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The limited medical and social risks are dwarfed by the benefits May 12th 2018 THIS year marks the 200th anniversary of the first successful human-to-human blood transfusion, conducted by James Blundell, an English obstetrician working just across the Thames from The Economist’s offices. Today blood is big business—with global exports worth more, in 2016, than global exports of aeroplanes. But that trade is distorted by the refusal of most governments to allow payment to people who give plasma, blood’s yellowish liquid component. 今年是英国产科医生就在经济学人杂志办公室的泰晤士河对面工作的詹姆斯·布伦德尔(James Blundell)首次成功进行人对人输血的200周年纪念日。如今血液是巨大商业，在2016年，其全球出口价值高于全球的飞机出口。但由于大多数政府不允许给提供血浆这一血液中黄色液体成分的人付钱，这种贸易被扭曲了。 The blood trade today consists mostly not of blood for transfusion, demand for which is falling as medical techniques improve, but of plasma. Most of this comes from plasma-collection centres, where it is extracted from whole blood and the platelets and blood-cells are transfused back into the donor. Plasma is used to make drugs such as factor VIII, which helps haemophiliacs’ blood to clot, and vaccines for rabies, tetanus and Rhesus disease. Almost 50m litres of it were used in 2015, enough to fill 20 Olympic swimming pools. America, the OPEC of plasma, produces 15 of those swimming-pool equivalents. Forget steel and cars: plasma makes up 1.6% of America’s total goods exports. 今天的血液交易主要不包括用于输血的血液，随着医疗技术的进步，对这种血液的需求也在下降，而血细胞被输送回捐献者体内。血浆被用于制造诸如因子VIII这样的药物，它帮助血友病患者凝结血液，制造狂犬病、破伤风和恒河猴症疫苗。2015年使用了近5000万升血浆，这足以填满20个奥运游泳池，美国这一血浆界的欧佩克，生产了15个这样的游泳池量的血浆。忘掉钢铁和汽车吧：血浆占美国出口总额的1.6%。 The secret of this success is simple: America lets companies pay people for their plasma. So do the few other countries that are good at collecting the stuff, including Germany and Hungary. Others don’t. Big importers such as Australia, France and Belgium have banned payment. In Canada, where the issue is a live debate, the lone company trying to collect paid plasma has recently been banned in two provinces and risks the same in a third. 成功的秘诀很简单:美国让公司付钱给提供血浆的人，其他少数擅长收集血浆的国家也一样（要付钱），包括德国和匈牙利，但其他国家不喜欢这一，澳大利亚、法国和比利时等大型进口国家禁止买卖。在加拿大，这个问题还正在辩论，改过唯一一家试图收集付费血浆的公司最近在两个省份被禁止，第三个省份也面临同样的风险。 Blood and treasure The aversion to paid plasma rests on three reasonable-sounding but largely groundless propositions. The first is that it is unsafe. Payment might encourage donors to conceal dangerous behaviour—such as intravenous drug use. In the 1980s and 1990s, tainted blood products infected half the world’s haemophiliacs with HIV, along with tens of thousands of plasma donors in China. But modern plasma products do not carry such risks. They are heat-treated and bathed in chemicals to sanitise them (an impossibility for blood for transfusion). Since the adoption of these techniques there has not been a single case of transmission of HIV or hepatitis via plasma products. Doctors agree that plasma products from paid donors are just as safe as those from unpaid ones. 对付费血浆的厌恶建立在三个看似合理但基本上毫无根据的主张上。首先是它不安全，支付可能会鼓励捐赠者隐瞒危险的行为，比如静脉注射毒品。在20世纪80年代和90年代，伴随着中国成千上万的血浆捐献者的是，受污染的血液制品让世界一半的血友病患者感染了艾滋病。但现代血浆产品没有这种风险。他们会经过热处理，浸在化学物质中消毒(对于用于输血的血液这是不可能的事)。自从采用这些技术后，就没有一例通过血浆产品传播艾滋病毒或肝炎。医生们一致认为，来自有偿献血者的血浆产品和无偿的捐献者一样安全。 A second argument is that, if people are paid for their plasma, fewer will volunteer to donate whole blood for transfusions. (Paying for whole blood would be unwise, since it cannot be sterilised as plasma can.) But there is no evidence that paying for plasma diminishes the supply of donated blood. That is why, in Canada, more than 30 economists and philosophers wrote an open letter arguing against bans on paid plasma. Americans voluntarily donate as much blood per person as do Canadians. 第二个理由是，如果人们为血浆付费，那么自愿献全血的人就更少了。(为全血付费是不明智的，因为它不能像血浆一样消毒。)但是没有证据表明为血浆付费会减少捐献血液的供应。这就是为什么在加拿大，30多名经济学家和哲学家写了一封公开信，反对对付费血浆的禁令。美国自愿献血的人数和加拿大一样多。 A third argument is that paying for plasma preys on the poor. It is possible that those selling plasma need the money and therefore might give too often. In America plasma donors can give twice a week; those in Europe can give just once a week. There is no evidence of harm to their health in either case, but more long-term study would be prudent. 第三个理由是，为血浆付费是在掠夺穷人。卖血浆的人可能需要钱，因此可能会经常卖血。在美国，血浆捐献者每周可以捐献两次；欧洲人一周只能捐献一次。在这两种情况下，没有证据表明他们的健康受到损害，但更多长期的研究显示对此需谨慎。 Those against allowing payment suggest using voluntary donors instead. Yet every country that does not pay ends up importing plasma. And the fact that America is by far the dominant supplier carries risks of its own. The dependence on a single source leaves the rest of the world vulnerable to an interruption of supply. To protect their people, therefore, other governments need to diversify their supplies of plasma. Paying for it would make a big difference. 反对允许支付的人建议使用自愿捐赠。然而，每个不支持为血浆付费的国家最终都会进口血浆。事实上，美国是目前主要的供应商，其自身也有风险。对单一来源的依赖使世界其他地区容易受到供应中断的影响。因此，为了保护本国人民，其他国家政府需要让他们的血浆供应多样化，而付费将会使它有很大的不同。 This article appeared in the Leaders section of the print edition under the headline "Blood money" |
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