By Sarah Seifert @TheSarahSeifert
GREEN BAY, WI – “Easy cash.”
“I stopped going because it hurt.”
“I don’t plan on ever going back.”
“It goes on to help people who need transfusions!”
“It’s not worth it anymore.”
BioLife Plasma Services and the college students of Green Bay, Wisconsin have a complicated relationship. Some have a relative or friend with a blood disorder. Some want to feel connected to their community. Others have been permanently barred from donating, or the voluntary pain is too much.
None of these enterprising young students know exactly where the dull yellow plasma goes after it’s slowly extracted from their veins. Most are optimistic that it’s helping people. One student said he would prefer not to know. Another said he would feel uncomfortable asking.
Most who cycle through the spotless glass doors of Green Bay’s BioLife location have one thing in common: they desperately need the money.
The phlebotomist sterilizes the needle, pricks my skin, and finds a vein with little trouble. She asks for the last four digits of my social security number. Confused, I give them to her. The other donators here know how to play the game, and recite their digits with little to no reaction.
The donation process, called plasmapheresis, takes me just under an hour. The machine hooked up to my arm sluggishly fills with my blood, extracts the protein-rich plasma, then filters it back into my vein through an IV. Throughout the process, a metallic taste fills my mouth – a common side effect.
The perky trainee who checks up on me a little too constantly is called a phlebotomist, a local pre-med student trained to draw blood. She chats with the middle-aged woman in the chair next to mine, asks her about her daughter in college, and compliments her on her homemade flowered headband, before coming back to me. “You’re so well hydrated,” she smiles, giving me an overly enthusiastic thumbs-up. “Keep doing what you’re doing.”
BioLife’s Appleton, Wisconsin location, about 45 minutes south of Green Bay. Image source: opnarchitects.com.
The colorful signs with feel-good messages are at odds with the sterile white facility. “Save a life in one hour!” a smiling woman in a lab coat promises me. In my introductory packet of donation materials, a helpful brochure informs me that my plasma will save the lives of people with blood disorders everywhere. Beyond promising that I’m a hero for donating, the information BioLife offers about the plasma treatment process is frustratingly vague.
I walk out of the doors with a newly bruised and bandaged arm, $25 loaded onto a prepaid debit card, the scent of lemon disinfectant clinging to my coat, and a headache. The BioLife location in Green Bay is in a fairly well-to-do part of town, and even though dusk is setting as I climb into my car, I don’t feel uneasy in the well-lit parking lot.
This BioLife facility, however, is the exception rather than the rule. Madison’s Interstate Blood and Plasma is located on West Gorham Street, right in the heart of the city, and is significantly less upscale. Milwaukee’s plasma donation centers are also in poor, predominantly black neighborhoods.
The plasma industry was built on the backs of prison inmates, drug-heavy neighborhoods, and poor sectors of large cities. Throughout the 1970s, 80s, and even 90s it spread tainted blood, slowly spread hepatitis and HIV, and was involved in dozens of scandals.
Is the plasma industry’s facelift enough to tempt Green Bay college students back through BioLife’s doors? The small, perfectly circular scars in the crooks of dozens of college students’ elbows are telling.
The author’s arm, after six months of donating and two months of recovery. Image source: Sarah Seifert
As I continued to donate plasma for the next seven months, people would ask to
see the scar, some with genuine curiosity, others in horrified fascination. Other donors roll up their sleeves to compare their pockmarks with mine. The signature BioLife debit card always gave us away.
There were always tales to exchange about bad phlebotomists, needles being yanked out halfway through a donation, and shivering your way to your car – the saline solution injected as a substitute for the plasma is kept at room temperature, which is much colder than the temperature inside your veins. We exchange horror stories while sipping on coffee bought with that purple debit card.
Blood money?
Plasma, IVIG, and the American Dream
According to the Plasma Protein and Therapeutics Association, plasma contributes to treatments for patients with bleeding disorders like hemophilia A and B, Von Willebrand disease, and immunodeficiency disorders.
There’s a reason why the industry is so efficient, why one facility can filter thousands of people in and out so quickly. It has no other choice. 1200 plasma donations are needed to treat 1 patient for hemophilia, 130 to treat 1 patient for a primary immune deficiency, and a staggering 900 to treat one Alpha-1 patient (a genetic deficiency that can result in lung disease or liver disease in anyone from children to the elderly.)
Plasma’s precious ingredient, one that scientists have not yet found a way to manufacture, is intravenous immunoglobulin (IVIG). Plasma f
rom thousands of donators is pooled, treated with chemicals to eliminate blood-borne pathogens and extract the immune globulins.
IVIG treatments are nearly impossible to conduct without insurance coverage – $100,000 to $350,000 per year, per patient. The relatively tiny cash compensation for donors, $50-$70 per two donations in the form of a prepaid debit card, might seem strange, given the precious value of IVIG.
The U.S. is one of only two countries that has not outlawed paying plasma donors (China is the other). “It is banned…for ethical reasons and in order to assure the safest supply possible,” said London School of Hygiene research fellow Lucy Reynolds in 2013.
“Hospitals, Red Cross units, and nonprofit agencies reject the plasma center model because cash incentives may give donors an incentive to lie,” said The Atlantic’s Darryl Wellington in 2014. People with transmittable infections will donate anyway, especially since the current low-paying system is focused on those who desperately need quick cash, Reynolds argues. She warns that another deadly outbreak of blood-borne disease is not only likely, it’s inevitable.
Bad Blood
The plasma industry is desperately trying to recover from the image it cultivated in past decades. Scandals upon scandals erupted due to erratic testing.
In a polarizing 1998 article, a Salon journalist reported that Arkansas was the last state to outlaw selling prison inmate’s plasma in 1994. However, throughout the 1980’s at one of the most notorious prisons in the state, prisoners were donating a pint of blood for a mere $7. The prison reaped the rest of the financial benefits.
Multiple prisoners who were known hepatitis B carriers were allowed to donate blood. It was pooled with dozens of other prisoners’ blood and shipped to Switzerland, Japan, Italy, and Canada. Connaught Laboratories of Toronto bought into the tainted units and sold them throughout Canada. The simple oversight erupted into a national health crisis.
More that 42,000 Canadian citizens had been involuntarily infected with hepatitis C and HIV. That negligence will most likely soon result in at least 7,000 Canadian deaths.
China, the only other country that uses a paid plasma donation model, has had its own blood contamination woes. A 2007 Reuters journalist said “Blood transfusion is still a major channel for HIV-AIDS transmission in China, and patient infections from blood-based drugs made with tainted plasma are reported sporadically by local media.”
Gregory Maddy of Spokane, Washington brought a medical malpractice suit against CSL Plasma for contracting a staph infection shortly after donating. The court ruled against Maddy, saying there the only possibility that donating plasma had caused his infection would be a contaminated needle. But is contamination really a stretch?
Plasma is precious – and pharmaceutical companies are realizing its true value. It’s now being used to treat a much wider variety of health problems – authors of a 2008 review of unlabeled uses of IVIG (IVIG being used to treat health problems other than primary immunodeficiency diseases) found that it was also being researched to develop treatments for childhood asthma, obsessive-compulsive disorder, and neuropathic pain.
Better treatments for more people sounds positive. If we continue to feed the plasma machine, how fast will it take before people begin dying from contaminated blood?
A Poor Man’s Game
The U.S. is the plasma industry’s top producer. “The OPEC of plasma,” a top executive of America’s Blood Centers calls it in a New York Times article. It’s a part-time job for many; the sole income source for some.
America has 495 plasma centers, compared to Europe’s 100, spread over Germany, Hungary, Austria, Belgium, and the Czech Republic. The real question about America’s plasma fascination is this: why are the majority of centers concentrated in the Midwest?
The “red zone” of plasma centers is the American Midwest. Image source: DonatingPlasma.org.
Furthermore, why are nearly all facilities in large cities found in high-poverty, primarily black, or drug-ridden neighborhoods? Detroit alone boasts eight centers; Chicago has seven. Wisconsin, with its affinity for small towns, hosts nineteen.
A 2003 American Journal of Public Health study found that commercial plasma donation clinics were overwhelmingly located in high-risk city areas – meaning areas with “active local drug economies.” Income and education, however, also play their part.
The average household salary in Madison, Wisconsin is sixty-one thousand dollars a year. The average household salary on Gorham Street, the location of Madison’s main plasma center? Seven thousand a year. Milwaukee isn’t much better, with an average household salary of forty-three thousand compared to the plasma center neighborhood’s average of eighteen thousand. Almost every Wisconsin city with a plasma center – Eau Claire, Green Bay, Beloit, Janesville, La Crosse – has a higher average household salary than its plasma center’s neighborhood.
Not only are Wisconsin plasma centers found in poor neighborhoods, but in uneducated ones. 47% of Madison dwellers over 25 have a bachelor’s degree; only 37% of Gorham Street inhabitants do. Comparing education level data in neighborhoods with plasma centers can be risky business, however, because college towns are an instant draw for the plasma industry. The built-in market in any town hosting a university would make any company jealous.
The plasma industry has never tried to deny it: college students, the poor and homeless, and the uneducated are their primary targets.
Community Service or Russian Roulette?
Plasma centers, without fail, offer an incentive for twice-per-week donation. Some give bonuses, coupons, gift cards to local businesses. However, the Red Cross’ recommendation is far, far less – once every 28 days, or about 13 times per year.
Asking the plasma industry to cut their revenue by seven-eighths to ensure the safety of donors is laughable. But why the discrepancy? Why do plasma centers downplay the risks of donating twice per week, ad infinitum?
Donors seem to accept that twice-per-week means migraines, fatigue, and a hugely increased risk of getting sick. “All I can say, I just got sick a lot. I easily caught the flu. Then, you know, I would go back and do some more, so I would get even more sick and wouldn’t even think about it,” laughs a UW-Green Bay senior, 27-year-old Benjamin Koenigs who donated twice a week for two months.
Like many other donors, Koenigs seems to realize the consequence of donating twice a week – migraines, weak immune system response – but plasma centers offer incentives. “I was trying to get Packer tickets. They were handing out tickets to anyone who donated eight times a month,” Koenigs says, rolling his eyes.
He lost his shot at the football tickets after developing a hematoma in both arms, blood pooling underneath his skin after a phlebotomist inserted the needle too far into his arm. The pain and frustration with BioLife kept him from returning.
If he knew the Red Cross recommended a donation rate of only once a month? “Unfortunately, if I needed the money, I’d probably still do it,” Koenigs says, looking more than a little guilty.
The Wisconsin Plasma Giant
BioLife, CSL Plasma, OctaPharma, and Interstate Blood and Plasma all pop up in poor towns around the state – but BioLife dominates the Wisconsin landscape, with 10 out of the state’s 19 total plasma centers. It was founded in 2000, a relatively new plasma company, and perhaps is untainted by the hepatitis and HIV scandals of older entities.
But in the town of Green Bay’s population is overrepresented by both college students and the elderly; furthermore, the city is known for its heroin problem. These factors combine to make Green Bay the perfect target for plasma donation. While the facilities sparkle and most of the phlebotomists are a certain Midwestern breed of friendly, many UW-Green Bay students regard BioLife with unease, distrust – or hostility.
Ashley Wisneski is a 23-year-old alumna of UW-Green Bay who donated a mere five times. The extreme fatigue after a donation is somewhat common, but after her arm began swelling and fell asleep mid-donation, she stopped making the ten-minute drive from UW-Green Bay’s campus to the BioLife facility. “It’s so uncomfortably painful and I was always worried about which nurse I would get,” Wisneski says.
A UW-Green Bay female student, who wishes to remain anonymous, says donating affected her health for several months. “I was getting sick all the time. I swear after I would donate, a few days later I would get a cold.” Towards the end of the six-month period of donating twice a week, she would experience constantly illness for nearly a month. “It was…pretty much destroying my immune system,” she says.
Yet another donor’s vein ruptured when a phlebotomist inserted a needle upside down and attempted to turn it while still inserted. Crystal Gruselle, also UW-Green Bay alumna, says attempting to donate plasma gave her a fear of blood and needles. After re-inserting the needle several times, Gruselle’s blood pressure dropped so quickly that facility staff had trouble finding a vein. Gruselle says she couldn’t bend either extremely bruised arm for over a week.
In 2013, a Washington woman sued BioLife for misdiagnosing her with hepatitis and HIV. The story is eerily similar to that of a UW-Green Bay student, David Burish, who was misdiagnosed with AIDS at Green Bay’s BioLife location in 2015. “Only working part-time gives you so much money, and you know, easy cash for an hour twice a week,” Burish said. He donated twice a week for four to six months, only experiencing the occasional migraine, before a confusing exchange led to a shocking email.
“I went to schedule my third appointment, and they wouldn’t let me. About two weeks later I called…they had the wrong ID under my name. Finally when I got a response back, I got this letter in the mail. It said their tests showed I had a diagnosis of AIDS.”
Within a week, the local STD testing center had delivered Burish his actual test results: negative. BioLife had sent Burish a false positive, and as a result, he is barred from donating for life.
The Midwest is slowly becoming a more popular venue for plasma donation centers, and is relatively safe. But the plasma donation center model of payment is clearly taking advantage of poor populations, and in Green Bay, Wisconsin, college students are slowly becoming disillusioned with the shiny silver-gray BioLife building next to East Mason Street, and the fast cash it promises.
Cover Image: WordPress.com
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