Blood Money

I first sold plasma in 2009 after years of avoiding it. It was a temporary solution to a continuous state of financial instability.

I was forty years old and failing to find steady restaurant work in Portland, where I live, because I couldn’t compete with the flexible hours of childless applicants. After the 2008 crash, the number of server jobs plummeted, and college graduates flooded the market. For me, it was a knockout blow.

I ended up on food stamps with a seven-year-old, working two part-time minimum-wage jobs, in crisis whenever a roommate left and dependent on a CareCredit card at 27 percent APR for my health care. I can’t remember the specific instigation for selling plasma, whether it was an empty tank of heating oil or a broken alternator, but one morning when my daughter was at her dad’s, I went out early to see what I could make.

Plasma donation centers tend to occupy the same real-estate market as tanning and nail salons, dialysis clinics, Goodwill stores, fast-food chains, and carwashes, which means they are often found in medium-crime neighborhoods subdivided by arterial roadways or freeway exchanges. The intake process for first-time donors can take the better part of a day. I arrived only a few minutes after opening, but the place was packed. A large man from a private security company stood in the corner with his arms crossed, gossiping about recent arrests and car crashes. I took a number and sat down.

The people around me seemed to be regulars who were trying to squeeze a donation in before work. I know because I heard them lying on their phones to their employers about why they were going to be late as the morning wore on. More women came in after nine, presumably because their children were now at school. There were men in the building trades with mud on their Carhartts, young Russian-speaking women in scrubs, one tweaker, and a freshly shaved guy in a crisp white shirt trying to make deals on the phone who I thought worked for either a church or a cleaning supplies company.

After a few hours in the waiting room, I was called into the back office where I answered a range of questions, from “Have you ever been paid for sex?” to “Have you ever had a blood transfusion in the Falkland Islands?” The screener asked me to spread my hands so she could see my fingernails. “Wonderful, they’re all there!” she said, and stained one of my nails with a yellow dye.

The dye, which was semipermanent and visible only under a black light, was a tracking method used to make sure that people weren’t donating in multiple places simultaneously. Desperate people sometimes filed off an entire fingernail to get around it, so the screener had to check.

The screener then pulled out a paper with the pay scale on it. As a new client, I would get $40 for my first “donation” and $60 for my second. After that I would make no more than $25 a visit. Each time, I would spend one to two hours in a waiting room, then roughly ninety minutes in a bed while the company siphoned off roughly as much plasma as federal regulations allowed.

Plasma is a physical manifestation of the body’s ability to bounce back. Albumin, immunoglobulins, and fibrinogen, some of the key components of plasma, perform essential functions, including transporting hormones, enzymes, and vitamins; defending the body from infections; and controlling bleeding. Plasma therapies have many uses, among them helping high-risk patients weather illnesses like avian flu and Covid-19.

The problem is that while plasma does many wonders for those who receive treatments derived from it, its removal threatens the health of the people who sell it. Repeated plasma donations can weaken a donor’s immune system and lead to other negative side effects. Very few countries allow payment for plasma, in part out of concern that financially vulnerable people would risk their health for money.

Other developed nations place stricter limits on the number of times one can donate. In Britain, plasma can be given every two weeks; in Germany, it’s up to sixty times a year. The United States allows a person to sell plasma 104 times a year. The word “sell” is, of course, rarely used in the United States. Instead, the term is “donate,” which allows companies to pretend they are not in the business of scavenging the bodies of poor people for biological treasure.

Our system of “donation” is so successful that the United States provides about two-thirds of the plasma available worldwide and accounts for 35 percent to 40 percent of the plasma used in medicine in Europe—so much of which comes out of the veins of America’s poor.

The first time I heard that you could sell plasma was in the mid-1980s. I was fifteen and living under a bridge. The people around me called the plasma center the “stab lab.” I was too young to donate but would have signed up in a second if I’d had a fake ID.

Living on the street is very hard, and donating plasma was far from the only way to put your health at risk. I remember an eighteen-year-old sex worker at a Denny’s showing me what to do if I ever had to perform oral sex for money and a guy refused to wear protection. Out of nowhere, she produced a condom, then popped it between her cheek and gum so fast, I barely caught it, then rolled it down over two of her fingers with her mouth. “In case you ever need to know,” she said.

There were also worse things to sell than plasma. The 1984 National Organ Transplant Act, which made it illegal to pay for organs, had just gone into effect, but I remember meeting a man who had sold one of his kidneys. In a moment of bravado, he hoisted his shirt to show everyone the scar. Soon, the conversation died away as his shame became palpable. The math had not penciled out. His plan to get ahead had failed. He looked sick and was back in temporary housing.

In my mind, a 1980s “stab lab” looked like a shooting gallery, an image inspired by Martin Scorsese’s “Mean Streets” and promotional stills from “One Flew Over the Cuckoo’s Nest.” My own experience in 2009 turned out to be more like a long day at the DMV.

Paperwork completed, I was taken to a room with maybe thirty beds, which were filled with people hooked to apheresis machines, staring up at an episode of “Law & Order” that was playing on TVs suspended from the ceiling. The bottles they were filling were bigger than I thought they would be. I’d also never seen plasma before and had assumed it would be red, but it was yellowish amber, a shade or two lighter than Lipton iced tea.

The phlebotomist punctured a vein in my arm with a seventeen-gauge needle and had me pump my fist until the blood started to flow up the line and into the machine where it would be separated into red and white blood cells, platelets and plasma. The plasma would go into the bottle, and the rest, along with complimentary saline solution, would flow back into me. She tinkered with the rate of draw so that it wouldn’t be too overwhelming for a first-time donor, and said that if I saw a bubble, I should call out right away.

My bottle took at least an hour to fill. I know because I was halfway into a second “Law and Order” episode before my machine stopped. When the phlebotomist was unhooking me, I asked how much they were going to make off my plasma. She shook her head and told me I did not want to know because it would only make me mad.

I sold plasma twice a week for a little over a month. After donating, I usually wanted to sleep. Sometimes I just felt mildly under the weather.

I was told that to make the most money quick, you had to hit all of the major plasma centers in the area in succession. That way you could rack up the incentive bonuses before you were a regular everywhere and permanently relegated to roughly $25 a donation. I also learned that if you drank a gallon of water in the afternoon the day before, the hydration would make donating faster.

I stopped doing it because $25 wasn’t worth it and, as a night shift worker, I didn’t need to feel more exhausted than I already was. But the strange thing about plasma, like many less than desirable ways to make money, is that once you know it’s an option, you can’t quite forget that it’s there. Economic precarity makes it hard to walk away from quick money.

Recently, I saw a flier saying I could make $825 a month selling plasma. Most of my life, I’ve lived under the delusion that there wasn’t a problem of mine that $400 to $800 wouldn’t fix. I don’t believe that anymore, but I am also not beyond a world where a hole like that wouldn’t have a real effect. I decided to go see how plasma donation had changed in the decade since I’d done it.

If my 2009 donation experience was like a trip to the DMV, my 2022 experience was more like shopping at a small Target. There were check-in kiosks in cheery colors and organized lines for regular donors, rewards programs, phlebotomists with preferred pronouns on name tags, and pictures of people helping each other hanging on the wall.

The clientele, however, was the same: poor people in need of cash. During the pandemic, the number of donations went down, forcing compensation to rise, particularly for people with Covid antibodies. Some donors reportedly began intentionally exposing themselves to Covid to earn more money.

During intake, my information popped up in the database along with a photo of me from 2009. Although this was a different location, I had apparently returned to the same company. I asked the screener if I could still get the higher new donor rate. He gave me a “you and me against the Man” smile and promised to make it happen.

I was examined for tracks, had my liver palpated, and pulled down my eyelids so they could check me for jaundice. I answered dozens of screening questions, including the one about visiting the Falkland Islands. Employees weighed me, pricked my finger, and ran my hematocrit level to make sure I could donate. Instead of staining my nail yellow, they took my fingerprint, which, they told me, could be shared with the government at its request. I downloaded the company’s app, and I was given the debit card I’d need to get my money, along with a warning that ATM fees apply.

Afterward, standing in the parking lot surrounded by twenty-year-old cars and dented minivans, holding a new debit card with notifications of coupons coming up on my new app, with a laundromat on one side of me and a liquor store on the other, I could not help thinking that I had found my way into an exceptional American experience. It’s one to which I no longer fully belong, but neither am I separate from it.

I have no problem with people being paid for plasma. I just think that companies should take less of the plasma and that donors should be paid more. I have always found poor and working-class people to be deeply altruistic. They know what it is to work sick, be dependent on a car you can’t afford to fix and need help from family, friends, and sometimes strangers. Such experiences lead to empathy, and like all people, they want to be a part of something bigger, something with a purpose.

I was paid $100 for my recent donation. The next donation will pay me $125 plus $10 from a coupon I was given, but only if I go back within forty-five days. If I go back later, I lose the new donor benefits and will make only $40 to $60 like the other regulars. Once or twice a week it goes through my head that I should just do the eight donations at the higher rate and then quit, and if not that, at least do the next one. I could get an oil change or maybe knock a little more off the balance transfer before the interest hits. After all, that $135 is just sitting there, cash on the table.

 

This essay was originally published as "The Treasure America Scavenges from the Poor" in the New York Times on September 9, 2022.

Tags

America, Equity, Health, Money, class