Wall Street Journal - November 14, 2002
Leslie Chang, Staff Reporter of The Wall Street Journal

Last year, Mr. Li retired. China's ill-regulated blood trade had already begun to spread deadly diseases, and AIDS was decimating entire communities that had lived off selling blood. But that's not why Mr. Li stopped. He did so because his son and daughter-in-law took up the blood-for-cash trade.

From remote villages like Wanzi, high in the mountains of Qinghai Province in China's far west, to the nation's teeming coastal cities in the east, blood selling remains endemic here despite repeated government pledges to stamp it out. The reason, simply put: supply and demand.

China's medical establishment, including the very institutions that warn against the spread of hepatitis and AIDS, can't survive without buying blood. Cultural taboos keep those who don't need the money from volunteering blood. Tight budgets constrain government spending in poorer areas for safer means of blood collection. And an entire economic underclass has become so dependent on money from selling blood that officials tolerate it.

The consequences for China -- on the brink of an AIDS epidemic -- and for the rest of the world may well be devastating. A recent report by a group advising the Central Intelligence Agency predicts that China could have between 10 million and 15 million HIV/AIDS cases by 2010; the report specifically cites poor hygiene in blood sales as a critical factor in the virus's spread.

This isn't news for the government, which in 1988 passed a law calling for unpaid blood donations to be the basis of the blood supply and banning the "illegal collection of blood." The Chinese government has also launched a $150 million effort to clean up licensed blood stations; but since paid donors are the most reliable blood source, government-run hospitals and blood banks perpetuate a system they publicly abhor.

In fact, government policies exacerbate the problem. To meet demand, the government sets blood-donation quotas, city by city. Cities, in turn, lean on local government offices and companies to cajole employees into donating and often impose fines on companies that don't comply. When employees refuse, these companies sometimes turn to "blood heads," underground brokers who round up blood sellers.

On a drizzly morning outside the Beijing Red Cross Blood Center, a licensed blood-collecting facility, a young man jumps up from the curb and accosts a passerby. "Are you giving blood? Why not give for the work unit instead?" he asks, speaking on behalf of a company he declines to name.

The man, who calls himself Zhang Bin, offers $96 for about a pint. He explains that the company would pick up sellers the next morning and deliver them to a local hospital, for a blood test, followed by a donation. On the next street corner, a rival blood head runs up, offering $42 for about half a pint.

Inside the blood center, a drafty cement building with peeling paint, a first-floor waiting room is filled with a dozen men in folding chairs, dozing or waiting listlessly for blood samples to be taken. Upstairs, about 10 people can be seen in a room behind a grimy window, leaning back on chairs and donating blood.

A wall poster reads, "Thank you for your tremendous support to Beijing's health system." Another poster promises a "nutrition fee" of $26 for either a half-pint of plasma or three quarters of a pint of platelets. At the Red Cross Society of China, Wang Baoming, head of the information department, says the society "advocates voluntary blood donation" but the ministry of health manages the blood stations. Officials at the ministry didn't respond to requests for comment.

The scenes within and without the Beijing center would seem to be worlds away from the Shanghai Blood Center, in China's showcase city. Recently refurbished with $1 million of equipment, the center has a lab stocked with Compaq computers and sunlit rooms where volunteers can watch music videos as they donate blood. Samples are tested for hepatitis, HIV and other diseases -- a process that takes about three hours -- and bags of blood are stored in refrigerated cabinets before being shipped out to the city's 300 hospitals. "Shanghai is already up to international standards," boasts Gao Feng, the center's vice president.

Yet even here, the blood trade intrudes. Mr. Gao says the Shanghai Blood Center's goal this year is to have 17% of its blood supply donated on a purely voluntary basis -- or 60,000 bags out of the total 350,000 bags it handles each year. That means the rest must come from companies who may offer employees inducements to give blood, like subsidies or paid holidays, or from professional blood sellers.

According to both farmers and city-dwellers who sell blood, the standard procedure is to give blood about two hours after a blood sample is taken -- theoretically enough time to test for HIV and other diseases. But it's questionable whether such tests are universally done -- or whether blood banks and hospitals really throw away tainted blood. Similarly, although officials now require that the collection of blood plasma -- a process that recycles part of the blood back into a donor's body -- be done with single-use kits, such kits cost between $20 and $50 per donor, an astronomical expense for most hospitals.

The health ministry is well aware of the blood-supply system's inadequacies. In China's pending grant application to the Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria, a section on blood supply reads: "Many aspects of medical blood donation/transfusion safety have yet to be improved including the technical skills of blood-bank staff, the management and operation of blood stations with better blood-testing capabilities and quality control."

In villages like Wanzi, blood selling remains a way of life. On steep terraced hillsides that tumble into the valley below, the farmers live a life that is almost medieval. Far from being an act of desperation, selling blood comes from the desire to move up in the world. In the neighboring village of Gan'goutan, farmer Liu Shuyao says he first sold blood in 1973 to pay for his wedding; later in the 1970s, and into the 1990s, he sold his blood to pay his children's school fees. A pint these days brings $29.

Mr. Liu, 53, has put three children through college through a mix of borrowing and blood selling. The villagers estimate that 80% of adults there sold blood at one time or another. "If my son stayed here, he would have to sell blood too," Mr. Liu says. "So this way, we sacrifice this generation for the next one."

The farmers say they have never heard of anyone falling ill after selling blood. "You get thin after selling blood. But I have never heard anything about people getting sick afterward," says Mr. Li, the Wanzi retiree from the blood trade.

This past spring, some domestic newspapers ran articles about the farmers in Qinghai province selling blood for a living. The government announced it was setting up a poverty-alleviation committee to help the families.

Some area hospitals that had been buying blood stopped. The provincial blood center in Qinghai also stopped accepting blood sellers, villagers say. The Qinghai blood center did not respond to requests for comment.

But in June, the center reopened. On a recent morning, its waiting room was filled with people, many of them farmers down from the mountainside.

One by one the men and women lined up at table and rolled up their sleeves as a doctor pricked their arms for blood.

Write to Leslie Chang at leslie.chang@wsj.com

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