Sol Levin was a successful stockbroker in Tampa, Florida, when he recognised the potentially profitable market for safe and uncontaminated blood and, with some colleagues, founded Plasma International. Not everybody is willing to make money by selling his or her own blood, and in the beginning Plasma International bought blood from people addicted to drugs and alcohol. Although innovative marketing increased Plasma Internationals sales dramatically, several cases of hepatitis were reported in recipients. The company then began looking for new sources of blood.1

Plasma International searched worldwide and, with the advice of a qualified team of medical consultants, did extensive testing. Eventually they found that the blood profiles of several rural West African tribes made them ideal prospective donors. After negotiations with the local government, Plasma International signed an agreement with several tribal chieftains to purchase blood.

Business went smoothly and profitably for Plasma International until a Tampa paper charged that Plasma was purchasing blood for as little as 15 cents a pint and then reselling it to hospitals in the USA and South America for $25 per pint. In one recent disaster, the newspaper alleged, Plasma International had sold 10 000 pints, netting nearly a quarter of a million dollars.

The newspaper story stirred up controversy in Tampa, but the existence of commercialised blood marketing systems in the USA is nothing new. Approximately half the blood and plasma obtained in the USA is bought and sold like any other commodity. By contrast, the health system in Australia, New Zealand and the National Health Service in Great Britain relies entirely on a voluntary system of blood donation. Blood is neither bought nor sold. It is available to anyone who needs it without charge or obligation, and donors gain no preference over non-donors.

In an important study, economist Richard Titmuss showed that the British system works better than the American one in terms of economic and administrative efficiency, price and blood quality. The commercialised blood market, Titmuss argued, is wasteful of blood and plagued by shortages. In the USA, bureaucratisation, paperwork and administrative overhead result in a cost per unit of blood that is five to 15 times higher than in Great Britain. Haemophiliacs, in particular, are disadvantaged by the US system and have enormous bills to pay. In addition, commercial markets are much more likely to distribute contaminated blood.

Titmuss also argued that the existence of a commercialised system discourages voluntary donors. People are less likely to give blood if they know that others are selling it. Psychologists have found similar conflicts between financial incentives and moral or altruistic conduct in other areas.2 Philosopher Peter Singer has elaborated on this point in the case of blood:

If blood is a commodity with a price, to give blood means merely to save someone money. Blood has a cash value of a certain number of dollars, and the importance of the gift will vary with the wealth of the recipient. If blood cannot be bought, however, the gifts value depends upon the need of the recipient. Often, it will be worth life itself. Under these circumstances blood becomes a very special kind of gift, and giving it means providing for strangers, without hope of reward, something they cannot buy and without which they may die. The gift relates strangers in a manner that is not possible when blood is a commodity.

This may sound like a philosophers abstraction, far removed from the thoughts of ordinary people. On the contrary, it is an idea spontaneously expressed by British donors in response to Titmuss questionnaire. As one woman, a machine operator, wrote in reply to the question why she first decided to become a blood donor: You cant get blood from supermarkets and chain stores. People themselves must come forward; sick people cant get out of bed to ask you for a pint to save their life, so I came forward in hopes to help somebody who needs blood.

The implication of this answer, and others like it, is that even if the formal right to give blood can coexist with commercialised blood banks, the respondents action would have lost much of its significance to her, and the blood would probably not have been given at all. When blood is a commodity, and can be purchased if it is not given, altruism becomes unnecessary, and so loosens the bonds that can otherwise exist between strangers in a community. The existence of a market in blood does not threaten the formal right to give blood, but it does away with the right to give blood that cannot be bought, has no cash value and must be given freely if it is to be obtained at all. If there is such a right, it is incompatible with the right to sell blood, and we cannot avoid violating one of these rights when we grant the other.3

Both Titmuss and Singer believe that the weakening of the spirit of altruism in this sphere has important repercussions. It marks, they think, the increasing commercialisation of our lives and makes similar changes in attitude, motive and relationships more likely in other fields.

You must undertake independent research into the theories of egoism and utilitarianism. Now apply them to answer follows:

1. Did Plasma International strike a fair bargain with the West Africans who supplied their blood to the company? Or is Plasma guilty of exploiting them in some way? Explain your answer.
2. Examine the pros and cons of commercial transactions in blood from the egoistic and utilitarian perspectives

In each case, you must identify the key feature of the theory being used and show how they apply to the case. Conclude the section by explaining how a theoretical knowledge of of ethics will help in answering these questions.