Pathogen reduction technology could extend platelet shelf life and eliminate bacterial testing, but U.S. blood centers will not adopt it because it costs $100+ more per unit

Pathogen reduction technology (PRT) treats blood components with a photochemical process (amotosalen/UVA or riboflavin/UV) that inactivates bacteria, viruses, parasites, and residual white blood cells in platelets and plasma. It has been FDA-approved for platelets since 2014. PRT-treated platelets could potentially have their shelf life extended beyond the current 5-day limit, dramatically reducing the 15% annual waste rate. PRT also eliminates the need for bacterial culture testing (which currently delays platelet release by 12-24 hours), gamma irradiation (for immunocompromised patients), and CMV testing — simplifying inventory management and reducing the number of different platelet "flavors" a blood bank must stock. Despite these benefits, PRT adoption in the United States remains far below universal. The primary barrier is cost: PRT-treated platelets cost roughly $100 or more per unit above conventional platelets. One cost analysis showed that converting entirely to PRT platelets would increase annual platelet costs by 7.9%. Blood centers operate on razor-thin margins and cannot absorb this cost, hospitals resist paying more per unit, and insurers do not reimburse differentially for PRT-treated versus conventional platelets. The irony is that the downstream savings — fewer bacterial sepsis events from transfusion ($300,000+ per sepsis case), reduced testing and irradiation labor, fewer wasted expired platelets — almost certainly exceed the per-unit upcharge, but these savings accrue to hospitals and insurers, not to the blood center that bears the upfront cost. The structural barrier is a classic split-incentive problem. The entity that pays more (the blood center or hospital transfusion service) is not the entity that saves money (the hospital infection control budget, the insurer, the patient who avoids sepsis). No single decision-maker sees both sides of the ledger. Additionally, blood centers fear competitive disadvantage: if one center raises prices to cover PRT while its competitor does not, hospitals will switch suppliers. In Europe, where national blood services can mandate PRT adoption across an entire country (France and Belgium have done so), the technology is widely used. In the fragmented U.S. market with hundreds of independent blood centers competing for hospital contracts, no single center wants to move first.