Our blood supply, which included blood and plasma taken from U.S. prisoners who were compensated for donations, was tainted. Many Canadians who had blood transfusions ended up with HIV and Hepatitis-C because of it. This historical fact is a significant reason raised by many opponents of a market in blood, like in this Globe and Mailopinion piece.

If this is a reason to prevent compensated blood donations, why doesn't it apply to tomatoes or blueberries?

Every year, about four million Canadians get a food-borne illness, with 11,600 hospitalizations and 238 deaths.

Despite this, no provincial government has yet proposed a bill entitled the Voluntary Tomato Donations Act, making it illegal to buy and sell tomatoes. There are no commercials urging us to replace our lawns with tomato gardens ("Tomatoes. It's in you to grow.")

And of course they haven't. If anyone were to seriously suggest it, we would all laugh. We all understand that if we don't permit farmers and grocery stores to profit from a basic human need, the basic human need will basically go unmet. We still romanticize the idea of a family farm, but we're not prepared to see our friends and neighbours starve or go hungry for the sake of a pastoral romance.

Instead, we respond to food-borne illnesses with improved methods of testing foods, improvements in farming techniques and machinery, and certification of farmers and agricultural workers by both regulatory agencies as well as by grocery stores, neither of whom want anyone to get sick.

That's also precisely what we've done with our blood and plasma supply. While no tests are perfect, modern donor assessments as well as screening and processing methods have made the worry about the quality of that supply basically moot. In the past 20 years, for example, there have been no cases of HIV or hepatitis transmission by any member of the Plasma Protein Therapeutics Association, an association representing private-sector plasma-derived therapies. And many of them pay donors.

We don't eliminate or try to neutralize the profit-motive from our food production. We recognize that money can help to encourage people to direct their energy toward food production rather than some other endeavour. We recognize that paying people is an effective way to incentivize them to provide us with things we value.

And without the added incentive, hardly anyone bothers. Lots of Canadians will support the idea of altruistic donation, and endorsed this legislation that prohibits payment. But when it comes to showing up and giving blood, it turns out it's just a lot of worthless talk, since only a lousy four per cent of us show up.

In fact, there exists no jurisdiction in the world that gets its entire blood and plasma supply from voluntary donors. That includes the Ontario supply, which will be topped-off with blood and plasma purchased from jurisdictions that compensate individual donors. That means, of course, that Ontario participates in paying individual donors. If you buy a product from a third party that you know gets the product by paying individual donors, then, morally speaking, it is the same as you paying those donors. Paying a third party is not a magical moral cloaking device, it's just obfuscation.

Claims that compensating donors lowered the supply of blood and plasma had some purchase based on a few early studies following Titmuss' book. But those studies were small, nonrepresentative, depended on survey data, or were not controlled. More recent, large-scale studies have shown that compensating for blood and plasma does not crowd-out altruistic giving. Economic incentives -- whether in the form of a day off work, a lottery ticket, a gift card, t-shirts, coupons, or free medical tests (with the sole exception of a free cholesterol test which had no effect) -- consistently increased donations in all countries studied so far, with larger effects from items of greater monetary value.

The simplest solution to the blood and plasma shortage is to desacralize blood and plasma. Instead of bowing our heads to this idol, we should see it as the false idol it is, and get back to having a market in blood.


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