Reminiscent of a medical facility, this plasma center, built only a year before is brimming with white lab coats, face shields and medical gloves. The sound of Velcro and beeps from blood pressure machines and the whirring of hematostats as they separate blood and plasma fill the air.
The appearance is all so sterile and clinical, but the workers here are not medically certified, they are only required to have a high school diploma and all are trained by each other. Of the almost 70 workers in this building, besides the LPN nurses and the one RN, certified phlebotomists (medically trained personnel that collect blood, plasma and tissue samples from patients) are 10 % of the workforce here which is a crapshoot for professionalism in the taking of blood and plasma.
As the donors (people who give a voluntary gift of plasma) are processed through, their vitals are taken and their appearance assessed as per the companies standard operating procedures (SOP). 38% of those interviewed come because they need the money to help pay for food, rent or bills, 60 % donate because the money supplemented their vacations or spending money, the other 2 % came because they believed that they were "Saving Lives." Most are not your typical college students, but instead housewives, part-time workers or the working poor.
Plasmapherisis (the removal, treatment, and return of blood plasma from blood circulation) began back in the 1940's in order to harvest clotting agents by the pharmaceutical companies - now there are more than 500 donation centers in the United States and more being built every day.
The buying and selling of Blood and Plasma is a multi-billion dollar per year business. Plasma is more commercial than Blood and can not be synthetically replicated. In 1988, more than 21 years ago, the industry made over 2 billion dollars per year alone making the current numbers staggering, but incredibly secret.
US Federal regulation is more liberal than anywhere else in the world allowing up to 60 liters (127 pints) a year. The next highest producing country is Canada allowing only 15 liters per year, which is the recommendation from the World Health Organization. More than half of the plasma used in medicines worldwide is from the US.
While US donors are the source of 60% of the world's plasma, foreign companies like huge mosquitoes, are the ones that control the product from Japan, West Germany, Austria and Canada, flying in to the US to puncture the blood and plasma supply and then fly the profits home to feed on them. Not only do foreign companies own the majority of plasma collection centers, the majority of plasma medications are also sold abroad as well.
There are two different types of plasma donations...the first is non-profit. The largest would be The American Red Cross. According to FDA regulations, truly donated plasma and blood, without any funds exchanging hands between the donor and the organization, is the only blood or plasma that can be transfused into humans. If an individual is paid any money at all, for their time or for their plasma, it can not be used to "Save Lives" per se. Because for-profit donation centers feed on the need or the greed of the economic world temperature, non-profit donation centers are suffering. When non-profit donation centers suffer, then those who need plasma: burn, shock or trauma victims go without. Those looking to make a humanitarian donations should be donating blood and plasma at non-profit donation centers like the American Red Cross.
Donations that are "paid" for are sold to drug and research companies and with the economic downturn of 2007-2009, plasma donation centers are on the rise with one of the largest Austrian Pharmaceutical backed donation centers achieving a 19% rise in stock prices within a quarter while other markets were plummeting.
The ethical question of Plasma Donation comes at a cost. Organ donation is not an unusual thing, but bodily "donation" that is suppose to help and not hinder human survival is questionable when big business gets involved, and for-profit donation of blood and plasma is very big business.
Plasma that is donated to drug and research companies is refined down and made into medicines that "Save Lives". What is the cost of those medicines to those that would die without them? $50,000.00 to $80,000.00 per year, which can really change the slogan, "We Save Lives" to "We Cant Afford to Live". Those without insurance or government funded backing can not afford the medications or treatments and without those "donated" treatments, die. Most are government funded solutions, which means tax payers, donors or non-donors, are paying to treat those that would die without the treatments that are suppose to be a voluntary gift...so the saying, "Give until it hurts" may be more applicable.
For-profit donation centers started targeting college students in the 1970's to improve the quality of the plasma supply. Companies speculated that college students should be healthier than the average population. In 1999 a study was conducted by Ohio University which found that university plasma donors were not as healthy as once thought. Paid donors are three times more likely than non-donors and four times more likely then Red Cross donors to drink alcohol five or more times a week. One eighth of non-donors, one quarter of Red Cross Donors to one third of paid donors smoke tobacco. Consumption of toxins or unhealthy lifestyle is not the only issue at hand today, body piercings, tattoos and branding are other issues that pose unhealthy donation bases as well. Body art is not always visible and unless confessed to, can not always be subject to scrutiny by the donation center.
For profit donation centers will pay $8.00 -$20.00 dollars for the first donation and then to encourage the donor to come back, will pay a higher price for the second donation within the seven day period.
Depending on the weight of the individual, the donation center will take 690mL to 880mL per donation. The 880mL bottles bring a price of anywhere from $300.00 to $1,700.00 when sold to the Pharmaceutical companies. If there is anything wrong with the plasma, if it's hemolysised (infused with red blood cells) or if the plasma is lipemic (excess fat within the plasma) the plasma is sold to veterinarian companies and bring a lesser price for the donation center.
Plasma donation was worth approximately 4.5 billion dollars in 2007. Today there are approximately 1.5 to 2 million donors worldwide and is expected to grow significantly in the struggling economy of 2009.
Because of the rapid growth within the industry, corporations train their workforce to take the donations, paying an average of $10.00 per hour. The workforce usually does not have medical certification or medical training unless they are one of the 8 LPN's or RN's that are hired. A licensed medical doctor covers the center with his license, but he is rarely seen on the floor of the center. He comes in maybe once a week to sign charts and watch vitals being taken once on those being trained and then he is off again, taking only his cut of the centers profits. The corporate training is not done by the LPN's or RN or even by the doctor, it is done by regular employees that do not have medical certification or license.
Corporate training consists of reading of Standard Operating Procedures in a conference room for several hours, sometimes days, then you are put out on the floor with a trainer to watch him/her go through the motions. If you have an efficient trainer, then you can process with professionalism, but if you do not, then most Medical Historians (Someone who takes vitals, transcribed medical information and does basic phlebotomy) struggle and their bedside manner, technique and record keeping will leave much to be desired and the donors do not get the care that they may need.
In this center, processing time is a task master. This center processed 570 donors in one day with an average of 390 customers a day. From the time donors check in with the receptionist until they scan out they are timed. Time is money in this industry. When doing vitals, the Medical Historians are given a maximum of 1 minute 21 seconds to complete the processing of the donor and sending them out to the phlebotomy floor for the donation which is not much time to practice accuracy. There is no time to check your gloves for contamination issues such as plasma, mucus or blood, so donors are subject to cross-contamination every time they come into the center. Company policy states that gloves should only be changed when they are contaminated with blood, torn, cut or every two and one-half hours.
That is to save time between donors and the crack of the whip comes from the managers as they wait with stop-watches and pink slips over their white coated slave labor force. The Medical Historians are moving so fast in order to keep from getting fired that there were 2 contaminations of workers within 2 months...both from filled but broken capillary tubes that were shoved into the workers skin through their gloves or through their lab coats and scrubs and into their skin. One contamination happened when a Medical Historian tried to pull a hair out of her mouth and realized that she had just consumed the previous donors blood. Donors have to ask specifically to have the Medical Historians "change your gloves" before they are allowed to do it.
Phlebotomists on the floor are moving just as fast. They have one minute to clean, find the vein and stick the donor. They can stick 3 times, twice per arm unless there is a loss of red blood cells or the donor is in danger and needing saline, then they can stick the third time for emergencies. This causes the likelihood of Hematomas (Blood that collects under the skin or in an organ) for the donors, large bruises over 3 inches and tender areas on the arm. Sometimes, because a donor has to be stuck twice, both arms result in hematomas. Donors have to heal up for several weeks before they can return to donate, which makes the donation process an unreliable source of income for anyone.
When this center is running at full gear, processing 570 donors per day, most who work an 8 hour shift are not allowed to take lunches and sometimes not allow to take bathroom breaks. The pace is fast and furious and as soon as the donors are processed and the plasma is back in the lab, they tear down the used sets and get ready for the next donor. Used sets can be dangerous, they are suppose to be heat sealed but sometimes if there is equipment failure, the tubing doesn't get sealed completely and when the phlebotomist pulls the tubes off the machines, plasma can splash up and out into the face, unprotected arms and saturate clothing. The Personal Protective Equipment required by OSHA doesn't always cover everything it needs to cover, especially since Personal Protective Equipment is not fitted or trained on, so the workers are in constant hazard of contamination, which happened at least once within a 3 month period of time in this center. There are not only hazards to the Employees, but to the donors as well in this atmosphere. Because the center is trying to fill beds as soon as possible, sometimes beds are not cleaned before the donors sit down and donors can find themselves sitting in the blood of the last donor.
There are 22 Right-to-Work states in the US, which means that in order to receive lunch and bathroom breaks, they have to be contractual or within Union Guidelines, if they are not, the Department of Labor can not enforce bathroom breaks or Lunches for the workers. Of the 22 Right-to-Work states, plasma centers flood at least 13 of those states, and build fewer plasma centers in non-right to work states.
Employees have a hard 8 to 10 hour shift in front of them, not only working long hours without breaks, but working in a precise and fast paced environment as well and without the certified medical training that is desired.
Because they do not have the training and because the bottom line pushes ethics, sometimes shortcuts are taken. When the plasma is delivered to the lab, the lab tech has only 30 minutes to process all those bottles. If the bottle is leaking, that bottle has to be thrown out because it is air contaminated, if the bottles take longer then 30 minutes to process before being put in the storage freezer, they are thrown out, a loss of a lot of money. What has happened in the past is that the lab tech will push the bottles back over into more time to process, or the lab tech will process an air contaminated bottle and just wipe it down, or instead of taking samples from each of the plasma bottles as required by FDA, they will open one bottle and take all the samples from that one bottle...because it saves time. These infractions can close a center, but only if it is caught and reported to the FDA, which questions the purity and usability of the plasma in the system and poses the question of contamination of medications as well.
Workers who stay in this business have after 3 months suffer from foot problems, back problems, hip problems, headaches, varicose veins and neck problems that are not covered by Workman's Comp and the conditions are not covered by OSHA. This doesn't include the possibility of contamination that may render them with HIV, Hepatitis or other communicable diseases. These are long lasting ailments and conditions with long lasting effects. Although there are only a few that stay in this field longer than 6 months, Supervisory positions are no better.
Supervisors have demanding jobs as well. They oversee the operations to maintain not only FDA standards but also the Company's SOP (Standard Operating Procedures). Supervisors not only man the course of Medical Historians, but also phlebotomists on the floor and incoming data entry. A supervisor must be trained and tested on all aspects of phlebotomy and medical history as well as incoming data. If the Medical Historians and Phlebotomy work 8 to 10 hour shifts without lunch or bathroom breaks, then the supervisor works 12 hour shifts with the same conditions and with the added responsibility of catching all non-conforming events that may give the center a Quality Incident Report that, depending on the severity, may be reported to the FDA if it effects the health of the public.
When new donors come through the door, they are required to read a "New Donor" booklet, which has in it all the side effects, what to expect and some of the documentation that they will be required to sign. From the time they check in until they are done reading the book, even the donors are timed, up to 10 minutes to read their packet of legal documents. After they are done reading, they are asked for two forms of identification, usually a current driver's license and social security card will be sufficient. If the driver's license is not current or an address is not current, then a piece of mail that is dated less than 60 days can be used to verify the address. Social Security must be verified by Social Security Card, current Tax Information or Pay stub.
Plasma donors are usually not aware of side effects and most likely told that plasma donations are safe in the long term...the reality is that 7% of the human population has an anaphylactic reaction to sodium citrate or saline of which they will need intravenous medications immediately. If they do not receive treatment within minutes, the reaction is fatal.
In this center, we have at least 5 to 6 lesser reactions a day, sometimes more. Immediate side effects can be fainting, bleeding, edema at the venipuncture site, nausea, vomiting, drop in blood pressure, faintness, dizziness, blurred vision, coldness, sweating or abdominal cramps.
If allowed to progress the side effects can be tingling around the mouth or in the limbs, muscle cramps, metallic taste in the mouth and further reactions can lead to irregular heartbeat or seizures.
After prolonged donations, 12% of donors will have a lowered level of antibodies, causing an inadequate immune system response and the probability of increased infection or disease for the rest of their lives.
Plasma donations can save lives, especially when given freely and as a humanitarian gesture...drug and research companies would like the public to believe that they are the good guys in order to increase the bottom line in this Multi-billion dollar business, profiting on the generosity of some and the desperation and greed of others, treating donors like Cash Cows grazing on the bottom line.
For-profit donations feed a fire-storm of ethical questions such as, "if selling human organs is immoral, unethical and illegal, then what makes selling Plasma any different?" "If harvesting a human organ and holding it ransom to those that can pay the price to live, if selling it to the highest bidder is wrong, then isn't harvesting plasma and selling it to those that would die without it the same thing?" What is the cost of a human life? With 15 million donations a year, the plasma industry looks the donor gift horse in the mouth everyday and laughs all the way to the bank. For-Profit plasma companies have a win-win situation...donors give their plasma or practically give their plasma to the industry and the blood sucking, plasma hoarding corporations can turn around and charge $50,000.00 to $80,000.00 a year to allow a person to live, long term cost projections are at $3.7 million to $5.9 million for medications that allow one person to live a normal life...and now we can put a price on what a human life is worth to the plasma industry.