Plasma collection and supply in Europe: Proceedings of an International Plasma and Fractionation Association and European Blood Alliance symposium

Developing a social model for blood and plasma donation

While the demand for blood and plasma products has increased globally, the supply from domestic donors remains critically low due to challenges recruiting and retaining donors. We use a constructivist grounded theory approach to explore factors influencing blood and plasma donation (BPD). We interviewed 66 current whole-blood donors, lapsed whole-blood donors, and non-donors. We then developed a model comprised of the 3 factors that influence BPD. The first factor identifies how individuals' presentations of self influence BPD. The second focuses on individuals' experiences navigating social structures and systems, including how group identity, presentations of self, and citizenship influence this process. The third examines pragmatic barriers to donation. We found this model represents individuals' experiences as they move towards, or away from, wanting to engage in BPD. This information could help inform future work on increasing BPD.

Understanding supply sustainability of plasma-derived medicinal products: Drivers and consequences of shortages

Plasma-derived medicinal products (PDMPs), particularly immunoglobulins (Igs), are essential treatments for numerous diseases, often serving as the primary therapeutic option and playing a critical role in patient care. The human origin of these products, however, can lead to supply constraints due to a lack of plasma collection, market dynamics, regulatory challenges and manufacturing complexities. Many nations lack plasma self-sufficiency and often rely on the United States, which supplies approximately 70% of the world's plasma. This supply chain is vulnerable to disruptions, such as those caused by COVID-19. Additionally, plasma processing timelines are lengthy-Ig manufacturing takes 7-12 months compared with 2-3 months for biologics. Despite the global Ig market's projected growth from $13.36 billion to $24.98 billion between 2023 and 2032, plasma shortages persist. The European Medicines Agency anticipated shortages to affect 14 European countries in 2024. These factors can have significant implications for patients, with growing demand likely leading to supply challenges and forcing countries to prioritize certain indications in the face of shortages. Policy interventions may be needed to ensure the sustainable use of these products in treating immune-mediated disorders and related conditions. Exploring alternative treatments where possible could also mitigate the risk of shortages and maintain access to these life-saving therapies. This review examines the sustainability of PDMPs, focusing on drivers and consequences of shortages, insufficient plasma collection, vulnerability of the plasma supply chain and impacts on patients. A scoping literature research was conducted in PubMed, supplemented by internal knowledge and targeted web searches.

[Strategic independence: a value model for improving access to plasma-derived medicines in Latin AmericaIndependência estratégica: modelo de valor para melhorar o acesso a hemoderivados na América Latina]

Plasma-derived medicinal products (PDMPs) are essential medicines required for the treatment of congenital, rare, and acquired diseases. At present, the market dynamics of these products have led to high dependence on a few producing countries, causing shortages, stockouts, and problems related to access in general. To help solve this problem, this document proposes a value model for PDMPs from a public health perspective, and considers the prospects, visions, and challenges to implementation in Colombia, as a case study. These proposals seek to contribute to the development of strategic independence in plasma, while promoting equitable access to PDMPs in the Region of the Americas. They are the result of a series of discussions and semi-structured interviews with national and international stakeholders from different public and private sectors, and with leaders of the National University of Colombia and the International Plasma and Fractionation Association (IPFA). It is hoped that these proposals will serve as an example for other countries in the Region to include this issue in their public policy agenda.

Fear of donation-related stimuli across different levels of donation experience and types of donation (whole-blood and plasma): A cross-sectional study in Italian donors

BACKGROUND

Donation-related fears are prevalent even among regular donors and can hinder both recruitment and retention. This cross-sectional study aimed to estimate the prevalence of these fears in Italian whole-blood and plasma donors, across different levels of donation experience.

STUDY DESIGN AND METHODS

A sample of 615 voluntary, unpaid donors from Italy (64.1% male, mean age 45.42 ± 11.80 years) completed an online survey assessing their fear of common donation-related stimuli (fear of blood, needles, pain, and fainting), experience of vasovagal symptoms at the last donation, and their intention to donate again. Donors were grouped based on donation history and their most recent donation type (whole-blood or plasma).

RESULTS

A significant negative relationship was found between donation history and most types of donation-related fears, suggesting that greater experience corresponds to reduced fear. Plasma donors reported lower levels of fear across all stimuli compared to whole-blood donors. Despite this, nearly one-third of the most experienced whole-blood donors and 20% of plasma donors still reported some level of fear. Greater fear was associated with increased reports of pain and vasovagal symptoms during donation, regardless of donation type. However, no significant association emerged between donation-related fears and the intention to donate again.

DISCUSSION

Donation-related fear persists even among experienced donors, for both whole-blood and plasma donors. Given its potential to impact donor comfort and retention, the assessment and management of donation-related fears should be integrated into donor care, with appropriate strategies to help donors regulate their fear throughout their donation careers.

Toward a Sociology of Plasma Products

Over the past 20 years, plasma has become a medical treatment characterized as "liquid gold" to signal its lifesaving potential. Through a manufacturing process termed fractionation, plasma, collected through blood donation, is turned into Plasma Derived Medical Products (PDMPs). The World Health Organization (WHO) has underlined the importance of PDMPs for global health care, including a number of PDMPs on the WHO Model List of Essential Medicines. The process of collecting plasma from a donor, manufacturing plasma derived treatments, and distributing those treatments globally requires the coordination of multiple social actors operating in different social, political and economic contexts, but has received little attention in scholarly literature on public policy or the social sciences. This paper will introduce a set of analytic questions and concepts that can direct a sociology of plasma products. We build on the behavioral turn in the policy sciences to identify relevant policy questions emerging from this field and offer the analytic tools necessary to investigate how different social actors in this space make meaning of plasma. To do this, we will draw on key concepts in the sociology of health and illness.

Balancing Donor Health and Plasma Collection: A Systematic Review of the Impact of Plasmapheresis Frequency

Most plasma used for manufacturing plasma-derived medicinal products (PDMPs) such as albumin, immunoglobulin (Ig), and clotting factors is obtained from source plasma collected via plasmapheresis, the majority of which is contributed by the United States (US). While the demand for PDMPs continues to rise, it remains unclear whether high-frequency plasmapheresis, such as the twice-weekly plasma donation allowed in the US, may have any (long-term) adverse health effects on the donor. To investigate the frequency at which plasma can be donated without harm to the donor, the current systematic review explores the impact of plasma donation frequency on cardiovascular health, protein depletion, and adverse events in healthy plasma donors. We asked the following research question: What is the impact of plasmapheresis frequency (Intervention) on the safety or health (Outcome) of healthy donors (Population)? Six databases (PubMed, Embase, Web of Science, CINAHL, the Cochrane Library, and Transfusion Evidence Library), 2 clinical trial registries (ICTRP and clinicaltrials.gov), and the PROSPERO database were searched. Four observational and 2 experimental studies were included. The results showed that very high-frequency donation (twice per week) may result in a clinically relevant decrease in ferritin and bring IgG levels below the lower threshold of 6 g/l. However, the evidence is of low to very low certainty, and solid conclusions are hindered by the healthy donor effect and methodological limitations of the included studies. To determine a safe threshold donation frequency that minimizes any possible harmful effect on the donor, more high-quality prospective cohort studies and experimental studies are needed. We should expedite such studies to support recommendations, as conclusive evidence confirming or refuting the safety of maximum allowed donation frequencies is lacking. Donor protection is essential, given that healthy donors receive no direct medical benefit from donating plasma.

Incentives for plasma donation

BACKGROUND AND OBJECTIVES

This work provides an overview of the incentives used for plasma donation in Europe and beyond. The overview can provide new ideas to blood establishments.

MATERIALS AND METHODS

We conducted a systematic online search of incentives used and asked national experts to validate the data across all European Union countries as well as other European and non-European countries. We categorized the data into level of incentive (using the Nuffield Council on Bioethics' rungs [2011]) and country.

RESULTS

We analysed more than 490 organizations across 26 countries. Our findings reveal different incentives used in these countries. Snacks and pre-donation health checks are commonly provided. In addition, loyalty programmes, small gifts, vouchers, lotteries, travel compensations and time off from work extend the strategic incentive portfolio. Only seven countries offer financial compensation ranging from the equivalent of 10-35€ for European countries. In countries with a decentralized model, where more than one organization collects plasma, we observe that more diversified incentive strategies are generally used, including monetary and non-monetary incentives. In countries with a centralized model, where only one organization is allowed to collect plasma, financial compensation is usually not offered. Centralized plasma collection without financial compensation relies on a wider range of non-monetary incentives than with financial compensation.

CONCLUSION

The country group analysis offers valuable insights into the relationship between incentive strategies and the prevailing centralized versus decentralized plasma collection model. This overview provides a broader understanding of incentives used by blood establishments and offers avenues for future practice.