In the past, umbilical cord blood was routinely discarded. Today, we know that it contains potentially lifesaving stem cells, which can be used in transplantation. There are two types of cord blood banks that help with the collection and storage of umbilical cord blood: public and private.
Public banks allow for donation for public use without fees. Private storage, which comes with a cost, allows families to save their cord blood for their child or a family member in case of a serious disease later in life.
Human cord blood contains cells that are in the bone marrow of adults. The function of bone marrow is to create red and white blood cells and platelets. These cells are vital for life. Red blood cells carry oxygen from the lungs to all the body’s tissues. White blood cells protect against invaders such as viruses (infl uenza, for example) and bacteria (strep throat, bacterial bronchitis or pneumonia). Platelets begin the cascade of reactions that stop bleeding when blood vessels are injured. So, if a child develops a problem with blood cell production due to bone marrow disease or damage, a source of bone marrow cells for replacement would be vital.
Preserving blood cells through rapid and deep freezing is called cryopreservation. Whether or not to bank human cord blood cells has provoked much scientific and ethical controversy. Considerations have included: whether cord blood banks should be required to have a public access component; how scientists would obtain and use the stem cells that recreate a variety of human cell types, thereby providing potential new treatments for certain chronic debilitating diseases; how to safely freeze and bank the blood cells from the four million U.S. births each year; whether the cells will still be viable if needed decades later; if the number of cells would be a sufficient amount for an adult; the probability of an individual needing cord blood cells; whether parents should pay for something they may never use; whether cord blood cells could ever be collected without consent for the benefit of someone else and preserved in a public bank; if this would provide usable cord blood cells, so that no fetus would be created purely for the purpose of harvesting cells.
Public Versus Private
You can donate your baby’s stem cells for public use, or you can store them, for a fee, for your own private use. Some states have passed legislation requiring physicians to inform their patients about these options. In most cases, the potential uses for cord blood cells involve illnesses with a low chance of occurrence. However, if someone is from a family with an inheritable disease that is treatable using cord blood stem cells, then these banked cells may be lifesaving, and the private donation of umbilical cord blood should be considered.
An individual’s chance of needing cord blood for a bone marrow stem cell transplant is estimated to be between 1 in 1,000 and 1 in 200,000 by the age of 18. Fanconi’s anemia occurs once in 360,000 people (1 in 30,000 for those of Ashkenazi Jewish heritage). The chance of umbilical cord blood stem cells being used for a child or a family member is estimated by the American College of Obstetricians and Gynecologists to be approximately 1 in 2,700
Current research focuses on developing ways to use cord blood to cure cancers and heart disease. Th erefore, parents must consider the personal cost of this potentially lifesaving technology. The initial charge for collecting, processing, shipping and storing the cord blood specimen in the first year ranges from $1,720 to $1,975, according to figures posted by the three leading companies offering the service in the U.S. Then there is an annual storage fee of $125, which will likely rise over the years.
Insurance companies will not cover these costs until the process is proven safe and cost-effective. Th e three leading cryopreservation laboratories each report between 100,000 and 140,000 clients worldwide. One even off ers a money-back college tuition plan for the donor. Public cord blood banking is free, but there is no guarantee that it can be used for your own family’s needs. It is for the public benefit, analogous to donating blood to the Red Cross.
A Look Into the Future
As the number of uses for blood cells rises, so will the demand for the service. If the cells prove to be “cryodurable,” and thus still useful for many years after they are frozen, the process could provide a form of insurance for the treatment of specifi c diseases. You are banking on the possibility of having illnesses that cord blood cells could fight.
Given the emotional and physical suffering of families who have a member affl icted with a devastating disease that may be treatable with cord blood cells, there is an understandable interest in the potential uses for human umbilical cord blood cells. Since you have a choice, check with your doctor about blood donation options in your area.
Adair R. Heyl, PhD, is an assistant professor, and Peter S. Heyl, MD, is an associate professor, at the Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk.