Inside the black market for covid-19 plasma donations
With donors charging thousands for plasma, the commercialisation of this therapy has raised legal and ethical concerns
When the health of Kanupriya Mal’s father began to deteriorate in the covid-19 facility at Saket's Max Hospital last month, the doctors advised transfusing plasma from a recovered patient, which contains antibodies against the virus and could potentially help him beat the illness. The family spent three days trying to find potential donors. One prospective donor demanded close to Rs. 25,000-30,000 for his plasma.
As her husband, Adwitiya, along with whom Mal and a friend started the platform Dhoondh to connect donors and patients, told Mint in an interview: “We have seen extremes of human nature in this process—a donor who volunteered to donate plasma who, despite not being well-off, spent his own money to get a blood test, pay for transport and so on and yet refused to take any money from us". He added, “The other extreme was people saying ‘paise aap transfer kar do, hum kal aayenge (transfer the money and we will come tomorrow).’ And I couldn’t really blame them, everybody’s hard up these days."
Their platform now actively blacklists any donor found asking for money.
“The ethical issues are similar to any other experimental intervention. People need to understand that this is something we're collecting data on—we don't have definitive data on efficacy, long term impact etc," says public health and bioethics researcher Anant Bhan. “Because this is being given as an experimental intervention, there should be some controls. There is a lot of hype around plasma and so people look at it as a magical cure and are willing to pay any amount of money. There need to be interventions to raise awareness and address these issues."
Like Mal, many have been confronted with high charges for plasma—and given the situation under which it is sought, many are willing to pay the price. Recently a leading daily reported that a plasma bank in Nalasopara, Mumbai, was charging upto ₹20,000 for the supply of 200ml of plasma to a critically ill patient. As demands soar, the informal market of plasma is seeing even higher bids—reportedly lakhs of rupees for antibody-rich plasma and chartered flights to ferry donors. This, in spite of existing legal provisions to circumvent such practices as well as a 1996 order from the Supreme Court prohibiting paid donations of blood and blood components.
“It's illegal under the National Blood Policy of 2007—you cannot charge someone for blood donations," says lawyer Madhav Chandavarkar. “Additionally, under section 27 and sec 18 of the Drugs and Cosmetics Act,1940, blood is classified as a drug. As per Section 27 read with Section 18, any individuals dealing in or monetising blood transfusions are violating and can face jail time of upto 2 years."
While price controls on the sale of blood exist for both government and private institutions, enforcement is weak. Experts agree that the National Blood Transfusion Council (NBTC) should ideally issue a separate policy on pricing for covid-19 plasma, since this would constitute a new category. Until then the existing prices need to stringently be enforced: the rate for platelets and plasma were fixed at Rs400.
“We should not have a situation where all the plasma is concentrated in elite hospitals and there’s nothing for the poor in government and municipal hospitals," says Dr. Swapneil Parikh, co-investigator, Kasturba Hospital, ICMR’s PLACID trial on plasma therapy.
To this end, Parikh, who also heads a startup called DIY.Health, has set up the platform Plasma Yoddha, where recovered patients can register, be screened by doctors and eventually donate to government or municipal blood banks. “What we're trying to do is connect these blood banks and create a real time inventory list for the government. From there, the government can then decide how they want to allocate the plasma and proceed accordingly," says Parikh.
As the number of cases surge, checking the rise of a black market of convalescent plasma will be a difficult feat. Still, given the legal and ethical concerns, it is essential that the government take note of this breach and take necessary action. This could be key in making sure there is healthcare for all.
As Parikh points out, the big fear is that the commercialisation of plasma will put a life saving resource into the hands of the classes, when it should be in the hands of the masses.
FIRST PUBLISHED16.07.2020 | 09:30 AM IST