America’s blood plasma industry is the largest in the world and preys on the economically desperate.

Plasma donation is a multibillion industry that has largely been hidden from public view. (Justin Sullivan / Getty Images)

When Montana-based journalist Kathleen McLaughlin set out to report on the United States’ blood plasma industry, she had a distinctly personal reason for doing so: McLaughlin has a rare chronic illness that requires her to receive infusions of a treatment made in part from other people’s plasma. McLaughlin, who has spent much of her career reporting from China, wanted to learn more about an industry that has played such a central role in her life.

Blood Money: The Story of Life, Death, and Profit Inside America’s Blood Industry, the book McLaughlin published earlier this year, is a harrowing dive into the underbelly of a multibillion industry that has largely been hidden from public view — a tour of places and people who have been forced to sell parts of their bodies to survive in a country that has all but abandoned them.

Jacobin caught up with McLaughlin to learn more about the blood plasma industry and the grinding economic conditions that have fueled its rise.

Abe Asher

One thing that jumped out to me in reading your book is that the United States is supplying, by far, the majority of the world’s plasma.

Kathleen McLaughlin

That’s the thing that struck me as well. When you start getting into the numbers, you realize that, first of all, we are a country with a large population — there aren’t many countries with a population as big as ours — and that we have a large population of people who are living on the economic margins. And we don’t pay that much attention or care that much, as a society, about people living on the margins. So there is plenty of room for exploitation of people, I think.

A few months ago, before the book came out, someone was asking me, “Oh, is there a country in the developing world that’s the biggest supplier of plasma?” And I said, “Actually, it’s us.” For me, it’s really interesting because I first became aware of the plasma industry when I was living in China, and they had tried to create this thing called the plasma economy. I thought that was so dystopian and weird. The fact is, we did it while nobody was really paying attention.

We’re in this very bizarre place that we are allowing widespread exploitation of people and demanding that people sell parts of their body. There hasn’t been a big political outcry to regulate this practice better or to pay people more, so I think it does say a lot about us as a society — of where we are and how we view people who aren’t wealthy.

Abe Asher

Many of the places you traveled for your reporting are places that, in their own ways, the United States has left behind. The geography of this industry seems pretty intentional. Is that fair to say?

Kathleen McLaughlin

It absolutely is. There have been a couple studies that show that plasma centers are much more likely to pop up in poorer zip codes. It’s not an accident.

Part of what I tried to do in the places I chose is to show a cross section of the demographics. So you have Rexburg, Idaho, which is majority white but not wealthy by any measurement, and then you have El Paso, which is majority Mexican, and then you have Flint, which is majority black. And the same thing is happening in all of them.

Abe Asher

It seems like there’s a range of opinions about these centers in communities. What did you feel like the pervasive opinion of these places was from people living in these areas of the country that have been kind of abandoned?

Kathleen McLaughlin

I would describe it as pragmatism. People are not stupid. People know what’s going on. They know why these places exist in their communities. They know that it’s exploitative. I didn’t talk to anyone who was like, “Wow, this is the best opportunity ever.” They’re doing it because they need the money. So there’s a very clear-eyed awareness of what is happening, why these places exist, and why they are engaging with them.

It’s very much what I’d call a gray economy, where it isn’t being watched; it isn’t being well regulated. Most people who are doing it are not filing taxes on the income they’re earning. The companies are quiet about how many people are selling plasma and about how much money they’re making. It thrives, in part, because these places are forgotten and left behind and ignored by a lot of powerful people and powerful media outlets.

Abe Asher

People are making a little bit of money selling their plasma, but who is really profiting off the donations?

Kathleen McLaughlin

The big profiteers are multinational pharmaceutical companies — two of the three biggest companies are headquartered in Spain and Australia. So essentially big pharma is making the profits.

The plasma industry owns the supply chain from beginning to end: it owns the extraction centers, the clinics where people go to sell plasma, the manufacturing facility that turns it into medication, and the distribution business as well.

Abe Asher

What is known about the medical cost of being a plasma donor over a long period of time?

Kathleen McLaughlin

Not much. There’s been one study that shows that it can deplete your protein levels in your blood even after you stop donating. There’s a lot of anecdotal reports of people feeling a lot of fatigue and things like that, but there hasn’t been any long-term study that shows serious negative consequences. But there isn’t a huge body of scientific research out there that says this is totally fine. There’s more an absence of scientific research.

When I said at the beginning that we as a society have a lack of care and concern for people who are on the economic margins, that’s part of it: these are not powerful people, and so we’re not studying what’s happening to their bodies when they’re donating plasma twice a week for five years. (Editor’s note: the Red Cross has significantly stricter limits on how often people can donate blood).

Abe Asher

You mentioned a couple minutes ago the extent to which plasma donors are selling part of their body. Did you see connections to any other profession or industry where mostly poor people are selling parts of their bodies?

Kathleen McLaughlin

Someone recently compared it to sex work to me, and that might be a fairly good comparison — in part because sex workers also lack labor protections, and it’s heavily stigmatized. It’s obviously not the same thing, but you can look at it as another way of earning an income that we don’t go very far in making better for workers because we’re reluctant to talk about it as labor. So I think sex work is a pretty decent comparison.

Abe Asher

One reading of the book is very dystopian: one class of people feasting on the blood of this other class of people. But obviously it’s not that straightforward — plasma clearly has huge health benefits for people. What might a better plasma industry look like, one that is less morally objectionable and offers more reasonable conditions for the people who are making it possible?

Kathleen McLaughlin

The number-one thing that would need to happen is a more transparent payment system.

Right now, people get paid more according to how many times they donate plasma. If you go once in a week, you might get $30. The second time, you might get $40. And you just never know exactly what you’re going to get, because it’s gamified. You get bonuses, you get referral bonuses — there are all these incentives that are designed to make you go as often as possible in order to earn the highest amount of income possible.

But what if it was designed so that you got a much higher payment every time you went, so that you knew what you were going to get and you didn’t have to feel compelled to keep going back twice a week forever and ever and ever? So let’s say you got paid $100. I’m just throwing that out there based on nothing, because I think it would take some research to figure out what is actually fair. But let’s say you could count on getting $100 for every donation — maybe it would feel less exploitative for people. That’s, I think, the number-one thing that could be done.

Like you said, it does have this vibe that it is one class of people feasting on the blood of other people — but my medication now is up to almost $15,000 per dose. So if you’re someone who doesn’t have great insurance, even if you’re getting this dose, it’s also exploiting you as well.

Abe Asher

This does seem like an industry that is rich for regulation, as you’re illustrating. Have you heard from elected officials, anyone working in and around legislative politics since you started this reporting?

Kathleen McLaughlin

Nope. Not a word. I think that part of this is the generational divide. People in politics in the United States are older, so they probably don’t have experience with this. And their families probably don’t have experience with this, because we know that people who are in elected office don’t tend to come from poverty or have any experience of poverty. So those are probably two big factors. This just isn’t something that affects them.

Abe Asher

In your book, I remember the gentleman who said that he was donating plasma and putting every cent away to be able to take a vacation with his family to Florida. For some reason, that stood out to me. Are there any moments you had talking to people in any of these locations that really stuck with you?

Kathleen McLaughlin

The one that kind of haunted me was Emily in Texas, who was selling plasma to pay court fines. She said to me, more than once in our interviews, that she would sell a kidney if she could. And she was dead serious. She kind of laughed when she said it, but we have set these arbitrary limits on what parts of our body we can sell. Right now, it’s blood plasma, eggs, and sperm. Those are the three pieces of your body you can sell in the United States right now. But why have we set it that way, and at some point are we going to decide it’s fine if poor people need to sell a kidney too? So we’ve drawn a line in the sand and said that’s okay, but is it okay? And should you really have people who are thinking, “God, I wish I could sell a kidney?”

That was in the middle of reporting this book, and that put everything in perspective for me — because there are a lot of people living in economic situations where they would take extreme risks with their health and their bodies just to make their financial situation better.

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