The medical and emotional issues surrounding cord blood banking.
What It's All About
Saving your baby's umbilical cord blood can be a life-saving decision, but it can also be an expensive one, and even unnecessary. Research into the benefits of cord blood banking is ongoing. "It's important for parents to realize that this isn't a definitive discussion, it's ongoing," says Dr. Zbigniew Szczepiorkowski, MD, PhD, codirector of the Blood Bank and Transfusion Service, and director of the Cellular Therapy Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. "There is the medical argument that says you probably won't need the cells, but then there is the emotional argument, too, which says, 'If something does happen, I will want to have done what is best for my child.'"
Some parents are banking their baby's cord blood because the cells have the potential to treat certain diseases of the blood and immune system.
Throughout pregnancy, the umbilical cord acts as the baby's lifeline, connecting him to the placenta that serves as a source of oxygen and nutrition. After the mother delivers her baby, she also delivers this temporary tissue. In the past it was routinely discarded, but this is starting to change. We now know that umbilical cord blood is a rich source of stem cells, the "progenitor" cells that develop into the major components of the blood, including platelets, red blood cells, and white blood cells. Stem cells from cord blood also may have the potential to give rise to other cell types in the body.
Stem cell transplants, also known as bone marrow transplants, are often an essential part of treatment for serious illnesses involving the blood and immune system, such as leukemia, lymphoma, certain forms of anemia, and immune deficiency syndrome. Healthy stem cells from the blood or bone marrow of a genetically compatible donor are used to "regenerate" the blood and immune system in the person who is ill. A sibling has the best chance of matching, but in most cases an unrelated donor has to be found.
Umbilical cord blood saved and stored at birth represents a potential new source for these stem cells. Ever since the first successful transplant using cord blood cells was performed 15 years ago, more and more parents have had to face the decision of whether or not they want to "bank" their newborn baby's cord blood. If your baby or another family member (most likely a sibling) should ever need a stem cell transplant, there is a chance that these cells could be used -- eliminating the need to search for an unrelated donor through the national registry of potential donors. Cord blood stem cells may have other uses, too, yet to be discovered by researchers.
On the other hand, the likelihood of your family ever needing the cells is quite low, says Dr. Szczepiorkowski. "There are a number of cases in which they've been used, but not many," he says. "Current estimates on the likelihood of needing the cells from the donor range from 1 in 10,000 to 1 in 30,000. More research is needed before we can say for sure what the odds are." Dr. Szczepiorkowski notes that he did store his own son's cord blood and plans to do so for his next child.
The American Academy of Pediatrics officially recommends that parents bank their newborn baby's cord blood only if they have family members with a disease that may require a stem cell transplant, or a strong family history of such diseases.
Nevertheless, some parents still choose to go ahead with banking, reasoning that any chance of needing the cells, no matter how small, warrants taking this precautionary step.
"This is being advertised as a form of health insurance and I think that is a good way to look at it," Dr. Szczepiorkowski adds. "Most of us pay money for health insurance coverage but hope that it is something we'll never have to use for anything besides routine care."
While many parents see peace of mind as the major advantage of cord blood banking, there are disadvantages as well:
Cost: Fees vary, but commercial cord blood banks charge approximately $1,000 to $1,500 to gather and store a sample, in addition to a yearly maintenance fee in the $100 range. You might also pay an additional fee of several hundred dollars for the cord-blood collection kit, courier service to the cord blood bank, and initial processing. These expenses are not covered by insurance.
No guarantees: There is no guarantee that the cord blood stem cells will be able to be used in your child or another family member, should they become ill, or that they will offer a cure. So much depends on the diagnosis, the nature of the illness, and the needs of the individual patient. Dr. Szczepiorkowski also notes that there is only a 25 percent chance that two siblings will be a perfect match for a stem cell transplant, after they undergo testing for tissue compatibility.
You'll need to weigh the advantages and disadvantages for yourself and discuss the options with your healthcare provider. If you decide to go ahead with cord blood banking, you'll have to make arrangements with a bank in advance. In most cases, the company provides a kit that your healthcare provider will use to collect the blood just after you deliver your baby. A courier service then delivers it to the cord blood bank, where it is given an identifying number and its components frozen.
Evaluating Cord Blood Banking Facilities
You should count on doing some research to find a cord blood bank that suits your needs. The American Association of Blood Banks (AABB), where Dr. Szczepiorkowski serves as chair of the Cellular Therapy Standards Committee, evaluates and accredits many of the nation's private and public cord blood banks. He recommends an independent parent-operated Web site, www.parentsguidecordblood.com, as a good starting point for objective information. He also suggests a number of questions parents might ask:
Are you accredited by AABB or some other accrediting body? Accreditation is not required, Szczepiorkowski notes, but voluntary accreditation shows the company has met some set quality standards.
How do you prepare and store the sample? The AABB suggests that the white blood cells be isolated first and that the sample be stored in plastic bags, not vials, to lower the risk of contamination (although experts debate this issue).
How much does it cost? Understandably, says Dr. Szczepiorkowski, the expense may make the decision for you. He also notes that higher-priced banks are not necessarily better in quality.
How quickly will the cord blood be transported to your facility? The quicker the better, says Szczepiorkowski, although the issue of timing is still a gray area. Ideally, the cord blood sample should arrive at the facility within 24 to 48 hours.
Storage and Donation
Because this is such a new area, researchers aren't yet sure how long the stem cells will last in storage. However, cells that have been stored for up to 14 years have been used successfully in transplants.
If you decide not to save your baby's cord blood for your family's use, you may have another option: donating it to public cord blood bank, where it could help someone else who needs a stem cell transplant. Every day, people throughout the U.S. and the world are searching the public registries for a potential life-saving match. The blood also might be used for research. Donating the blood to a public bank or research program won't cost you anything, but keep in mind that you give up all rights to it, no matter what happens in the future.
Also, since there are only a handful of public banks equipped to store cord blood, your hospital may not offer this as an option. You can visit the Web site of the National Marrow Donor Program, at www.marrow.org, to see if there is a program accepting donations in your area.
"It's most important that parents be educated about their options," says Dr. Szczepiorkowski. "It's also important for them to realize that in some cases, whether because of cost or location, there really won't be any options."
From the National Women's Health Resource Center. Copyright 2003-2004 by the National Women's Health Resource Center, Inc. (NWHRC). All rights reserved. Reproducing this content in any form is prohibited without written permission. For more information, please contact firstname.lastname@example.org.