For 20 years, I’ve relied on a drug made from other people’s blood parts to keep myself upright. I’ve had dozens, maybe hundreds of infusions by now, and each time I wonder whose blood plasma was extracted to make the drug on which I depend. Several years ago, I set out to find some of them and ask why. There are millions of Americans who have sold their plasma for money when jobs and savings aren’t enough. Their stories are the focus of my new book Blood Money: The Story of Life, Death, and Profit Inside America's Blood Industry.
As I recount in the excerpt below, college students are a favorite target of plasma companies, who know that young students need extra cash. I spent time in one unique college town in the Mountain West asking why so many students there sell plasma.
The geotargeting of plasma extraction leaves a lot of people out and maintains it as something people do while in school. A look at the economics of getting a college degree can help explain why.
In the thirty years leading up to the present, the average cost of college tuition in America has tripled, landing at the high end at more than $35,000 a year for private colleges. And that’s not counting accompanying living expenses, which can add another $20,000 a year for each student, according to the Education Data Initiative. The tuition and living costs vary widely, of course, but the expectation of students to go to college has risen and so has the debt that so many take on to make that happen. In the empty space where government funding should be, plasma extraction has materialized as a Band-Aid for many students.
Along with the untenable rise in the cost of higher education, student debt has soared. In my wider survey of plasma donors around the country, I heard from people who have used blood plasma money to help pay down their student debt. In essence, these loans have saddled entire generations of students with payments the size of what their parents and grandparents might have spent buying a house and a nice car. By some estimates, student loans typically take twenty years to pay off.
The U.S. government has has taken some initial steps toward student debt relief and limiting untenable loan payments. Even that ignited a fight over extending grace to the “wrong” people who have too much money—those who come from wealthy families or earn above a certain income level after college. We are a rich yet incredibly stingy country especially when it comes to extending a hand to those in need. State and private universities continue to raise their tuition, the cost of living is on the rise across the land, and so plasma often flows from students’ bodies to fill the financial gaps.
Looking back through recent history, the American culture of young people selling pieces of themselves, literally, is not new or wholly confined to blood. Even when I was in college in the 1990s, I knew students who sold parts of themselves to pay for what they needed. One of my roommates was paid to be a sperm donor; a friend enrolled in every campus clinical trial possible, making $40 or $50 for each. Paid plasma wasn’t an option in my city back then, but I heard about women selling their eggs, a prospect I found both intriguing and horrifying.
Diane Tober, a medical anthropologist at the University of California, San Francisco, has investigated the reasons women sell their eggs. Tober conducted interviews and surveys involving more than 600 egg donors, and she found that, in the United States, college debt is a leading reason women undertake this process. Contrary to the soothing stock imagery and easy moneymaking opportunities advertised, egg donation is a complex and invasive procedure involving intensive hormone therapy. It does pay women generously if they participate in multiple cycles. But especially if repeated, the practice can have serious, long-term health consequences. A piece Tober wrote for Salon aligned with what I heard from plasma sellers:
The United States emerges in my study as the only country where women in their 20s feel compelled to make medical decisions with life-long implications to reduce or eliminate the affliction of student debt. Without this burden people may still decide to donate eggs for financial relief—even in countries like Spain where donor compensation is much lower than in the US—but they are not driven by the same financial desperation arising from the cost of education.
We demand that young people go to college to get the jobs that will lead them into comfortable lives, but the years of higher education themselves are increasingly difficult for most people to navigate financially. Tuition, rent, gas, and food—the basic essentials of life while in school, not even counting money for fun—have reached record highs and there’s been little effort made in most communities to alleviate these burdens. This paradox forces students to make difficult and too-soon decisions about their wealth, finances, health, and bodies.
Much of the mainstream discussion about higher education in America centers on a few wealthy private colleges where many of the students come from affluent families. I have long believed this fascination with the Ivy League and expensive private colleges stems from the fact that the people who run for national office and who write for the national media have attended those schools in outsized numbers compared with the rest of the population. Many of their children strive for the same schools and careers. They see what they are used to seeing and talk about who and what they know best. Many of them have never met someone who sells plasma to eke out a living. They might not know how students at public universities use the plasma money to make the rent. But in the rest of the country, in pockets like Rexburg and across cities and states less wealthy, students are selling their body parts to pay for their education.
At BYU-Idaho in Rexburg, tuition is much lower than the national average—less than $5,000 per year. The university is deliberately affordable. Many of its students come from rural parts of the Mountain West, where family incomes are lower than in other regions of the country, and whatever extra money students can earn for meeting their living expenses is welcomed.
Among the students I interviewed outside the plasma center in Rexburg, most said they use the money for rent, gas, or groceries. Tuition itself isn’t the issue; their blood money goes toward the price of living. The median household income in Rexburg is less than half the national average—about $31,000 a year here, compared with $67,000 nationally. This persistent wedge of income disparity helps to explain why a city so small has two thriving paid plasma extraction centers.
On the front window of the Grifols Biomat right near the BYU-Idaho campus, a large sign spells out for students how much they can make by selling their plasma every month:
DONOR PAYMENTS
- 1st donation $25
- 2nd donation $30
- 3rd donation $35
- 4th donation $40
- 5th donation $75
- 6th donation $75
- 7th donation $75
- 8th donation $100
- 9th donation $100
- 10th donation $100
- Total in 9 donations: $555
- Total in 10 donations: $655
Below this schedule in the window is the schedule for new donors, for the first month they sign up, who make $100 each time. It’s a lure to pull them into the system and get them hooked on blood money. I can’t help but think back to the dystopian plasma economy slogans of China, urging farmers who were poor to offer up their veins to be tapped in exchange for promises of potential wealth: “Stick out an arm, show a vein, open your hand, and make a fist, 50 kuai.” Or, “If you want a comfortable standard of living, go sell your plasma,” and “To give plasma is an honor.” It seemed ludicrous in China; it feels the same here.
At the plasma center just off campus in Rexburg, I met a few students who showed up twice a week to make the maximum amount of money. Across from a fancy chain cookie store, I stood on the sidewalk and caught plasma sellers as they left the building. Many of them did not want to use their real names in print, but they seemed happy enough to talk about it.
I asked a person I’ll call Paul, a junior at the college, if he was embarrassed to tell people he sold his plasma. He looked at me like I wasn’t that smart. No, he’d never thought to be ashamed of it. That’s because nobody cared if you sold plasma in Rexburg. “It’s just what we do,” he said. The downside was that if he got bounced from donating for some reason—or if he missed a week for any reason—he had to start all over again. He referred his friends to the center as new donors so as to get bonus money whenever he could. I asked if he ever got sick from the process, and he said no, but his girlfriend had to quit after only two donations because it made her too tired to function the rest of the day.
I’ve noticed this divide repeatedly. Some plasma donors don’t notice anything but the hassle of time and needles, while others can’t get past the crushing fatigue. I’ve spoken with several scientists about the health impacts, and the main concern is the frequency of plasma donation in the United States. To refill that giant pool, companies do what they can to draw donors in twice a week, every week, for as long as possible. We are the only country in the world that allows people to donate their plasma so often. And even though formal studies have not linked serious health problems with long-term donors yet, the rush and demand for plasma as much as twice a week does raise questions. The fatigue, the nausea, the chills—they are all aftereffects.
The plasma industry insists it is not exploiting people, that payment schemes are, technically, only tokens of appreciation for donors who give their time. But the business has built a deliberately complex pyramid of payments and incentives designed to draw people and keep them in the system. The reality of the plasma economy tells an entirely different story from the one the industry wants to present. In college towns like Rexburg, a steady stream of willing raw material is derived from a large part of the population who are willing and need money.
Nobody gets rich selling their blood plasma. They get by, barely, or get a little closer to being able to afford some of the things that bring them some joy. Though the industry maintains that its payment schedule is to compensate donors for their time, that donation time doesn’t increase with each donation. Rather, the payment schedules are clearly designed to pull people in as often as possible to make the maximum amount of money. More specifically, in Rexburg, a person who never misses twice-weekly donations can make more than $7,000 a year—a healthy income for a college student in a town with a high rate of poverty. If you’ve already made seven donations in a month, why not up your income just by adding one more trip to the plasma center? This is how the companies keep people returning, even when the crushing schedule feels like too much for their bodies to handle. In essence, the payment structure punishes those who don’t come as often.
I left Rexburg after two days of chats with students on the street corner and drove back through the mountains to Montana, all the while thinking about the trap that is higher education. The students I met were focused on getting a degree, graduating, and moving into middle-class jobs. But to get there, they had to sell pieces of their bodies.
From BLOOD MONEY by Kathleen McLaughlin. Copyright © 2022 by Kathleen McLaughlin. Reprinted by permission of One Signal Publishers/Atria Books, a Division of Simon & Schuster, Inc.
