Paid plasma in low- and middle-income countries: The strategy or the strategy-frustrating: A short account of Iran experience involved

Sir, WHO and International Society of Blood Transfusion have emphasized on voluntary donation of blood, plasma, stem cell, and transplant. The proponents of the paid system hold the contrary belief that the voluntary unpaid plasma donations would not be adequate enough to meet the demand for plasma derived medicinal products (PDMPs) thereby the patients would be deprived from access to the essential pharmaceuticals.[1] However, the opponents of the paid plasma system assert that it would help the spread of newly emerging diseases in the society.[2] Canadian Blood Services has stated that paid plasma collection has not helped the supply of PDMPs; thus, the concept of for-profit plasma collection centers is illogical and contrary to voluntary system.[3] The United States experience shows that voluntary donation among 17–35-year-olds has largely shrunk and access to paid plasma donation could possibly worsen it. This experience shows that the concern for the negative effect of paid plasma on voluntary donation of blood, platelet, and plasma is not baseless. It is also claimed that payment to plasma donors does not just compensate for cost of donor transfer to and back from plasma centers but it takes the form of monetary aid to low income donors and is a clear practice of plasma purchase. To prove this claim, the proponents refer to the disproportional scatter of plasma collection centers and their being located on colleges, weak economic regions, borderlines, and previous factory hubs.[4] The concentration of 80% of plasma centers of the states adjacent to the most vulnerable regions shows that pharmaceutical companies collecting plasma aim at low-income and poor people who are interested to convert their plasma into cash.[5] The author believes that countries should consider three important factors. The first factor is the existence of an industry-scale capacity to manufacture PDMPs. The second factor pertains to the status of the social capital in each country and the consequent anticipation of the impact paid donation would place on the voluntary-based system of plasma and blood donation. The third factor is the estimation of the real demand for PDMPs in each country. We should not ignore the higher risks on the part of paid plasma donors than voluntary ones and we should try to strengthen the voluntary system. We have had no emerging diseases like AIDS in the recent years and ignoring the safest way might endanger our supplies in case of unknown emerging infections.[6] If a country can meet its plasma demands through voluntary nonremunerated donation, why should it risk by applying the paid plasma system and depart from the safe approach? In addition, concerns about mismatch between demand and supply may be addressed by offering nonmonetary incentives, compatible with social norms and standards. This will help achieve balance between the quality and quantity of plasma and avoid the negative effects of paid plasma collection on the nonremunerated voluntary system. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

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