At the root of it however, is health care being seen as a commodity/business. Companies making factor 8 in the states where all blood is sold not donated, didn't want to know about whether the blood was from a high risk individual. Prisoners had reductions in their sentences for donating, poor people got badly needed cash for their blood - they were all incentivised to lie about their risky behaviour and health problems that made their blood unsafe. The people collecting the blood just wanted as much as possible to sell to increase their profits. In Richard Titmuss' amazing work, The Gift Relationship ( which is how he describes the free donating of blood in the U.K.) he describes a blood collection clinic in NY where homeless men gave blood, then went round the block and joined the queue again - staff knew and did not care in the slightest.