Part I: Export Sales, Blood Collection, and Rights of Donors.
For decades, the Cuban state has run a multi-million dollar business with blood, collected from unknowing and un-remunerated citizens.
As early as the mid-1960s Cuba was reportedly selling blood to at least Vietnam and Canada. By 1995, blood exports of US$30.1 million were Cuba’s 5th export product after sugar, nickel, crustaceans, and cigars.
Cuba’s official statistics, published by the Oficina Nacional de Estadísticas (O.N.E.), do not report these exports, but global trade data indicates that in the 1995-2014 twenty-year period), Cuba exported $622.5 million —an annual average of $31 million— under SITC (Standard International Trade Classification) 3002 for human blood components (plasma, etc.) and plasma-derived medicinal products (PDMPs). (See export data by year and country of destination here). The bulk of these exports has gone to authoritarian governments, politically allied with Cuba, presumably to state entities applying laxer standards, ethical and otherwise (Iran, Russia, Vietnam, Algeria until 2003, then to Venezuela, Brazil, Argentina, and Ecuador).
Cuba reports that 95% of all collected units of human blood is fractionated into components, allowing for a much more lucrative trade than for plasma alone and for the production of highly valued PDMPs such as interferon, human albumin, inmunoglobulines, coagulation factors, toxins, vaccines, and other medicinal products. This export business has an important edge over competitors by saving the usual cost of paying donors for the raw material, their blood.
The business could be much larger than as reported under SITC 3002. In 2012, O.N.E. reported $808 million in exports of pharmaceutical/medicinal products, of which some —or many— might also be derived from human blood and not classified as such. Cuba’s unreliable statistics are standard fare and, in fact, Cuban officials have reported to the media that pharmaceutical and biotechnology exports are more than $2 billion.
Blood collection in Cuba: massive government deception and exploitation
Mass blood drives soliciting volunteer and altruistic donation began very soon after Fidel Castro’s rise to power in January 1959. But, a much more sinister approach was also put in place. In the 1960’s, the blood of political prisoners was drained right before their way to execution. The Inter-American Commission on Human Rights denounced this in a scathing April 1967 report. Cuba Archive has documented at least eleven cases and obtained numerous anecdotal accounts of this island-wide practice lasting several years. (See our report).
Cuba has long had a 100% donation rate. By 1998, Cuba was reporting that the ratio of voluntary altruistic blood donation had surpassed the PAHO/WHO goal of one per 20 inhabitants. In 2014, the last year of official statistics, it reported 407,989 voluntary non-remunerated blood donations, of which 392,244 (96%) were useful. Surprisingly, citizens are required to donate blood before any medical procedure, even minor ones, and there is often no blood when needed for emergencies or surgeries. PDMPs are also not readily available to the population, reserved for foreigners, the nomeklatura, and the well-connected.
Cuba has an average monthly wage of less than US$20 and the monthly food rationing only covers ten days of the average citizen’s nutritional needs. Despite the widespread economic deprivation, donors are not remunerated. Given the country’s chronic food shortages, just the cheese sandwich and watered-down glass of juice given to donors is incentive enough for many to give of their blood.
Numerous, diverse, and concerted state efforts are devoted to collecting blood year-round. Media and mass communications in Cuba, all state-owned, effusively promote nationwide campaigns to fulfill quotas. Voluntary blood donations are portrayed as “a duty” to “save lives” of fellow citizens or victims of disasters in other countries. Family doctors and an extensive web of state-controlled mass organizations, health institutions, and the Red Cross, promote blood donation. The neighborhood “Committees for the Defense of the Revolution” (CDRs) —with around 8 million reported affiliates in the country of 11 million— are divided territorially with annual blood donation quotas. They reward “good revolutionaries” with diplomas and medals; in the past, TVs, refrigerators, and other scarce consumer goods were awarded. Blood is collected using different degrees of coercion at “work centers,” schools, among members of the police and Armed Forces, among young men serving the obligatory two-year military service (getting typically meager food rations), and at prisons, where many hungry donors are easily found.
Some people are tricked into becoming “permanent donors” under false science. They are told, with no apparent scientific basis, that unless they continue giving blood regularly, they will overproduce red blood cells (polycythemia vera) and put their health in peril. Select donors are recruited from a pool of people in very good health who are then sensitized to generate certain proteins in their blood to produce “hyperimmune” plasma, which is subsequently fractionated. These harvested and “permanent” donors reportedly receive just a slightly more generous monthly food ration.
The government goes to great lengths to conceal its blood export business, hypocritically cheering “the solidarity of the people.” State officials tell the population that “each donation saves three lives” and that their blood is used for surgeries, medical emergencies, and to treat diseases. Export sales are never mentioned. Even scientific publications join in the ruse with outlandish statements such as this: “Even in our contemporary unipolar and neoliberal world in which countries such as the United States defend remunerated donation, Cuba emerges as paradigm of altruistic donation…” 
Rights of blood donors
“The Code of Ethics of Blood Donation and Transfusion” of the International Society of Blood Transfusion (ISBT), adopted by the World Health Organization, holds (among other things):
1. “Blood donation … shall, in all circumstances, be voluntary and non-remunerated; no coercion should be brought to bear upon the donor.”
2. “The donor should provide informed consent to the donation of blood or blood components and to the subsequent (legitimate) use of the blood by the transfusion service.”
3. “A profit motive should not be the basis for the establishment and running of a blood service.”
From an ethical and public health perspective, whether to pay blood donors or not —instead of solely relying on altruistic donations— is subject of continuing debate. In many developing countries blood donation is still paid —albeit poorly— and in many developed countries for-profit corporations producing PDMPs pay donors. In certain countries, in order to maintain blood supplies, some medical facilities ask family members to give voluntary donations. In the U.S., for example, although the Red Cross only collects voluntary blood donations, it is reimbursed by hospitals for the costs associated with providing the blood —recruitment and screening of potential donors, collection, processing, testing, labeling, storage, and distribution. What is clear, according to ethicists, is that informed consent is an indispensable requisite for donations and that the donor must receive information concerning the possible uses of his/her blood, the potential beneficiaries, and the procedures involved, including accurate and unambiguous information regarding the possibility of commercial use.
For a government to run an export business with the unremunerated altruistic donations of its unknowing citizens is contrary to solidly established international practices and standards and, in fact, unheard of. According to Kenneth Goodman, Ph.D., director of the University of Miami’s Biothethics Progam, “it’s depraved.”
The international community is compelled to:
1. Demand by all possible means that Cuba cease all coercion, deception, and mandatory practices on blood donations and offer donors adequate compensation.
2. Demand that all countries receiving imports from Cuba of human blood or other biological material require evidence of consent from the donors and inform recipients of their origin.
3. Appoint an independent team of international experts to investigate Cuba’s blood donation system, and manufacture of PDMPs to assure adequate ethical and sanitary standards and transparency.
*The Spanish translation will be posted on our website’s Spanish page at www.ArchivoCuba.org.
Coming soon: Part II: Regulatory framework, sanitary concerns, and the rights of recipients.
 Dra. Silvia M. Melians Abreu, Dra. Anadelis Gámez Pérez, et. al. (Centro de Información y Gestión Tecnológica (CIGET), Pinar del Río), “Problemas filosóficos y sociales de la donación altruista de sangre,” Avances, Vol.5 No.2 abril-junio 2003.
 The International Society of Blood Transfusion (www.isbtweb.org) is the premier international professional society for the field encompassing transfusion and transplantation science and medicine. Founded in 1935, it brings together over 1300 professionals from over 101 countries. Its Code of Ethics was adopted by its General Assembly on July 12, 2000, amended in 2006.
 Kenneth W. Goodman, Ph.D., is founder and director of the University of Miami Bioethics Program and its Pan American Bioethics Initiative. (Interview in Miami, May 15, 2014.)