Why does Canada use more human plasma than almost any other country?

This is an excerpt from Second Opinion, a weekly roundup of eclectic and under-the-radar health and medical science news emailed to subscribers every Saturday morning. 

If you haven't subscribed yet, you can do that by clicking here.

Canada now uses more human plasma products than any other country in the world after the U.S., and that matters because there's a raging debate about how Canada can become self-sufficient in this potentially life-saving human raw material.

​"There is, at the findings of the panel, no good clinical basis to explain why we're such a high user," Dr. Penny Ballem told reporters at a media briefing on Wednesday.

Ballem is chair of the Expert Panel on Immune Globulin Product Supply, which earlier this week released its report into Canada's plasma supply commissioned by Health Canada.

Most of the plasma in Canada is used as immune globulin (IG) therapy for people with dangerous immune disorders.

But the panel said it found evidence that doctors are treating some patients with IG even in the absence of solid evidence that it's the best therapeutic option.

The panel was struck to help inform the debate over how to increase Canada's plasma supply. 

Some private companies, patient groups and academics insist that Canadians should be allowed to sell their plasma.

But several health advocacy groups have protested against attempts by private companies to set up paid plasma clinics. And Canada's national blood agency, Canadian Blood Services (CBS), favours non-remunerated plasma donations.

Canada has a long-standing tradition of not paying for body parts including blood, organs, sperm and eggs. And four provinces, governing 80 per cent of Canadians (Ontario, Quebec, Alberta and B.C.), have passed laws banning payment for plasma.  

Canada is not alone in struggling with this question. Some other countries including Australia prohibit the paying of donors. And the World Health Organization urges countries to use voluntary, non-remunerated plasma-collection systems.

There appears to be no emergency or crisis related to supply of IG for Canadians.- Expert Panel on Immune Globulin Product Supply

"Plasma, as a starting raw material, is a public resource, the same as fresh blood is viewed as a public resource," Dr Graham Sher, CEO of Canadian Blood Services told CBC News.

It's an expensive treatment that can cost more than $100,000 per patient per year.

Because it's made from human blood products, rather than synthetic chemicals, Canada's blood agency arranges contracts with manufacturers and then supplies the plasma to hospitals, which then give the plasma, at no charge, to patients. Provinces cover the cost through their hospital budgets.

Still, most of the world relies on a commercial supply of human plasma generated by private, paid plasma clinics, mostly in the U.S. (one of just a handful countries, including Austria, Germany, Hungary and the Czech Republic, that allow citizens to be paid for plasma). That's a situation that makes many countries uneasy, especially with a growing demand for this important therapy that must be harvested from human arms.

'No emergency' related to supply

In its report, the panel reassured Canadians that there is no immediate problem with securing enough raw plasma.

"There appears to be no emergency or crisis related to supply of IG for Canadians," it said.

Still, the panel said Canada should reduce its dependence on U.S. plasma and harvest more from Canadian donors — but it did not recommend how that should be done.

And that brings the conversation back to the hot-button question: to pay or not to pay?

It's estimated that 10,000 Canadians receive IG and other plasma treatments every year. About 2,500 have a genetic life-threatening illness where IG is the only option.

Other patients need IG for a short-term boost to their immunity after a bone marrow transplant or other immune compromising conditions.

The panel raised the need for increased scrutiny over how plasma products are being used.

"There are multiple other situations where IG is used by clinicians, but many of these lack strong evidence of efficacy," the report stated.

"Overall, the panel feels more needs to be done in Canada to enhance utilization management of IG," the report stated. "This will also contribute to self-sufficiency goals as well as ensuring a secure supply of product to meet real need."

Sher say "utilization controls" are important but that won't be enough to increase the domestic supply.

"We do not believe that, given the rate of growth of this drug both in Canada and internationally, that this problem can be solved purely on the grounds of utilization."

The panel did not make any direct recommendations about whether Canadians should be paid for their blood plasma, but it said the supply would be safe either way. 

To read the entire Second Opinion newsletter every Saturday morning, subscribe here.