Our Blood Institute Oklahoma City, Oklahoma, United States
Background/Case Studies: Scant research is published on the blood supply impact of paid plasma harvest as an alternative to voluntary blood donation in the US. Investigation of such lost transfusable blood donations, termed “crowding out,” are important due to the doubling of plasma centers numbers to 1,234 since 2016 and the rising pay for individual donors (ranging above $10,000 per year). Since US collections provide two thirds of global plasma for fractionation and because demand for plasma derivatives is growing, crowding out warrants attention.
Study
Design/Methods: We examined the plateletpheresis (PLAP) donors and collections from 2019 thru 2024 in one of our facilities (Center 1) which is less than two miles from the first and only plasma center in its region (50-mile radius) that opened on Feb 6, 2023. We compared average quarterly donation rates over three time periods: Pre-Covid (Q1, 2019 - Q4, 2019), Covid (Q2,2020 – Q4, 2022), and Post-Plasma (Q2, 2023 – Q1, 2025). Due to spanning transitioning events, we excluded Q1, 2020 (US Covid outbreak) and Q1, 2023 (plasma center launch). We analyzed donor data according to demographic variables including gender and age, and by donation profile (number of previous PLAPs and time elapsed since last donations). Our Center 2 served as a control, being in a town of similar size and rurality, but without nearby plasma centers. Self-reported explanations were solicited by phone and text from Center 1’s PLAP donors who had not returned during the Post-Plasma period.
Results/Findings: As shown in the graph, trends in average quarterly PLAP donations from 18 to 28-year-olds shows a persistent decline in Center 1, losing 57% productivity across the three timespans. In contrast, Center 2 shows partial recovery in the last period. For all platelet donors, Center 1’s average quarterly drop off was much less dramatic: Pre-Covid (803 [100%]), Covid (793 [99%]) and Post-Plasma (766 [95%]). This compared to Center 2’s upward moving values: Pre-Covid (371 [100%]), Covid (394 [106%]), and Post-Covid (442 [119%]). Similar discordant dynamics were seen for all donation types collected in the Center 1 facility Pre-Covid to Post-Plasma (1667 dropping to 1532 [92%]) and Center 2’s fixed site (1189 rising to 1421 [119%]). Follow-up with the lapsed donors from Center 1 confirmed switching to the plasma center reduced voluntary PLAP collection.
Conclusions: Platelet collections and lapsed donor follow-up at a blood center with new plasma center competition showed evidence, both imputed and direct, for crowding out of voluntary giving. We identified that certain donor populations (18–28-year-old PLAP donors) were more vulnerable to lapsing during this event period. More rigorous study is needed to confirm these findings.
