When the development of blood component therapy was in its infancy countries were by and large self sufficient for whole blood. Large scale export and import of plasma started in the 1960s and early 1970s, when both albumin and coagulation factor VIII became commercially available. The industry needed more and more plasma, and the development of plastic bags made plasmapheresis feasible. Large plasma donation centres were established, primarily in the United States but also in countries such as Nicaragua and Haiti. Exploitation of donors gained wide publicity, and the trade in “red gold” became an important international media event. In Europe self sufficiency in blood production has again become an important concern, but the picture is now more complicated and self sufficiency is often confused with the issue of the source of the blood—paid or unpaid donors.

Reacting to the bad publicity over exploited donors from developing countries, the assembly of the World Health Organisation in 1975 urged member states to “promote the development of national blood services based on voluntary non-remunerated donation of blood and enact effective legislation governing the operation of blood services and to take other actions necessary to protect and …