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116 Plasma KCE Reports 120 To attract a larger number of donors it would not be allowed to resort to paying for the blood or plasma collected. The principle of voluntary donation free of charge constitutes the essential ethical framework for all European countries. But the likes of advertising campaigns, benefits in kind and tax breaks could be considered and set up at a cost probably lower than that of the subsidies given to the Red Cross to arrive at the same result. In most European countries (see part 1 of this report), in particular France and Germany, it clearly emerges that a major effort has been made in recent years aimed at the priority age groups, namely 18-25 years, usually involving a close partnership with the schools and universities concerned. More generally, communication campaigns using a wide variety of media have been implemented, paying special attention to managing the donors over time in order to improve their loyalty. Germany has given special thought to the geographical location of plasma collection centres in relation to the profile of potential donors, in particular in terms of age. It is nevertheless necessary to reflect on the different treatment currently given to private sector and public sector employees. The quest for equal treatment of all donors could lead the authority to reduce the benefits, in terms of days of leave, granted to members of the public services and make donating blood and plasma totally charitable. This would open up the possibility of reconverting the resulting savings into campaigns promoting blood and plasma donation. Finally, a wide-raging debate in terms of demographic prospects has taken place in Germany in order to emphasise the importance of this dimension for the future satisfaction of the needs of the population. This debate will make possible better forecasting of the donor population. 4.3.4 Transparency and better control of the supply of derivatives As we have already seen, it seems that the quantities of derivatives sold in Belgium by the CAF-DCF are below what the firm should be able to produce if she were using all the quantity of plasma sold to it by the Red Cross. There are various possible explanations for this situation, but the information available does not enable us to identify the correct ones, largely because of the complexity of the market and of the fractionation circuit implemented via agreements with foreign firms, the terms of which are not known to us. Given the indirect subsidy granted to the CAF-DCF via the below-market price at which plasma is sold to it, it would make sense to have public control over the terms and costs of its agreements with foreign partners. Relations between the organisations responsible for collection and fractionation are a delicate and complex subject in all western countries. France and Germany first sought to ensure standardisation of the technical collection process (in particular the volume of individual donations) in order to improve the volumes effectively delivered to the fractionation firms, with the same number of donors. Of all the countries studied, it is without doubt in Australia where the debate on contractual relations between the fractionator and the other actors involved has gone furthest. The contract binding the National Blood Authority and the fractionator (CSL- Ltd) covers all aspects of the relationship between the two partners, including the financial, logistical, technical (health security, risk management) and legal dimensions (ownership clause, appeal jurisdictions, etc.). This contractual relationship also takes into account that the National Blood Authority is responsible for all functions touching on the question of the supply and distribution of blood and plasma products within the country.
KCE Reports 120 Plasma 117 4.4 CONCLUSIONS The issue of the independence of supplies of plasma derivatives is fundamentally a political one, and the public authorities must define the degree of independence they wish to achieve and, as a corollary, the degree of insecurity that they are willing to accept. The substance of these choices would then determine the measures to be taken within the three fields of action identified in this report: plasma collection, the production of plasma derivatives and the consumption of these derivatives. Each of these fields concerns different actors that require specific instruments in order to move towards the collection of more plasma, more profitable transformation of plasma into derivatives, and consumption of derivatives more in step with recognised medical conditions. Maintaining or increasing our independence therefore requires the application of a combination of measures in these three fields. However, independently of any quest for a specific degree of independence, it would appear that consumption that satisfies the rules of good practice, collection at minimum cost and satisfactory yields from the fractionation process are basic requirements. The scale of each possible measure must be linked to established facts, in which respect it is important to take into account the limitations of any scientific study. In this case they concern international prices and certain data relating to the consumption of derivative products. For each of these limitations, further studies would make the results more robust, not forgetting the confidential nature of certain data, which will always be subject to some uncertainty. Nevertheless, it is not necessary to wait for certainty regarding every parameter before taking the necessary measures.
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KCE Reports 120B Plasma i PRÉFACE
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KCE Reports 120B Plasma iii MÉTHOD
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KCE Reports 120B Plasma v En ce qui
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KCE Reports 120 Plasma 3 GLOSSARY A
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