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Melissa Harris-Perry: It's The Takeaway. I'm Melissa Harris-Perry. Millions of people across the world rely on life-saving medications made from blood plasma, and the US is the leading exporter of that plasma. Here in the US, donating is legal and regulated, and it's also a paid exchange. No, you can't sell a kidney, and you can't even sell your blood, but there are parts of you for which you can earn money.

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Melissa Harris-Perry: For example, donating eggs for assisted reproductive technology is legal and paid. The US is one of only a few countries in the world that allows people to sell their blood plasma. Millions do so every year. As we learned from some of you who called in.

Tricia: I did it for years. I actually stopped after I got COVID.

Ben: I have recently donated plasma for the first time.

Janelle: I restarted giving plasma about two months ago.

William: I sold plasma when I was in college.

Elizabeth: I did give plasma three times.

Anita: I'm about to sell my blood plasma for money.

Mike: This is my only source of income.

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Melissa Harris-Perry: We're going to hear a lot more from you later this hour about your own experiences, but first, I sat down with Kathleen McLaughlin, journalist, and author of Blood Money: The Story of Life, Death, and Profit Inside America's Blood Industry. Kathleen's book explores the US Blood Plasma market but she begins in China.

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Kathleen McLaughlin: I lived in China for about 15 years working as a foreign correspondent. I moved there not long after I was diagnosed with a very rare autoimmune disease that requires me to have periodic infusions of a drug that's made from human blood plasma. China, after an AIDS debacle in the '90s, had banned the importation of human blood products, and so the only way for me to get my own safe supply of medication into the country where I lived was to stuff it in my suitcases and hide it.

The period that I was living in China, this would be through the 2000s and into the early 2010s, I would say the borders were loose when it came to things like this. It was technically smuggling because I had to check a box on the customs form that said I was not carrying human blood. It was one of the specifically banned substances, but no one ever checked my bags. I did this several dozen times over the years that I lived there, and no one ever inspected my bag. It was smuggling without, I would say, a lot of fear of serious consequences, because things were pretty open and loose back then.

Melissa Harris-Perry: All right. Now help folks understand what blood plasma is, as opposed to direct blood donation.

Kathleen McLaughlin: Yes. I think most people are not familiar with plasma. Plasma is simply the protein component of your blood. When blood is separated into parts, plasma is the yellowish liquid, that is basically the protein part of your blood. It doesn't include the red or white blood cells or the platelets. The potentially more important parts are stripped out, and it's just the protein component that contains things that can be made into medications, like the kind that I take.

Melissa Harris-Perry: Okay. On the one hand, you have to mark on your custom form that you're not bringing in human blood, because it's one of the banned substances, but there's an enormous market. Can you tell me more about what you describe as this blood market in China at this time?

Kathleen McLaughlin: Yes. Back in the 1990s when China had made a decision at the very top to open up and become, I would say, a capitalist nation, the governments around the country, provincial and local governments, all started looking for money-making schemes. There were all sorts of different ideas. You ended up with the factories in the south that make all of our stuff, everyone knows about that at this point, I think.

You ended up with some industries that were maybe a little bit less savory. In one province, called Henan Province, which is the most populous province, and at that time had a whole lot of people living in poverty, farmers who had no real way to make an income, someone came up with the notion that the economic force in that province could be blood plasma so they developed something called the Plasma Economy.

What that meant is, they would harvest the blood plasma of farmers, pay the farmers something for their time and their blood plasma, and then sell it to international companies and around the world to make medications. This worked really well in the beginning. There were thousands and thousands of people who showed up at these government-run plasma centers to donate and get paid. People in villages got wealthy, they had money they had never seen before.

At that time, the AIDS epidemic was traveling around the world, and it hadn't really struck China. In part, because China was fairly closed off from the rest of the world in the '90s still. There just wasn't a lot of, I would say, opportunity for the virus to get into China. However it did, because as we know, that's what viruses do, they find an opportunity to travel and it entered the blood plasma system.

What was happening in Henan at the time, was the system was operating so quickly, and there were so many people in and so many people out that a lot of the clinics were reusing supplies, reusing tubing, reusing needles, using practices that were not safe. As soon as the virus entered the system, it spread like wildfire. Now, we still don't know to this day how many people were actually infected with HIV through the Plasma Economy but it's in the tens of thousands.

The one number that I have heard from an activist that remains and sounds true is around a million people. At that time, there weren't a lot of therapies for people living with HIV, and so a whole lot of people died from it. This continued until the time that I was there, the Plasma Economy had been shut down but there were ongoing problems with the safety of China's blood supply because of corruption, because of a lack of safety protocols.

Even when I was living there, long after all of this had happened, there would be periodic outbreaks of Hepatitis C within plasma drugs. Because I knew I was taking a medication that was made from human blood, I paid a lot of attention to this, and so I knew that the blood supply there was not something that I wanted to depend on. Also, I had the privilege of being a foreigner who had access to a safer medication.

Melissa Harris-Perry: Okay. I feel like it's key to say here that donating blood in the US was safe, is safe, donating plasma was safe, is safe, but there's something else about the US market. I so appreciated the way you drew us into this in the text because I feel like you were telling us, "Okay, it's easy to say this is a problem happening in China, but surely back at home in the US, it couldn't be like this," but there are elements of a US blood plasma market here as well.

Kathleen McLaughlin: I had the classic case of American living abroad who thinks that my country is better than the place that I'm living. It's really just the classic case of that happening. I lived in China for ages, I reported on all of this stuff around the Plasma Economy and the ongoing fallout from it. I thought, "Oh, this could never happen in the US. We have better regulations. We're not taking advantage of poor people in the same way."

I came back to the US in about 2016 and I wanted to meet a woman who was the whistleblower on the Plasma Economy in China. Her name was Wang Shuping. She had basically fled to exile and was living in Salt Lake City working as a cancer researcher. I went to meet her in Salt Lake, and we spent a few days together. Near the end of my time with her, she said, "I want to show you something." We drove to a strip mall in downtown Salt Lake City, and it was a plasma center.

She said, "There's something going on here. I don't know what it is." She knew it was plasma donation for money, and she said, "But I don't trust it, there is something wrong with this system." She really led me down the path of investigating what was going on in the US. What I discovered was, I thought that only China would attempt to create something called the Plasma Economy.

The fact is, the United States has created it without very many people noticing. You have millions of people every year in this country now who sell their plasma in order to get by, in order to pay bills. It just hasn't gotten much attention. Other than an oddity or an abstraction, something people might make jokes about when they need to do it, but we have really developed the thing that China tried to develop, and we've done it, I think, in a safer way. At this point, there's very little chance of viral contamination in the system, but we did it.

Melissa Harris-Perry: That was fascinating that these first stories you tell us are in Salt Lake City. You begin, I think, in a place maybe we wouldn't imagine a story of economic need and being paid for a donation of parts of our human bodies would begin. You start with college kids, like good Mormon college kids who need extra money.

Kathleen McLaughlin: One of the main targets of the plasma industry is college students. These tend to be kids who are going to large public universities, maybe come from families who don't have a lot of money and they need extra cash to get by. You will see if you're in a college town in the US that has a sizable population-- those are the two key things about the plasma industry. They want a lot of people who need extra money, and so they're not going to go for a tiny college town. The place that I found that was fascinating is, as you said, Rexburg, Idaho, which is 95% Mormon and it has a large Mormon university and a lot of kids from the Mountain West, from that region, who come from families who don't have a lot of money.

Rexburg is small. I think there are 35,000, 36,000 people there. It has two plasma centers, which is really a huge number for a place that size. I visited Rexburg four or five times while reporting this book. The plasma centers were always full. There's always people coming in and out, and it's typically college students. What's interesting is there's very little stigma around it in Rexburg, and I think that's because it is so common and so people talk about it. You can get t-shirts in Rexburg that say, "Plasma paid my tuition." It's really become, I would say, embedded in the culture of that place.

Now a friend who is former LDS, former Mormon, told me that this meets the Mormon ideal in a way that you are doing something that is public service. You are giving back, you're doing something altruistic, but you're also getting paid for it. It's very much a win-win for a lot of people. There are, as I got into in that part of the book, there are potential risks for people. The reason I found Rexburg is that the college administration had put a warning out to students during the early days of the pandemic that there had been reports of students trying to get COVID because plasma from the people who had recovered from COVID paid more than normal plasma. There were some pretty heavy associated risks at that time.

Melissa Harris-Perry: Stick with us, more on the blood plasma industry in the US when we get back. It's The Takeaway. We're back with Kathleen McLaughlin, author of Blood Money: The Story of Life, Death, and Profit Inside America's Blood Industry.

Kathleen McLaughlin: I've interviewed more than a hundred plasma donors and I will say, first and foremost, the primary reason people do it is money. There is an altruistic aspect to it. People who don't have a lot of money, this is something they can do and also get paid. It is, again, that win-win. The trends that I had seen is college students, people who are just starting out in their career, so early 20s and they're trying to get established in their career, people who work in middle-class. What used to be middle-class professions, I would say, this has become much more common for them to do to supplement their incomes.

As our wages have not kept pace with the cost of living, people are perpetually looking for different ways to supplement their income. Selling plasma is something that you can do that isn't actually a second job or a third job. What's interesting is there has been some research that shows that these plasma centers do tend to congregate in communities of color. I would say Rexburg, Idaho, is in some ways an outlier because it is heavily majority-white.

If you look at where plasma centers are in the Rust Belt, for example, and in other parts of the country, you'll find them in places that have higher percentages of Black people, of people who are not white. The industry, by virtue just of economics, does tend to prey on non-white communities. The other aspect that does get overlooked is what the plasma industry calls its most productive plasma centers are set on the US-Mexico border. Those places depend on a steady stream of Mexican citizens coming into the US to sell plasma. That's something that's in a legal gray area.

There's been a series of lawsuits back and forth over whether or not that should be allowed. It is continuing at this point, but for people who live in Mexico where payment for plasma is banned, like most of the rest of the world, coming into the US and earning money this way can replace an income that they would make in Mexico doing a really difficult job in a factory. There's all sorts of different components to it. What's interesting to me is the plasma industry is one of these industries that has figured out where the weaknesses are in American society in terms of economics. They really have established themselves in places where there are a lot of people who need extra money, is quite deliberate targeting where they are.

Melissa Harris-Perry: How much can a person make in selling their blood plasma?

Kathleen McLaughlin: That's an interesting thing. It really depends on where you live. Some people it might be $400 a month. The highest I have ever seen is $1,200 a month, and that was in a plasma center that was trying to attract new donors. They were offering lots of bonuses and specials. The aim appears to be, to me, paying people the least amount possible that will keep them coming back. The payment system is really gamified. It's almost like, I don't want to say gambling exactly, but it's like playing a game.

You will earn more for your second donation in a week than for your first, you might get $40 for your first and $50 for your second. You'll get a bonus at the end of the month if you go twice a week every week for the entire month. You get a bonus if you refer your friends. People will download an app and they'll get all these bonuses and coupons. The design of the payment system is meant to keep you coming back as often as possible. The most often possible is 104 times in a year, which seems crazy for anyone who's never done it.

Melissa Harris-Perry: You have a medical condition where you rely on blood plasma. Would it be possible to have a sufficient supply if it weren't-- not just for you personally, but for people who need it, would there be a sufficient supply if people weren't paid to give it?

Kathleen McLaughlin: Yes, it's a really good question and I think this is the thing that I have thought about through all of this reporting, and there's a couple of pieces to that. The first thing we need to keep in mind is that America is a net exporter of plasma. Our human blood plasma exports are bigger than our soybean exports. Because we're one of a very small handful of countries that allow payment for plasma, and because we have a very large population of economically marginalized people, we have more plasma than anyone else, and it is sold around the world. Then the question becomes, what would we need to have a supply of medication for people who live in the US if we decide we don't want to be a net exporter of plasma?

There's ongoing debates in different places. There's an ongoing debate in Canada that people should be paid for their plasma in order to increase the amount of plasma that country has. To me, I think this has been so woven into the fabric of American society that it's not going to go away. We should be looking at ways to make it better for people. Should we be paying people more? Should we make it more transparent? Should we further limit the amount of times that people can donate in a year? Instead of 104, maybe we should look at what the Red Cross does, which is limiting plasma donation to 13 times a year. I think there's all sorts of different things that could be done to make this a fairer, less exploitative system.

Melissa Harris-Perry: At the base of the book, of the stories that you're telling us, is it about wanting to reform the blood plasma industry or is it about telling us what that industry can show us about the realities of economic inequality in our nation?

Kathleen McLaughlin: I went into this reporting thinking it was a science book, and that I would come up with some ideas on recommendations about what we could do and make the industry better. The fact is, the industry to me is a symptom. The larger problem is the cost of college education, the fact that our wages are stagnant, the fact that people just have a really difficult time affording to live in this country when they aren't wealthy. Ideally, the solution is to look at living wages, to look at reducing the cost of higher education, to look at increasing our social safety net in such a way that people don't feel compelled or coerced to have to sell parts of themselves to get by.

Melissa Harris-Perry: Kathleen McLaughlin is a journalist and author of a truly fascinating book, Blood Money: The Story of Life, Death, and Profit Inside America's Blood Industry. Kathleen, thanks for writing the book, and thank you for joining us today.

Kathleen McLaughlin: Thank you so much. I really appreciate it.

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Melissa Harris-Perry: We heard from some of you about the economic circumstances that led you to sell your plasma and some of y'all were or are college students trying to make some extra cash.

William: I am William from Phoenix. I sold plasma when I was in college as often as I was allowed and healthy enough to sell. I'm not going to lie, that money paid for my drinks on Friday and Saturday. I was working as much as I could and I was in college full-time and still struggling to make ends meet, and so it was a good source of a small amount of cash each week. I sold, I think, twice a week for at least six or eight months.

Janelle: Hi, I'm Janelle from Jackson, Mississippi. I restarted giving plasma about two months ago. I needed to supplement my income while finishing school. Previously, I donated in 2019.

Melissa Harris-Perry: Other folks are just trying to make ends meet.

Elizabeth: My name is Elizabeth. I'm calling from Raleigh, North Carolina. I did give plasma three times in 2018 so that I would be able to buy groceries for my family. At that time, I was working full-time at a bank, but my partner was unemployed and it was really hard to make ends meet. I gave plasma so I didn't have to put groceries on my credit card.

Landro: Hi, my name is Landro. I'm calling from St. Petersburg, Florida. I actually have not donated plasma for money because I'm not able to, but my partner has. She has because it has become increasingly difficult for us to make ends meet and it's a way to get through the month a bit easier. She actually only just started donating this month and is about to make a second donation in a couple days.

Mike: Hi, this is Mike from St. Louis. Currently, the whole plasma donation, this is my only source of income after getting out of prison. I was briefly getting SNAP benefits, which allowed me to eat, but those were cut off. Now, I'm relying on food pantries until I can get a job. I donate twice a week.

Anita: My name's Anita. I'm calling from Blackstone Valley, Massachusetts. I'm about to sell my blood plasma for money. I'm a senior on a fixed income, and I have elderly cats who need some expensive care in their last year of life.

Ben: Hi, this is Ben from Oxford, Michigan. I have recently donated plasma for the first time. I heard about it on NPR and thought I'd give it a try. Although I earn a decent living, I'm getting squeezed because of the inflation and increasing cost to everything. I figured, if I am consistent with it, I can earn an extra $4,000 to $5,000 a year by donating plasma. It helps a good cause on top of it, so it sounds like a win-win to me.

Tricia: This is Tricia in Denver, Colorado. I'm calling about being a plasma donor. I did it for years. I actually stopped after I got COVID, but I did it for years. At first, it was for the money, of course, but it became more about service to the community and support to the community.

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Melissa Harris-Perry: Thanks so much to everybody who called in using 877-869-8253. The line's always open at least for another few months.

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