RESUMO
Plasma Derived Medicinal Products (PMDPs) are an essential component of the modern therapeutic armamentarium. They are differentiated from most other medicines in several ways, particularly the unique nature of the raw material used for their manufacture. Human plasma has been fractionated to PDMPs for the past 75 years, and the economics of manufacturing requires currently that as many products are harvested from each litre as is feasible and reflective of clinical needs. PDMPs may be purchased on the open market from the various commercial and not-for-profit (NFP) manufacturers. They may also be manufactured under contract (CM) from plasma supplied by government and similar agencies as a product of blood transfusion services. Clients for CM aspire to make full use of donated plasma, hence maximizing the donors' gift after the standard components of transfusion have been harvested. Many such countries also aspire to making their national clinical needs self-sufficient in PDMPs, attempting to acquire strategic independence from the vagaries of the commercial open market. The increasing commercial imperatives operating in the PMDP sector generate a tension with such ethical aspirations which are not easily resolved. In particular, the need to harvest as many proteins as possible may generate products which are surplus to national needs, necessitating an ethical paradigm for the optimal provision of such products. In addition, traditional relationships between blood services and domestic fractionation agencies may come under stress as a result of the competitive processes underpinning such transactions, which are now subject to international norms of free trade. Blood services engaged in the supply of hospital transfusion components are detached from the pharmaceutical Good Manufacturing Practices (GMP) culture needed for the production of plasma for CM, while the generation of such plasma through extraction from whole blood donations deflects the focus from that of a dedicated raw material for CM to a byproduct of the donation process. We review the field of CM, assess the current tensions within the sector, and offer suggestions for the strategic positioning of governments and other clients to ensure optimal outcomes for all the stakeholders involved.