Should blood donors be compensated? Exploring alternatives to blood donation

Frequently, there’s a pressing need for blood donations when relatives face critical conditions. Often, families come together to secure blood donations for friends or loved ones, but sometimes this effort proves too late, resulting in missed opportunities to save their dear ones.

The World Health Organization (WHO) recommends member states to develop blood donation based on voluntary unpaid donations and the Korean Red Cross Blood Services (KRCBS) aligns its blood donation policies accordingly. 

However, countries that allow paid blood donation, like Germany, Austria, Hungary, the Czech Republic, and the U.S., provide plasma for close to 90 percent of global demand. 

This alone paints a clear picture of the unsustainable reality of voluntary blood donations worldwide. Are there alternatives to keep the blood bank fully stocked without begging for voluntary blood donation?

What it’s like to donate blood in Korea

Previously, I tried to give blood in my home country, Trinidad but was disqualified for not meeting the minimum weight criteria of 50kg. Currently, my weight has not improved that much but Korea requires women to be 45 kg to donate blood so I managed to overcome this hurdle here while ticking all the basic requirements such as staying in Korea for more than a year with no more than a 90-day stay outside the country and without traveling outside the country within a month from donating. 

In alignment with this, you are also required to fill out an online survey related to medications you might be taking or vaccinations recently received, countries recently visited linked with malaria risks, or other infectious diseases resulting in temporary bans for a certain period. 

However, many are not aware that a permanent ban exists for those who visited countries linked to variant Creutzfeldt-Jakob (vCJD) disease including the U.K., France, and other European countries based on your period of stay in that country within a designated period. For example, donors are ineligible if they stayed in the UK for one month or longer between 1980 and 1996, or three months or more from 1997 going forward. 

I was inspired by my Peruvian friend who regularly gives blood. She has already given blood seven times in Korea but developed this practice in her home country in Peru to challenge herself to lose the fear of needles. However, she continues giving blood because she believes there are many benefits outside of saving lives. 

“People believe that there are more disadvantages associated with giving blood but I think there are more advantages as giving blood can improve heart health as it facilitates better circulation to compensate for the donated blood,” said the Peruvian.

As a first-time donor, I too was a bit nervous because people around me always made it seem like such a scary process where the needle was larger than life itself. However, after getting a quick five-minute consult with the doctor to check my blood pressure, blood type, and a few samples of my blood to scan for diseases, I was given the all-clear. 

Before giving blood, I was advised to drink two cups of water before giving blood to stay hydrated. The needle itself is very similar to the ones for administering intravenous (IV) fluids in hospitals and there was only a slight pinch of discomfort at the very beginning and then the donation was quickly finished in 10-15 minutes because the donation quantity for women is 320 milliliters in Korea but the standard for whole blood donation in other countries is often higher at 500ml. I think this is another positive for donating blood in Korea as it’s more manageable and lowers your risk of fainting.

After donating blood, you can receive a certificate for four volunteer hours each time you donate blood which can be given every eight weeks in Korea. But this is not the only perk. I also received a free movie ticket, snack, and Dunkin’ Donut coupons. However, there is a range of other options such as coffee coupons, nail clipper sets, umbrellas, cultural tickets, and lunch sets but these incentives still pale in comparison to monetary compensation in the U.S. where donors can receive $50 to $75 per plasma donation appointment.

Unethical but what’s the alternative?

As unethical as it might seem to hand out monetary compensation in exchange for blood plasma, it’s also quite difficult to find a way around it. Currently, Korea is experiencing shortages of a plasma-based medicine called intravenous immunoglobulins (IVIG), causing difficulties in treating pediatric patients. Accordingly, the government convened a meeting with two of the main producers of blood products in Korea, SK Plasma and GC Biopharma, but no solution was found. 

Apart from immunoglobulins, many critical plasma-based medicines such as albumin, coagulation factor, and antithrombin III, rely on human blood or plasma donations. The Covid-19 pandemic also exacerbated the issue with blood donations in Korea falling from 2,791,092 in 2019 to 2,604,437 last year according to data from the Ministry of Health and Welfare (MOHW). As a result, the domestic supply of plasma for making plasma-derived products decreased, thus increasing dependence on imports.

These companies have had to rely on imports from the U.S. to maintain their business as blood donation. However, during the Covid-19 pandemic, the Red Cross in the U.S. was also affected demonstrating its first national blood shortage crisis. This calls for more creative incentives to secure a stable blood supply. 

For example, in Romania, blood donors receive free tickets to attend major summer festivals and have been conducting this for 8 years resulting in 60,000 lives saved due to 18,000 donations, according to the organizers. While this might seem like a small number, it is not insignificant. Similar efforts can be made in Korea for local summer festivals such as Water Bomb and a range of other shows around the year.

Despite this decline in blood supply, there has been an increase in the export of blood products from SK Plasma and GC Biopharma to countries in Asia, Latin America, and the Middle East. However, an official from SK Plasma explained that Korea is only the manufacturer of those blood-derived products but the raw blood itself is supplied from the respective country. However, SK Plasma is also making efforts to support blood production in Indonesia by transferring its blood product manufacturing technology to operate a local SK plasma plant with the capacity to produce a million liters of plasma products annually when construction is completed in 2025.

Are artificial blood products a distant reality?

However, one company in Korea pursuing alternatives to voluntary blood donation is YiPSCELL. They use Rh-negative O-type peripheral blood mononuclear cells (PBMC), to produce pluripotent donor artificial red blood cells by going through induced pluripotent stem cells (iPSC) generation followed by differentiation, enucleation, and maturation process for developing artificial red blood cells (RBCs).

“Starting with the production of clinical-grade Rh- O-type iPSCs, we aim to produce artificial RBCs by conducting the entire process within GMP facilities,” said a company official from YiPSCELL. 

The company has already secured a large amount of Rh- O blood through a blood bank run by the Korean Industrial Health Association and plans to secure at least two clinical-grade iPSC cell lines with good RBC differentiation efficiency within 2023. 

However, the company official explained the need to establish regulatory guidelines for blood products at the national level to facilitate clinical trials. The Korean government expects to commercialize artificial blood in the mid-2030s with the K-Blood Farming project but the official pointed out the need to first secure mass production technology and enucleation technology to make artificial blood products become a reality.