What is cord blood banking? Once a baby is delivered, stem cells in the cord and placenta can be collected, stored, and potentially used to save someone’s life. In the US and around the world, cord blood has been used to treat more than 80 medical conditions, especially hematologic malignancies, like leukemia, and hemoglobinopathies, such as sickle-cell disease. Because the cells are collected after the cord is cut, the procedure is completely safe and poses no risk to the mother or baby.
At this point in time, there are two ways to bank cord blood–either publicly or privately. With public donation, families relinquish ownership of the cells, whereas families choosing private banking retain ownership. The AAP strongly recommends public donation, which makes sense for multiple reasons. Public cord blood donation is completely free, whereas private banking is expensive. The initial enrollment fees for private banks range from $1350-$2300, with additional fees of $100-$175 yearly into adulthood. Furthermore, public banks are subject to strict regulatory measures, whereas oversight in the private sphere isn’t as stringent, possibly leading to decreased specimen quality. If a family suffers from a specific illness that is treatable via stem cell transplantation, then private banking makes sense. But if not, the likelihood of using privately banked cord blood is low (one in several thousand) compared to publicly banked blood.
Families choosing to bank blood privately should understand that a child with a malignancy like leukemia cannot use her own banked blood, because the cells are premalignant at birth. This means that a healthy baby’s cord blood is more likely to be used for siblings who develop hematologic malignancies. If you’re planning to have only one child, private cord blood banking might not be useful (unless stem cells eventually become the cure for Alzheimer’s disease or dementia).
Why is cord blood banking so important? Due to evolving medical practices, such as expanding screening for SCIDS (severe combined immunodeficiency) in the newborn period across many states, the need for stem cells transplantation utilizing cord blood is increasing. Unlike a bone marrow transplant, which requires close HLA matching between the donor and recipient, cord blood cells can be successfully transplanted even when HLA matching isn’t perfect; and after transplantation, the risk of graft-versus-host disease is significantly lower with cord blood.
In October 2017, the AAP revised its guidelines on cord blood donations, and the recommendations are worth reviewing. The introduction to the new AAP guidelines reads as follows:
“By 2013, more than 30,000 hematopoietic stem cell transplants (HSCTs) have been performed by using cord blood as the source of stem cells worldwide. The disease distributions were 57% for malignancies, 32.5% for hemoglobinopathies, 6% for severe combined immunodeficiency disease (SCID) or related T-lymphocyte disorders, and 1.5% for other disorders. Approximately 800,000 cord blood units are being stored in public cord blood banks, and more than 5,000,000 cord blood units are stored in private cord blood banks. The trajectory of increase in the number of cord blood units being transplanted in patients older than 16 years has progressively increased over the past decade. Clinical outcomes of both malignant and nonmalignant disorders are beginning to emerge in the literature, and it is certain that HLA barriers can be breached more easily with cord blood transplants compared with nonmatched marrow or peripheral blood HSCT transplants.”
Another point made in the new guidelines is that a great need exists for banked cord blood amongst minorities. The genetic background of minority groups is not well represented in either private or public banks. Raising awareness amongst minority families is therefore of the utmost importance.
While writing this piece, it occurred to me that there are potential ways to bridge the gap between the public and private cord blood-banking spheres. My youngest daughter’s cord blood has been taking up space in a private bank for about 10 years now, not doing anyone much good. If her cells were a match for someone who needed a transplant, my family would be happy to give up ownership and save a life. At the time of private banking, why not consent families to enter their child’s HLA type into a national, comprehensive database? If someone develops a need for a particular specimen, families could be contacted for permission to donate. Then the family could decide whether to give up ownership or not. For privately banked cord blood that isn’t likely to be used, I imagine most families would agree to make the donation. This type of system would require excellent communication between private cord blood-banking companies and the public organizations.
If you have questions about cord blood banking, the 2017 AAP guidelines can be found at the site listed below:
Feel free to discuss cord blood banking with your pediatrician or obstetrician. If you’d like to investigate banks in your neighborhood, a foundation called Save the Cord provides a list of all public and private banking facilities in the US on their web site. The Center for Cord Blood at the National Marrow Donor Program maintains a list of participating hospitals that collect cord blood units for their network of public banks. You can find the current list at https://bethematch.org/support-the-cause/donate-cord-blood/how-to-donate-cord-blood/participating-hospitals/.
If you live in state that does not have a public cord blood bank, it is still possible to arrange public donation. To do so, call the Cord for Life Foundation/Lifeforce Cryobanks at (800) 869-8608. This organization helps to arrange both public and private cord blood banking. A cord blood collection kit can be mailed to expecting mothers who wish to donate, but arrangements must be made before 34 weeks gestation.
Given the number of families who need stem cell transplants to treat otherwise fatal illnesses, cord blood donation is an extremely important public service. By choosing public cord blood banking, you’re probably helping to avert someone else’s medical disaster rather than your own, but this is a truly worthy cause. I would encourage everyone having children to do it!
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