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• W199813109 abstract "Olivier Garraud and Jean-Jacque Lefrere’s article “Blood and blood-associated symbols beyond medicine and transfusion: far more complex than first appears”1 competently examines the profound symbolic value of blood. The authors skilfully delve into our historical, spiritual and human cultural heritage to reveal contrasting symbolisms such as death/life, health/sickness, alliance/rivalry, among others.The abstract of the article refers to an incongruity that is important not only because of its symbolic significance but also because of its legal, social and above all ethical implications, namely the contrast between the gratuitous nature of blood donation and the trade in plasma-derived products. Surprisingly, the issue is not examined further in the text of the article, though it warrants closer investigation.The relevant laws and regulations of several nations envisage both the gratuitous, voluntary and unremunerated donation of blood and the commercialisation of plasma-derived products. The present article offers some considerations on this (presumed?) contradiction, taking French legislation as an example. Before proceeding further I should like to clarify two points in order to avoid possible misunderstandings:The contrast between the voluntary donation of blood and the commercialisation of plasma-derived products can effectively be construed as a contradiction. I am personally convinced that we should maintain and defend schemes based on the gratuitous, voluntary and unremunerated donation of blood2; I am also convinced that it is reasonable (or at least almost inevitable) that some plasma-derived products should enter the commercial network. The paragraphs that follow are an attempt to motivate my argument.The choice of France as an example is not intended in any way as a criticism of French legislation: the situation in numerous other nations is similar. It is not possible in the space of an editorial to review the regulations of several countries and, needing perforce to choose one country as an example, I decided (perhaps rather boldly) to refer to the country that is home to the authors of the article.The situation in FranceThe principle that the donation of blood should be unpaid, voluntary, anonymous and free of coercion was first propounded in Law 52-854 of 21st July 19523, and confirmed and extended in subsequent acts, such as Laws 93-5 of 4th January 19934 and 98-535 of 1st July 19985.Law 52-854 explicitly excludes financial gain, but Article 5 establishes payment for donations “d’urgence” (particularly arm-to-arm transfusions in hospitals), adding that “the prices for operations involving human blood, plasma and other blood-derived products are fixed by decree of the Minister for Public Health in such a way as to exclude all financial gain” (hence the current provisions of L. 673 of the Public Health Code).Article L.1221-1 of the Public Health Code states that “blood transfusions shall be performed in the interest of the recipient and raise ethical principles regarding the voluntary nature and anonymity of donation and the absence of gain”.Article L 1221-3 of the Public Health Code defines the conditions of gratuity: “no payment may be allocated to the donor, without prejudice to the reimbursement of expenses incurred, as specified by decree”. The Code also clarifies that:- “In this respect all cash payments, gift tokens, discount vouchers and other articles granting entitlement to favours extended by third parties, as well as objects of value, services or the bestowal of any advantages, are specifically forbidden” (Article D.1221-1);- “Payments made by an employer to a donor within the context of his or her professional activities may be maintained for the duration of the donation and shall not be construed as payments within the meaning of Article L. 1211-4 provided that the duration of the absence does not exceed the time required for the journey from the workplace to -and, where applicable, from- the (blood) collection centre, as well as the time required for medical tests, the collection procedures and any recovery and refreshment period considered necessary for medical reasons” (Article D. 1221-2);- “Tokens of gratitude offered to the donor in accordance with current regulations and the offer of refreshments following the donation are also authorised” (Article D.1221-3);- “Blood transfusion centres may reimburse blood donors for any transport expenses incurred in connection with the donation, excluding flat rate reimbursements” (Article D. 1221-4).Thus the voluntary nature of donation and the ban on selling blood do not preclude a reimbursement to the donor for his or her time and inconvenience. This is in line with both the Additional Protocol to the Convention on Human Rights and Biomedicine on the transplantation of organs and tissues of human origin (Article 21)6 and the WHO Guiding Principles on human cell, tissue and organ transplantation (Commentary on Guiding Principle 5)7.Similar regulations are in force in a number of European countries. At the international level, however, it is worth noting that there is a considerable difference between the donation of whole blood and the donation of plasma for apheresis: in some states the gratuitousness of whole blood donation is strictly laid down, while in others the donation of plasma for apheresis is much less rigidly imposed (in some countries compensation of € 25 is paid to donors, as provided by the European Commission)8.The French regulations make an important distinction between “produits sanguins labiles” (labile blood products) and “produits sanguins stables” (stable blood products); the former are treated as medication, the latter are not9.Article 1221-9 of the Public Health Code envisages a procedure to set tariffs for the transfer of labile blood products; this was subsequently implemented in the decree of 9th March 201010." @default.
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• W199813109 date "2014-01-01" @default.
• W199813109 modified "2023-09-23" @default.
• W199813109 title "Blood and blood-associated symbols: some ethical and legal considerations." @default.
• W199813109 doi "https://doi.org/10.2450/2013.0217-13" @default.
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