Blood for Sale
CASE 2.3 Blood for Sale
Sol Levin was a successful stock broker in Tampa, Florida, when he recognized the potentially profitable
market for safe and uncontaminated blood and, with some colleagues, founded Plasma International. Not
everybody is willing to make money by selling his or her own blood, and in the beginning Plasma
International bought blood from people addicted to drugs and alcohol. Although innovative marketing
increased Plasma International’s sales dramatically, several cases of hepatitis were reported in
recipients. The company then began looking for new sources of blood. Plasma International searched
worldwide and, with the advice of a qualified team of medical consultants, did extensive testing.
Eventually they found that the blood profiles of several rural West African tribes made them ideal
prospective donors. After negotia-tions with the local government, Plasma International signed an
agreement with several tribal chieftains to purchase blood. Business went smoothly and profitably for
Plasma International until a Tampa paper charged that Plasma was purchasing blood for as little as
fifteen cents a pint and then reselling it to hospitals in the United States and South America for $ 25 per
pint. In one recent disaster, the newspaper alleged, Plasma International had sold 10,000 pints, netting
nearly a quarter of a million dollars. The newspaper story stirred up controversy in Tampa, but the
existence of commercialized blood marketing systems in the United States is nothing new.
Approximately half the blood and plasma obtained in the United States is bought and sold like any other
commodity. By contrast, the National Health Service in Great Britain relies entirely on a voluntary
system of blood donation. Blood is neither bought nor sold. It is available to anyone who needs it
without charge or obligation, and donors gain no preference over nondonors. In an important study,
economist Richard Titmuss showed that the British system works better than the American one in terms
of economic and administrative efficiency, price, and blood quality. The commercialized blood market,
Titmuss argued, is wasteful of blood and plagued by shortages. In the United States, bureaucratization,
paperwork, and administra-tive overhead result in a cost per unit of blood that is five to fifteen times
higher than in Great Britain. Hemophiliacs, in particular, are disadvantaged by the U. S. system and have
enormous bills to pay. In addition, commercial markets are much more likely to distribute contaminated
blood. Titmuss also argued that the existence of a commercialized system discourages voluntary
donors. People are less apt to give blood if they know that others are selling it. Psychologists have
found similar conflicts between financial incentives and moral or altruistic conduct in other areas.
Philosopher Peter Singer has elaborated on this point in the case of blood: If blood is a commodity with
a price, to give blood means merely to save someone money. Blood has a cash value of a certain number
of dollars, and the importance of the gift will vary with the wealth of the recipient. If blood cannot be
bought, however, the gift’s value depends upon the need of the recipient. Often, it will be worth life
itself. Under these circumstances blood becomes a very special kind of gift, and giving it means
providing for strangers, without hope of reward, something they cannot buy and without which they
may die. The gift relates strangers in a manner that is not possible when blood is a commodity. This may
sound like a philosopher’s abstraction, far removed from the thoughts of ordinary people. On the
contrary, it is an idea spontaneously expressed by British donors in response to Titmuss’s questionnaire.
As one woman, a machine operator, wrote in reply to the question why she first decided to become a
blood donor: “ You can’t get blood from supermarkets and chain stores. People themselves must come
forward; sick people can’t get out of bed to ask you for a pint to save their life, so I came forward in
hopes to help somebody who needs blood.” The implication of this answer, and others like it, is that
even if the formal right to give blood can coexist with commercialized blood banks, the respondent’s
action would have lost much of its significance to her, and the blood would probably not have been
given at all. When blood is a commodity, and can be purchased if it is not given, altruism becomes
unnec-essary, and so loosens the bonds that can otherwise exist between strangers in a community. The
exist-ence of a market in blood does not threaten the for-mal right to give blood, but it does away with
the right to give blood which cannot be bought, has no cash value, and must be given freely if it is to be
obtained at all. If there is such a right, it is incompatible with the right to sell blood, and we cannot
avoid violating one of these rights when we grant the other. 23 Both Titmuss and Singer believe that the
weakening of the spirit of altruism in this sphere has important repercussions. It marks, they think, the
increasing commercialization of our lives and makes similar changes in attitude, motive, and rela-
tionships more likely in other fields. Update Dr. Arthur Matas, a prominent kidney- transplant surgeon, is
pushing for one change that it’s doubtful either Titmuss or Singer would like. Lately, he’s been traveling
the United States making the case for lifting the legal ban on kidney sales. That ban was imposed in 1984
by an outraged Congress after a Virginia physi-cian had proposed buying kidneys from poor people and
selling them to the highest bidder. By contrast, Dr. Matas isn’t trying to make money. He would like the
government to handle kidney sales, and the kidneys to go to whoever is at the top of the current
waiting list, whether the patient is rich or poor. And that list grows longer every year as the gap
continues to widen— it’s now nearly five to one— between patients in need and the number of kid-neys
available from either living or deceased donors. With eligible patients often waiting for five or six years,
more and more people are taking Dr. Matas seriously, but many experts still balk at the idea of organ
sales. One of them is Dr. Francis Delmonico, a professor at Harvard University and president of the
network that runs the nation’s organ-distribution system. He worries that Dr. Matas’ plan would exploit
the poor and vulnerable, that it would cause altruistic kidney donations to wither, and that wealthy
patients would manage to find a way around a regulated market to get a kidney faster.
1. Is Sol Levin running a business “ just like any other busi-ness,” or is his company open to moral
criticism? Defend your answer by appeal to moral principle.
2. Did Plasma International strike a fair bargain with the West Africans who supplied their blood to the
company? Or is Plasma guilty of exploiting them in some way? Explain your answer.
3. What are the contrasting ideals of the British and U. S. blood systems? Which system, in your opinion,
better promotes human freedom and respect for people? Which system better promotes the supply of
4. Examine the pros and cons of commercial transactions in blood from the egoistic, the utilitarian, and
the Kantian perspectives.
5. Are Titmuss and Singer correct to suggest that the buying and selling of blood reduces altruism? Does
knowing that you can sell your blood ( and that others are selling theirs) make you less inclined to
donate your blood?
6. Singer suggests that although the right to sell blood does not threaten the formal right to give
blood, it is incompat-ible with “ the right to give blood, which cannot be bought, which has no cash
value, and must be given freely if it is to be obtained at all.” Assess that idea. Is there such a right?
7. Many believe that commercialization is increasing in all areas of modern life. If so, is it something to
be applauded or condemned? Is it wrong to treat certain things— such as human organs— as
8. Do you believe that we have a moral duty to donate blood? If so, why and under what circumstances?
If not, why not?
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