In 1992, Michael McCarthy visited his doctor hoping for answers. McCarthy had been feeling sick for years—fatigued, with aching joints and pain in his abdomen.

“They said, ‘By the way, you have hepatitis C,’” McCarthy recalls. “I said, ‘What’s that?’ And they said, ‘Don’t worry, it’ll take years to kill you.’”

McCarthy is among thousands of hemophiliacs who used blood transfusions for decades to manage his disorder. And he, along with thousands of other Canadians during the major 1980s tainted blood crisis, contracted something far worse than what he was trying to treat.

Now, a company that pays for plasma donations is looking to set up in New Brunswick, reigniting this decades-old ethical debate on blood.

In the 1980s, the Red Cross controlled Canada’s blood supply. The organization was slow to implement donor screening and blood testing regulations. As a result, more than 30,000 Canadians were infected with hepatitis C and HIV from blood transfusions.

After investigating the scandal, the Krever Inquiry recommended, in 1993, that the Canadian Blood Services be founded, and that all blood donations be made voluntarily—no more paid donations. It’s a seemingly small move, but it has drastically improved the blood supply.

“Most people who sell their blood plasma are from vulnerable populations, having a difficult time, or they’re students,” explains Kat Lanteigne, co-founder of BloodWatch.org, a non-profit advocating for voluntary blood donations. “They’re more inspired or willing to cut corners because they need the money.” And when plasma donation centres were paying for donations, Lanteigne says, they targeted these demographics.

Canadian Plasma Resources (CPR), which pays its donors, set up shop in Saskatchewan in early 2016, and is eyeing New Brunswick next; Health Minister Victor Boudreau has so far welcomed the idea.

Lanteigne says this could lead to catastrophe. In addition to health concerns, studies from the European Blood Alliance show that once people expect payment for donations, only one in six

people will donate voluntarily.

Health Canada issued CPR a licence, but it’s up to individual provinces to allow the company to operate. Meanwhile, the World Health Organization advises against paid donations, and is advocating for 100 percent voluntary donations of plasma and tissue by 2020.

For McCarthy, it’s too high a risk: “This is a not-so-gentle reminder that we can’t forget the lessons learned in the past.”