Why Aren’t You Paid to Donate Blood?

It is legal to pay people who donate blood and plasma, but while plasma donors are almost always paid in America, blood donors rarely are. Why the difference?

It reflects the differing functions and constraints of the two collection processes. Whole blood can be donated once every 8 weeks, or 6.5 times per year, while plasma can be donated twice a week, or 104 times per year. Whole-blood donations only take 10 minutes, but screening usually takes an hour. The initial plasma donation takes 2-2.5 hours, and follow-up donations take around 90 minutes.

The Red Cross estimates that around 6.8 million Americans donate blood in a given year and that 13.6 million units of blood are collected annually, meaning the average blood donor donates 2 units of blood annually. In 2019, 3 million people in America donated plasma and provided 53.5 million units of plasma, meaning the average plasma donor donated 17.8 times annually.

Essentially, whole blood is easier to donate but can be done infrequently, while plasma donations take longer and can be done 16 times more frequently. These differences mean that an ideal blood donor is very different from an ideal plasma donor. Plasma collectors are looking for people who can put up with longer donation times and donate frequently. Ten percent of plasma donors donate at least 40 times a year. Financial compensation for plasma is effective at maintaining a core set of donors who regularly donate.

Moreover, compensating blood donors could create more problems than it solves. It could encourage ineligible people (those who have bloodborne diseases, are currently sick, or are on certain medications) to falsify their personal information to donate despite their ineligibility. The risks associated with a tainted donation are higher for blood than for plasma because, while plasma is broken down into proteins for medical treatments, blood is transferred directly to patients. The broken-down plasma components can more easily be processed to remove risk from diseases than can whole blood.

The FDA requires that blood be labeled to indicate whether the donor was paid. Hospitals distrust blood from paid donors because of the higher potential risk, and donation facilities that pay donors face higher costs than those that take only unpaid donations. So, payment for blood is virtually nonexistent.

Further, blood donation has historically met demand without compensation or with non-monetary gifts. Non-monetary gifts have been found to increase donations and can be used to alleviate shortages.

However, blood donations have been declining since 2008. Although donations started to level off in the wake of the COVID-19 pandemic, the blood supply has frequently been at critically low levels in the past five years. Blood collection centers may need to explore monetary compensation for blood if non-monetary compensation proves insufficient to increase blood donation to meet demand.

Finally, the title of this article is not entirely correct. Although most blood donors are uncompensated, people are paid for specialized blood donations. In the Red Cross Specialized Donor Program (SDP), blood is more intensely screened. If eligible, compensation starts at $200 per donation. This blood is used for cell and gene therapy.

SDP donors are paid because the market for their blood is similar to the market for plasma. The costs to SDP donors are higher than those to regular donors: as noted, donors go through a more intense initial screening, and SDP locations are relatively few.

The Red Cross also wants to incentivize the specialized donors to return as frequently as possible, even though each donor can donate only a handful of times each year. The SDP must have a dedicated donor base, considering the limited number of locations and the more rigorous screening.

Finally, the SDP donations are not used for whole-blood transfusions. Like plasma, they are separated into parts to be used to develop a variety of therapies. The screening and the separation lower the risk of complications from taint.

Compensation type for blood and plasma donors is determined by the constraints in their respective markets. When it is important to have a dedicated set of donors, when donation is difficult or inconvenient, and when there are lower risks associated with a tainted donation, paid donation is prevalent. Voluntary or non-pecuniary compensation is the norm where these conditions do not hold. It currently does not make economic sense to pay donors for blood in almost all cases.

Caleb Petitt is a research associate at the Independent Institute in Oakland, Calif. @CalebDPetitt