Only around 17,500 people across the country donate plasma regularly. It’s not enough and our needs are growing. Gabi Lardies investigates.

Four people recline on tan leather seats. You could be mistaken for thinking they were enjoying the advanced technology of massage chairs, were it not for the thin tubes taped to the inside of their elbows and threaded through the complicated faces of bulky plastic machines, almost as tall, and wider, than me. 

One man lies back with a book. On his right is a little plate with Squiggles and Toffee Pops biscuits stacked on top of cheese and crackers. A nurse fusses around his elbow. A bag about the size of a palm has filled up with his blood. It’s dark. This is a sort of overflow filter; it catches the first blood to leave the body, which is more likely to have some bacteria from the surface of the skin. This small bag will be used to thoroughly test the blood.

The blood pushes forward, coiling through the tubes and around the machine, making its way to a white cylinder, about the size of a toilet roll. Red soaks through a white filter. Here, it’s divided. Red blood is piped to a plastic container, and plasma – the golden liquid our red blood cells, white blood cells and platelets are suspended in – drips down into a bag. Once that bag reaches a certain weight (related to the man’s size), the red liquid in the plastic container will reverse its journey, returning to the donor.

When the donation is finished, all the tubing, needles and filters will be put into a hazardous waste bin to be incinerated. The donor will rest on a couch nearby for 15 minutes under the watch of a nurse. Then he will be on his way, his body already replenishing the plasma, and in two days his blood will be back to normal.

This man is one of around 17,500 people across the country who donate plasma regularly. It’s a much smaller figure than the 117,000-odd people on New Zealand Blood Services’ (NZ Blood’s) donor list, and even that is only about 4% of New Zealanders who are eligible to donate. It takes a little longer to donate plasma – an hour and a half all up, instead of an hour for donating blood – and plasma can’t be collected at mobile clinics, because those machines that separate the blood are heavy, delicate, and expensive. The plasma from whole blood donations is separated out later, but not as much can be collected. 

In 2012, New Zealanders were donating enough blood and plasma for our blood service to be completely self-sufficient. Today, we can meet the demand for red blood cells, platelets, and fresh plasma through donations within the country, but we are importing antibody concentrates or immunoglobulin, an important product made from plasma. We need about 250 more plasma donations a week to be self-sufficient again, and the need is growing by about 10% year-on-year. 

“Demand for red is pretty much flat, we kind of peaked about 10, 15 years ago,” says Richard Charlewood, a transfusion medicine specialist at NZ Blood. He’s been giving me a tour around NZ Blood’s Epsom centre, which has more big machines and fast-walking people wearing white lab coats than I’ve ever seen before. “The science came out saying the hospitals were over-transfusing – you don’t need to transfuse so many patients, and so, yeah, the number has eased off.”

The opposite is true of plasma: demand is increasing. “Plasma is science-changing medicine,” he says. Over the past few decades, more and more uses have been found for biopharmaceutical products made from plasma. “It doesn’t appear that there’s going to be any sort of let up,” Charlewood adds. 

Plasma can currently be made into 11 treatments for cancer patients, trauma and burns victims, pregnant women (where they have a different blood type to their baby), auto-immune diseases, blood-clotting issues and compromised immune systems. The growing demand is driven by a growing need for immunoglobulins, antibodies made by our immune systems that protect us from bacteria and viruses. They are extracted from a healthy donor’s plasma and given to someone who cannot make their own, either because of disease or other treatments.

“Our favourite customers are the children in Starship’s oncology ward,” says Charlewood. After treatment wipes out the kids’ immune systems, immunoglobulins make up for it. Some patients, like those with auto-immuse disorders, may need immunoglobulins once a week for the rest of their life. Depending on their weight and illness, each dose could require the antibodies from 50 plasma donations.

Something happens when I ask Charlewood about self-sufficiency. He’s a tall man, with greying hair, but it’s like I’ve bought up a happy memory from childhood, a feeling he’s trying to capture again that’s almost in reach. He’d love for us to be self-sufficient again, and compared to other countries, we’re pretty close. He says we’re about 70-80% self-sufficient, while Australia is about 40% self-sufficient, and Canada is trying to get to 20%. 

The small percentage of plasma products we do import doesn’t look anything like the donated bags of plasma hanging from the machines. It’s already been processed into immunoglobulin, a clear liquid packaged in glass bottles in branded boxes. They’ve got the look of Big Pharma. Simple, white with black, sans-serif text, and just a triangle of colour in one corner. One of the products is called Privigen®. When the same product is made from our own plasma, it’s called Privigen® NZ.

We buy these plasma products from CSL Behring, an industrial-scale biopharmaceutical manufacturer in Australia. It’s the kind of place where “you could eat off the floor, but they wouldn’t let you,” says Charlewood, because obviously our mouths are full of nasties. That is also where our plasma goes to be made into Privigen® NZ and other products. 

On the day plasma is collected from donors in Aotearoa, it’s put into a big, stainless-steel cube. It’s a freezer that looks a lot like the dish sterilisers that grace almost every hospitality kitchen, and indeed this one was originally designed to freeze cakes at a cheesecake factory. “There’s a lot of repurposing from the food industry,” says Charlewood.

Once frozen, the bags of plasma are kept in a walk-in freezer at minus 30 degrees celsius or colder. When you walk in, you can feel the moistness in your nose get crispy, and glasses have to be taken off, as they’re instantly frosted. The bags accumulate for a month or so, on steel trolleys, until they’re sent to CSL. By that time, there will be about 10 tonnes of plasma. There, it’s pooled into huge vats and fractionated – divided by different processes into different parts. 

The quantities sound massive, but plasma is mostly made up of water, and “that goes out the window,” says Charlewood. The most common protein in plasma is albumin, the same stuff that makes up egg whites. This is bottled and used for burns patients and patients in intensive care to keep their blood pressure up. Then there’s clotting factor concentrates made for people with bleeding disorders (like Willebrand disease) and people on blood thinners who have had an accident. “What people most want,” though, Charlewood says, is the antibody concentrates like Privigen® NZ. For each bag of plasma, “we maybe get three grams, like, not even half a teaspoon” of antibodies, he adds.

It’s expensive to process plasma into these products. Charlewood says antibody concentrates are, on a gram for gram basis, more expensive than gold. That, along with its colour, is why plasma is known as “liquid gold”. On a per-capita basis, we are not high users of antibody concentrates, says Charlewood, perhaps because of its high cost. They’re administered carefully, only when there’s a high chance they will help someone.

The antibody concentrates that we import, for example Privigen®, are made identically, but with a different source of plasma. “The US collects a vast amount of plasma,” says Charlewood. Some of that is collected by a subsidiary of CSL Behring called CSL Plasma. The US plasma fractionation market was worth 15.64 billion USD in 2022 – considerably more than their natural gas exports, which are in the tens of millions. US plasma is “supporting most of the world, because very few countries are self-sufficient,” says Charlewood. 

But the US will always support the US first. When less plasma was coming in during the Covid pandemic, Charlewood says suppliers made it very clear that if there wasn’t enough for all, it was “a USA-first policy”. He says that although we’re spending millions each year, we’re a comparatively small country and client – “so we would be dropped so quickly.”

There are plenty of ethical concerns around plasma gathered in the US. Unlike much of the rest of the world, people are paid for their plasma. Collection centres – many with “CSL Plasma” in chunky red lettering on the buildings – are mostly set up in impoverished areas, including on the southern border with Mexico. Payments have been as little as US$10, and at times paid in liquor store vouchers. At the bottom of the billion-dollar industry are “the poorest of the poor,” says Charlewood.

On one front it’s working, since the US is providing lifesaving plasma to much of the rest of the world, including us. So should we pay people in New Zealand to encourage more donations here? Charlewood thinks not, because “that introduces more dangers.” Apart from the ethical considerations, when you dangle money in front of poor people for their plasma, they’re less honest about their medical conditions and lifestyle choices, because they need the money.

This is also true of replacement donor systems, where family or friends are required to donate the same quantity of blood that has been given to their loved one. It’s been proven that using plasma from altruistic donors means less diseases and other problems with the plasma. This is important because gathering, checking and processing it all is extremely expensive – and because we want the blood to be safe. 

Another issue is that if you make something a commodity instead of a gift, altruistic donors drop off. While the US may have heaps of plasma, they’re “quite short on fresh stuff,” says Charlewood, meaning whole blood donations. “They really live hand-to-mouth in that area.”

I am one of those bad people who have never given blood. I am not scared of needles. I meet the requirements most of the time. I have no excuses, only that it hasn’t seemed a pressing priority. When I ask friends and colleagues why they don’t donate blood or plasma, that’s the most common answer I hear. People are not opposed to donating, but they just don’t get around to it. We’re the 96% of possible donors who could make our blood service self-sustainable. 

“This is what you can do to help your community,” says Charlewood. “So many charities are always asking for a little bit of this and a little bit of that, and we can’t always help financially, or not everybody can. But this is one thing you probably can do.”

Today, I fail the eligibility test, because I travelled to South America just two months ago. But there’s still something I can do to get a taste of what it’s like to donate, and apparently it’s the worst part: a finger prick. Usually the prick is to make sure the donor has a good amount of haemoglobin, indicating they’ve got plenty of iron. For me, it’s to find out my blood type. 

“It’s not too bad, honestly,” says Sophie, a nurse who has set up a towel, some droppers and a little fan in a room called “Rangitoto”. She lifts a little pink device and a card with three circles on it from a plastic tub. She asks for my finger and places it under the pink thing. “One, two…” and it shoots, like a tiny ear-piercing gun.

“That is often the worst part,” she says. Apparently the inside of the elbow is less sensitive, and once the needle is in, you “really don’t feel it.” Blood beads at the site of the prick, and she suctions it up with the world’s tiniest straw. Then, she dabs the blood on the three circles on the card. 

Next, serum from the three droppers is mixed with the blood in each circle. In the first two circles, my blood mixes smoothly. In the last, it speckles. Speaking in simplified terms, each blood type corresponds to a different combination of speckles and smoothness. Sophie helps me decipher it on a chart. “O Positive,” I exclaim, truly surprised because my mum always told me I was either A or B, so O seems much more exciting. My dreams of blood donation swell. 

“It’s the most common blood type in New Zealand,” says Sophie. I deflate. I thought I was special. Sophie picks up on my disappointment, and quickly soothes me. “It’s the most needed, because about 30% of people in hospital needing blood are your same blood type,” she says. “People always want to be rare, but what we really want most of the time is O Positive.” I feel myself edging closer and closer to the donor list.