Blood for money: my journey in the industry buying poor Americans’ plasma

I was sitting in the bright sun watching a college football game next to my dad last fall, talking with him about the book I’d just finished writing and he’d just finished reading, several months before it would be released to the public.

“Are there really that many people who sell plasma?” he asked.

I paused for a minute and thought about it for what must have been the thousandth time. It was a central question that had puzzled me for years.

It’s a tale of Americans who sell their blood proteins to get by financially, and my own physical dependence on them (I need regular plasma injections to keep me healthy). It’s also a tale of a system that relies on economic precarity, a hidden part of the US economy shunted off in strip malls by the Dollar Store or relegated to the poorer sides of the tracks in major cities, in places often neglected and ignored.

By the roughest guess, working backward from the number of plasma units collected in a single year, you could surmise that up to 20 million people in the US donate or sell their blood plasma, the yellowish liquid protein component of blood, in a year.

The number stunned me then, but in the bigger picture, maybe it’s not that hard to believe. The business centered on Americans’ blood plasma is a massively profitable one. In 2021, the global blood plasma industry was valued at $24bn. As one of only five countries – including Austria, the Czech Republic, Germany and Hungary – in the world that allows donors to be paid for their plasma, with a large and growing population of people on the economic ropes, the US has become a primary source provider of an essential bodily fluid that is spun into profit-making medicines.

More than 1,000 paid plasma centers thrive across the country, often concentrated in poorer zip codes and college towns, luring in donors with financial rewards of hundreds of dollars a month if they go twice a week, and keeping them hooked on the ability to supplement their incomes.

Millions of plasma donors represent a substantial portion of the US population, and yet we hear little about it as a segment of the American gig economy. There are scattered news stories here or there, of course, about plasma as staple of hard-luck life. There are the usual anecdotes of teachers selling their plasma during a strike or to make ends meet. We read that inflation might be driving more people to plasma centers around the country. And college students are always using this one particularly odd income stream for books, food and beer money. Still, we’ve failed to recognize how this endeavor – something that is often marginalized and maligned – is sewn into the very fabric of American society.

It’s a fact of life for many. The practice – seen as unsavory by many who’ve never had to rely on it – has replaced what used to account for a social safety net. Where wages have failed to keep pace with costs, where housing prices rise out of reach, where basics like gas can feel unattainable, blood money often fills in the gaps.

With all this rolling through my head, I got up out of my seat at the University of Montana football stadium and walked up the concrete stairs to the women’s restroom. Inside the stall, I glanced at one of those routine bathroom ads for a bail bondsman. Then right above to it, what appeared to be a job ad caught my eye. “Part time, pays well.”

Over a photo of a spritely young woman with a great haircut, the stadium bathroom stall ad urged college students to go to the Biolife plasma extraction center across town and earn money for their blood. It’s easier and better than a part-time job, the ad told them. Unlike so many of these ads, there was no mention of saving lives. In addition to the financial lure, plasma centers often appeal to donors’ sense of altruism, but in this case it didn’t bother.

It’s a whiplash experience I’ve had often in the past few years, but especially since my book came out last month. I’ll mention it to someone I know and immediately get a personal story about plasma selling from them in return. Friends, their children, colleagues and acquaintances have confessed to me, often in jokes and lowered voices, that they sold plasma to get through rough financial patches.

A lot of times, they’ve never told their families about it.

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The day after my book was released, I had dinner with friends in Seattle. Over pizza and beers in a cozy neighborhood joint, two of them described the scars they still carry inside the crooks of their arms from three years of selling their plasma to make ends meet early in their careers. I’ve known them for years, but never knew this about them. One told me how the process made her feel sick and exhausted, every single time, but she continued because she needed the money. They stopped as soon as they were financially able.

Barely two hours later, while speaking to an audience about the book and the financial exploitation of people like my friends, a heckler in the crowd grumbled, over and again: “It’s not exploitation. It’s just college students.”

He’s wrong. Over the course of three years, I interviewed more than 100 people who have sold their blood proteins, from Idaho to Texas to Michigan and all over in between. They told me stories of using the money to buy groceries, gas, pay off student debt and even for small fun things like vacations.

But even if it were just students, is that the kind of society we want to be? One where 19-year-olds are expected to sell pieces of themselves to get by? Much of the rest of the world has decided that paying people for their plasma is coercive, but the United States allows it without asking the hard questions of whether it’s ethical, moral or fair to expect this much of people. We haven’t bothered to interrogate whether people get paid enough, or are compelled to donate too often.

From interviewers and others who have never been poor enough to need to sell parts of their bodies, I’ve heard the questions, “Why does this matter? What’s the harm?”

In truth, there isn’t a large body of scientific research about what long-term plasma donation at a high pace – the industry allows up to 104 donations per person per year – might do to a person’s health. The practice is sold as safe, but a lot of donors do worry, especially when they are left fatigued by one donation.

Beyond that, it seems to me we should be asking why most of the rest of the world doesn’t allow payment for plasma but the US has normalized it as an everyday practice. It’s part of our insistence on forcing people to pull themselves up by their bootstraps, but those bootstraps now often entail IV lines, plastic tubing and a centrifuge to remove blood and separate out its protein.

Related: ‘It’s gamified’: inside America’s blood plasma donation industry

I’ve seen the other side of how this discussion makes people uncomfortable, on Twitter, where negative assumptions and bad faith abound. Yes, I know, Twitter. The day my book was released, a smattering of users who didn’t read the book attacked me for saying the industry was hidden. But given its breadth and a lack of widespread public and political attention, there is no other way to describe it.

Perhaps nothing confuses and bedevils Americans more than talking about class. It’s the thing we’re supposed to pretend doesn’t exist, doesn’t define us, doesn’t lay out the road map to our lives from birth. But we are a society organized by socioeconomic class and the intersection of racism and regionalism. All of these factors are layered within the stories of who needs to sell their blood plasma to make ends meet. Plasma centers proliferate in communities of color, along the US-Mexico border and in other parts of this country that are less white.

My own reasons for this project have been deeply personal, and perhaps a tiny bit selfish. I rely on the plasma extracted from other people, their proteins spun into a medication that has for 20 years kept me from serious disability. Knowing it’s a business that thrives on people’s economic hardship comes with no small amount of guilt. It might seem against my own self-interest to write about this business and the way it preys upon the cracks in American society. But ignoring our tangled and growing class divide won’t make it disappear.

• Blood Money: The Story of Life, Death, and Profit Inside America’s Blood Industry, is out now

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