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**Exhibit 4.28**

|  | 1. | Section 4.5 of the Agreement shall be replaced with the following paragraph: |
|--|----|------------------------------------------------------------------------------|

| Fifth Amendment to the Exclusive Manufacturing, Supply and Distribution Agreement Confidential | Page 1  |
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|  | 2. | Section 2.2 of the Agreement shall be replaced with the following paragraph: |
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|  | 3. | Section 3.1 of the Agreement shall be replaced with the following paragraph: |
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|  | 4. | Section 6.4(a) of the Agreement shall be replaced with the following paragraph: |
|--|----|---------------------------------------------------------------------------------|

| Minimum Period(Calendar Year) | Minimum Purchase Levels (50 mL vials) |
|-------------------------------|---------------------------------------|
| 2010                          | [*****]                               |
| 2011                          | [*****]                               |
| 2012                          | [*****]                               |
| 2013                          | [*****]                               |
| 2014                          | [*****]                               |
| 2015                          | [*****]                               |
| 2016                          | [*****]                               |
| 2017                          | [*****]                               |
| 2018                          | [*****]                               |
| 2019                          | [*****]                               |
| 2020                          | [*****]                               |

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|  | 5. | Section 1.77 of the Agreement is hereby amended to read as follows: |
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| Calendar Year | 50 mL vials/month |
|---------------|-------------------|
| 2010          | [*****]           |
| 2011          | [*****]           |
| 2012          | [*****]           |
| 2013          | [*****]           |
| 2014          | [*****]           |
| 2015          | [*****]           |
| 2016          | [*****]           |
| 2017          | [*****]           |
| 2018          | [*****]           |
| 2019          | [*****]           |
| 2020          | [*****]           |

|  | 6. | Section 5.1(d) of the Agreement shall be replaced with the following paragraph: |
|--|----|---------------------------------------------------------------------------------|

|  | (d) | Annual and Market Price Adjustments. |
|--|-----|--------------------------------------|

|  | (i) | Beginning [*****] and on each January 1 thereafter during the Term, the then-current Transfer Prices (taking into account any prior year adjustments and Market Price adjustments) shall be increased by [*****] of: (A) [*****] and (B) the percentage increase, if any, in the Producer Price Index (as published by the U.S. Bureau of Labor Statistics) over the prior year. |
|--|-----|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|  | (ii) | If, during any calendar year, the Transfer Price identified above is, at any time, less than [*****] of the average Market Price for the Product for the applicable calendar year, the applicable Transfer Price shall be increased when calculating the final Transfer Price for Product in the annual true-up at the conclusion of each calendar year during the Term to be equal to [*****] of such average Market Price. |
|--|------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|  | (iii) | If Baxalta purchases quantities of Product from Kamada [*****], Kamada shall [*****]. |
|--|-------|---------------------------------------------------------------------------------------|

|  | (iv) | The Transfer Price specified in Sections 5.1(d)(ii) and 5.1(d)(iii) above applies only to [*****]. |
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|  | 7. | A new Section 6.5 shall be added to the Agreement, as follows: |
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|  | 6.5 | Marketing Contribution Payments. In order to support Baxalta’s marketing efforts for Product in the Baxalta Territory, Kamada shall reimburse Baxalta for a portion of Baxalta’s documented marketing expenses. Examples of such marketing expenses include, but are not limited to, [*****]. Baxalta shall provide Kamada with an invoice statement detailing the expenses for which Baxalta seeks reimbursement on a quarterly basis. Kamada shall pay to Baxalta any undisputed amounts so invoiced [*****] days after receipt of the invoice. Kamada shall reimburse up to the following amounts for the designated calendar year period: |
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| Calendar Year | Limit of amount to be reimbursed by Kamada |
|---------------|--------------------------------------------|
| 2017          | up to [*****]                              |
| 2018          | up to [*****]                              |
| 2019          | up to [*****]                              |
| 2020          | up to [*****]                              |

|  | 8. | All provisions of the Agreement which are not expressly amended by the terms of this Fifth Amendment shall remain in effect and without change. |
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| BAXALTA US INC.                                                                                              | KAMADA LTD.                                                                                                                                                              |
|-------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| By: _________________________________________Name:Title:Date: ________________________________________  | By: _________________________________________Name:  Amir LondonTitle:  Chief Executive OfficerDate: ________________________________________              |
|                                                                                                              | By: _________________________________________Name: Gil EfronTitle:  Deputy CEO and Chief Financial OfficerDate: ________________________________________  |

| Fifth Amendment to the Exclusive Manufacturing, Supply and Distribution Agreement Confidential | Page 4  |
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