Why do many countries ban the sale of one's own blood?

Question

According to this article, (in Spanish) blood from people recovered from covid-19 is a millionaire's business, laboratories in the US were paying up to thousands of dollars for blood from people who had recovered from Covid-19.

According to this other article (also in Spanish), blood was being sold for 3,000 dollars in Bolivia, but in that country, selling blood is illegal, because it's considering "trafficking".

And in Argentina, a proposal to pay people who recovered from Covid-19 for their blood never happened.

I have a friend who lost his job due to covid-19 (the business he worked in closed because sales went down), and now he can't pay the rent, if he could sell his own blood to a private clinic or lab or something, that could save him from the bad moment he's going through.

What's the logic behind banning the sale of one's own blood in several countries?

Answer 1

Many countries are seeking to move to a system of 100% voluntary (unpaid) blood donations, and many others already have; according to the World Health Organization's Global Status Report on Blood Safety and Availability 2016, fifty-seven countries reported collecting 100% (or more than 99%) of their blood supply from voluntary non-remunerated donations. The WHO has long advocated for countries to develop blood donation services on this basis - in 1975, WHA28.72 stated:

Noting the extensive and increasing activities of private firms in trying to establish commercial blood collection and plasmapheresis projects in developing countries;

Expressing serious concern that such activities may interfere with efforts to establish efficient national blood transfusion services based on voluntary nonremunerated donations;

Being aware of the higher risk of transmitting diseases when blood products have been obtained from paid rather than from voluntary donors, and of the harmful consequences to the health of donors of too frequent blood donations (one of the causes being remuneration),

[...]

URGES Member States:

1. to promote the development of national blood services based on voluntary nonremunerated donation of blood;

There are a variety of arguments employed when advocating for a 100% voluntary blood donation service. Firstly, the issue of coercion. Many organisations, including the WHO, the IFRC, and the Council of Europe argue that the provision of a financial incentive as motivation for donation amounts to coercion of the donor, and is incompatible with individual autonomy. Seemingly small payments can be significant even in developed countries - for example, the German Red Cross has pointed out that "the €25 usually on offer for blood was three times the daily allowance for those on the lowest level of unemployment support in Germany."

This leads us to a related argument - under a paid system, donations are more likely to come from those with a poorer background, something which the WHO has labelled 'exploitation':

Paid donors are vulnerable to exploitation and commercialization of the human body as they usually come from the poorer sectors of society and become paid blood donors due to economic difficulties. Any form of exploitation of blood donors, including payment for blood, coercion and the collection of blood from institutionalized or marginalized communities such as prisoners diminishes the true value of blood donation. A blood donation is a “gift of life” that cannot be valued in monetary terms. The commercialization of blood donation is in breach of the fundamental principle of altruism which voluntary blood donation enshrines.

However, barring payment for blood wouldn't improve the situation of those who may rely on these payments - this is clearly a problem at a deeper level than blood donation.

The quote from the WHO above, however, does introduce a more moral-based argument - some believe that putting a price on blood constitutes an objectification of the human being. According to the European Blood Alliance:

From a Kantian perspective, the offer and acceptance of payment for blood could be considered as constituting an instrumentalisation of a person, in that the paid donor becomes a mere means to the ends of others. In this view, payment for blood donation would violate the principle of human dignity. In putting a ‘price’ on a personal ‘good’ – blood – human dignity would be threatened through devaluation of the person involved.

At a more practical level, there are also safety concerns under remunerated donations. The payment incentivises donors to hide factors which would disqualify them from giving blood, for example infections transmitted by blood transfusion or drug abuse. Again, according to the European Blood Alliance:

Monetary incentives, as fixed allowances, can encourage undesirable donor behaviour through concealment of existing risk factors in the pre-donation interview. This can pose a threat to the quality of collected blood and ultimately to patient safety. In the South of the USA, donors from Mexico, some of whom are illegal drug users, travel across the US border to donate at centres offering even modest payments, whereas they do not donate in Mexico itself, because payment for donations there is forbidden. It is noteworthy that similar practices are presently developing along the eastern borders of Germany and Austria.

Answer 2

The other answers were about general problems with having a market for blood, but the specific context of your question adds even more problems.

If viral antibodies being present in blood elevates its market value, what's to prevent someone from attempting to deliberately infect themselves in the hopes of recovering and then selling their now very expensive blood? The economic incentives would directly conflict with attempting to actually curb the spread of the virus.

Answer 3

In my country (Bulgaria), paid blood donorship is forbidden. What the donor gets is a pack of food/drinks/snacks and 2 paid days off (days off are at the expense of the employer, as the law is from communist times, but most employers don't oppose).

Then again, there is a stable black market of donor blood because voluntary donorship is simply not enough. It's not that they don't try - the donorship is widely advertized, transfusion centers work extended hours and also weekends, temporary (for 1-2 days) transfusion labs are frequently deployed at employment or educational centers, etc, etc...

When there is a shortage (i.e. almost always), planned interventions and transfusions are delayed until one shows 1/2/3 (depending on the situation) donorship certificates. Emergency procedures are not delayed and they deplete the blood bank even more. One can ask for help from relatives, friends... or the dealers of the black market that are easy to find around the transfusion centers.

And this black market shows and emphasizes all the bad things that are listed in the @CDJB answer - donors donating blood more frequently than is healthy for them or for the recipient, ineligible (because of health issues or age) donors showing repeatedly at the donation center, sometimes with falsified or borrowed IDs, dealers getting a greater part of the payment, etc, etc.

In some parts of the country with weaker economies it is even expected to pay a certain amount (~ 60 EUR) to relatives, friends and friends of friends for a blood donation. People just consider it an ordinary medical expense and think it is immoral not to pay even when the donor refuses. Of course, it is not covered by any possible insurance and just depletes one's finances when one is already in trouble.

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Disclosure: I am a frequent voluntary blood donor.

Answer 4

One reason may be that people desperate enough to sell their own blood, may not live the healthiest of lives. I know paying for blood donations was common for blood banks in the USA when the AIDS epidemic hit in the early 1980s, which meant many intravenous drug addicts sold their blood - some of which were infected with HIV, which ended up contaminating the blood supply and infecting haemophiliacs.

Answer 5

Prohibitions against selling blood are a specific case of prohibitions against any trafficking in body parts. This is generally intended to prevent poor people from being taken advantage of by rich people.

One can easily imagine a billionaire who needs a kidney transplant, but doesn't want to put themselves on the normal waiting list. Instead, they go to a homeless shelter and offer to pay $10,000 to someone willing to give them a kidney. This is petty cash to the billionaire, but a fortune to the donor. This power imbalance due to wealth is considered extremely unfair, and effectively forces people to put themselves at grave risk for money.

For similar reasons, we don't allow people to sell themselves into slavery.

While it may seem at first glance that these are personal decisions that should be left to individuals, they're often not in a position where they can afford to say no. So it's a form of economic coercion, not a free choice.

Answer 6

Moral hazard is the thread that explains most restriction on paid donation

While there are many detailed and specific reasons why many countries ban payment for blood donation, the threat that connects them all is moral hazard.

The use of payment for blood donations introduces an incentive into the decisions made by the donor. And that incentive is unrelated to whether the donor is healthy and a suitable donor. There is no such incentive for voluntary donors.

In fact the people most likely to contribute blood when there is a financial incentive but not to contribute voluntarily in the absence of an incentive are somewhat more likely to be unhealthy than the voluntary donors. One particular concern is that intravenous drug users (who are often unhealthy and far more likely to be infected with dangerous diseases such as AIDS or various varieties of hepatitis). While blood is often now screened for dangerous viruses, this has not always been so. Therefore an incentive likely to be significant for particular groups likely to be risky, is a bad incentive. In future this might still apply because new infections are likely to arise in risk-prone populations and may do so before tests for them are widely applied.

While voluntary donors might also be unhealthy, there is no incentive in non-paying systems that is particularly attractive to groups of higher risk. So why acept higher risk by paying for blood?