Paid plasma in Canada: 10 things to know about the business of blood

While blood looks red, its largest component is a clear, liquid gold known as plasma what's left after red blood cells, white blood cells, platelets and other components are removed. And it's worth a lot of money.

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The issue of pay-for-plasma blood clinics was raised in the House of Commons this week after a facility opened up in Saskatoon.

Health Minister Jane Philpott said she believes such clinics will help close the gap in Canada between supply and demand for plasma products. But critics are concerned about ethical issues that come along with paying donors.

Here are 10 things to know about the pay-for-plasma landscape in Canada:

1. This is a business story, not a health story.

A group of Canadian investors is trying to start a domestic for-profit plasma industry. But to do that, they need a large amount of raw material, which only comes from one source: the human body. To generate the volume of plasma needed to start a profitable business, Canadian Plasma Resources intends to set up 10 collection centres across Canada. And to get people to agree to have their plasma harvested, the company will give donors $25 gift cards.

2. There is no shortage of plasma in Canada.

Right now, there is lots of plasma to go around. In fact, Canadian Blood Services shut down plasma collection centres over the past few years because they were too expensive to run. Canada even has surplus plasma, left over after whole blood is broken down into its various components. That plasma is sent to the U.S. to be made into plasma products, which are then imported back into the country. The remainder of Canada's plasma needs are easily met by U.S. pharmaceutical companies under contract to supply the Canadian market with the various processed plasma products including albumin, clotting factors, and immune globulins(IGIV).

3. There are two kinds of plasma.

Fresh plasma is used for transfusions. Processed plasma, which is pooled from millions of donors, is turned into pharmaceutical products.All fresh plasma used in Canadian transfusions comes from volunteers, as does blood and platelets. Demand for fresh plasma is falling, due to changes in medical procedures. Demand for processed plasma, as a manufactured pharmaceutical product, is rising; it is used in the treatment of immunocompromised patients as well as patients with bleeding disorders and other rare conditions.

4. The international plasma industry is highly competitive and profitable.

Every five years, Canadian Blood Services tenders the contract to supply Canada's processed plasma products from one of the handful of international plasma companies that dominate the world market. These products are expensive and are marketed just like any other pharmaceutical product, with an industry association that lobbies governments and pushes to expand the customer base.

5. Canadians can't easily give away their plasma.

It's a bit of a challenge for Canadians to donate plasma because there are only a handful of centres across Canada that accept it from volunteers. There are no plasma donation centres in B.C. or Manitoba. There are just two in Alberta and one each in Ontario, Nova Scotia, New Brunswick and Newfoundland.

6. Plasma would be the first human material Canadians would be allowed to sell.

Right now it is prohibited in Canada to sell blood, organs, tissue, sperm, eggs or embryos. Quebec has forbidden the sale of human blood or plasma, and Ontario recently passed legislation to prohibit paying blood or plasma donors.

7. Paying for plasma won't lower the price of theprocessed plasma products for patients.

The pharmaceuticals made using paid plasma are expensive but the price is not based on a shortage of plasma (see No. 2). Rather it is set by international pharmaceutical companies who control their supply of raw plasma through networks of paid plasma clinics throughout the U.S. They collect more or less plasma as they need it. The finished products can cost as much as $7,000 per treatment, and more than $200,000 annually. Because processed plasma products are delivered in hospitals, the cost of the plasma is paid by provincial governments. Even if Canada has a domestic plasma industry, costs are not likely to change. Canadian Plasma Resources CEO Dr. Barzin Bahardoust said: "We are not going to be substantially cheaper, but we will be able to compete with U.S. plasma." This is after the company can secure enough raw plasma to fulfil its ultimate goal of setting up a Canadian fractionation plant, where it would be able to break down blood into its components.

8. The plasma right now being collected in Saskatoon is not being used.

That's because the company doesn't have a buyer yet. Since the Saskatoon clinic opened last week, about 100 people have sold their plasma. But it's being stockpiled until the company has enough to offer up for sale. At this point, Dr. Bahardoust said they do not have a contract to sell it anywhere.

9. Inpermitting paid plasma donations, Canada will be the exception.

Only a handful of countries currently permit people to sell their plasma, including the U.S., Germany, Austria, Hungary and the Czech Republic. The World Health Organization and the EU maintain that voluntary, non-remunerated donation is preferable, as did Justice Horace Krever, who investigated Canada's tainted blood scandal. His 1997 report ultimately sought to ensure the safety of Canada's blood supply and led to the establishment of Canadian Blood Services.

10. Canada appears destined to have a for-profit plasma industry, despite the debate.

Ontario introduced legislation to block the sale of plasma, but Canadian Plasma Resources simply moved its equipment to Saskatoon and were welcomed with open arms by Saskatchewan's health minister, who participated in the clinic's grand opening. The company says several other provinces have given them the thumbs up to open clinics both in the West and the East. And Canada's new federal health minister appears to be open to the possibility of a for-profit plasma industry. The idea of doing things differently, perhaps through a public, non-profit system, does not appear to have ever been on the agenda, even though Canada is one of the world's largest users of processed plasma products.