262 DOI: 10.4324/9781003188742-23 18 BLOOD AND PLASMA Or, if you’re such an altruist, why don’t you sell your plasma? Peter M. Jaworski Introduction 1 We collect blood and plasma for transfusion, but we also collect plasma to make plasma-derived medicinal therapies, or plasma therapies. These therapies include immunoglobulin, albumin, clotting factors, and others. These are used mostly for rare diseases and ailments, like primary and secondary immune defciencies, a variety of bleeding disorders including von Willebrand disease and hemophilia, and a growing list of neurological ailments like multifocal motor neur- opathy. Hardly any country, including the U.S., uses donor compensation when blood or plasma is used for transfusion. This is because as of yet we do not use pathogen inactivation and removal procedures for this purpose. But when we collect plasma in order to make therapies, we do use these procedures. These procedures make the therapies “inordinately safe”, or “equally safe” 2 regardless of whether donors receive money for the donation or not. Even though there are no safety or effectiveness concerns when it comes to therapies made with the plasma of compensated donors, most countries nevertheless have bans on commercial collections of plasma or ban donor compensation. 3 Every country with these bans has a plasma collection defcit for plasma therapies. To meet the needs of their patient communities, they import therapies from the commercial market. All of the therapies available on the commercial market are made using commercial compensated plasma collections in one of the handful of countries that allow it. Overwhelmingly, this plasma is collected in the United States, but some imports also come from Germany, Austria, Hungary, and the Czech Republic. These fve countries are also the only countries with surplus plasma collections. This chapter attempts to go some way in defending the view that a commercial model ought to be the default model for plasma collections used to make therapies. The commercial model preserves and promotes security of supply of therapies and so patient health, while non-commercial models put patient health at risk. The challenge to those who think banning commercial models is a good idea is to offer reasons that are important enough to justify the foreseeable risk to patient health. This chapter argues that the challenge has not been met, that bans on commercial models put patient health at risk without promoting, preserving, or protecting anything of even compar- able moral weight. 9781032037370_end_p105-426.indd 262 9781032037370_end_p105-426.indd 262 30-Sep-23 00:37:26 30-Sep-23 00:37:26