What is Cord Blood Banking? Pros, Cons, and How It Works

Throughout pregnancy, the umbilical cord acts as the baby's lifeline, connecting them to the placenta that serves as a source of oxygen, antibodies, and nutrition. In the past, this tissue was routinely discarded after delivery, but that's starting to change. More parents are storing (or "banking") their baby's cord blood for potential use by their family or the general public. In fact, donating umbilical cord blood can save lives—and it's free and easy to do so.

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. Because cord blood cells can morph into all sorts of other blood cells, they're ideal for treating a variety of diseases that harm the blood and immune system.

Diseases that can potentially be treated using cord blood include leukemia, some cancers, sickle-cell anemia, and some metabolic disorders, says Mitchell Cairo, M.D., chief of the division of pediatric hematology and blood and marrow transplantation at Westchester Medical Center in New York. Additionally, new therapies continue to be developed that utilize stem cells.

Learn more about your options for banking umbilical cord blood, including the pros and cons of public and private cord blood banks.

Medical Uses of Stem Cells

Essentially, stem cells from the cord blood of a genetically compatible donor can "regenerate" the blood and immune system in someone who is ill. "For a whole host of disorders, cord blood is a potential gold mine for treatment and, in some cases, cures," adds Nancy Green, M.D., a pediatric hematologist and former medical director of the March of Dimes.

"It's not experimental; cord blood transplants have been in use for [many years], and they're accepted for childhood leukemia and other kinds of disorders," says Dr. Green. Plus, scientists are still studying ways to treat more diseases with cord blood, including heart disease, stroke, diabetes, spinal cord injuries, and more.

Cord Blood Stem Cells vs. Embryonic Stem Cells

Cord blood stem cells are not the same thing as embryonic stem cells. Embryonic stem cells are obtained from an embryo. Their use is controversial because obtaining them requires a human embryo to be destroyed. Typically, they are obtained from leftover embryos created for possible use in fertility treatments that are no longer needed. Many experts say cord blood cells have much the same potential as embryonic stem cells without the same ethical concerns.

Will My Baby Need Cord Blood?

Most of the time, cord blood is not used by the family that banks it. It's unlikely that the child in question will develop an illness that can benefit from treatment with stem cells. Instead, banking cord blood is to protect against the hypothetical possibility of your baby needing a treatment that uses stem cells.

Alternatively, you can donate them so that anyone that's a match in need of stem cells can have access to this precious, lifesaving resource. There are also cases in which a second baby is born that can offer cord blood for an older sibling who is sick.

Public vs. Private Cord Blood Banking

Cord blood banking means storing cord blood (and its valuable stem cells) for potential use in the future. There are two types of cord blood banking: public and private. Here are the key differences between them.

Public cord blood banking

Public cord blood banks are usually nonprofit companies that store your donated cord blood for free. The great thing about public cord blood banks is that even if you don't bank your baby's cord blood, they can access stem cells if needed. Anyone can, which is a big benefit to this option. Plus, there's a much greater chance that your cord blood will be used because it could be given to any child or adult in need, says William T. Shearer, M.D., Ph.D., former professor of Pediatrics and Immunology at Baylor College of Medicine in Houston.

Cord blood is donated and put on a national registry, to be made available for any transplant patient. So, if your child should need the cord blood later in life, there's no guarantee you would be able to get it back. However, very likely, another person's donation will be available for their use.

According to the American Academy of Pediatrics (AAP), which recommends donating to a public bank, "Thirty times more publicly banked cord blood units are used for transplants compared to privately banked cord blood." Public banks are also looking to diversify the registry by encouraging more people from different ethnic and racial backgrounds to donate. It's completely free to donate blood to a public cord blood bank.

Private cord blood banking

Private cord blood banks are companies that require a registration fee (plus annual storage fees) for your cord blood, but it's saved specifically for your own family, so you'll have ready access to it if it's ever needed. This could potentially eliminate the need to search for an unrelated donor through the national registry of potential donors.

Private banks charge between $1,400 to $2,300 for collecting, testing, and registering, plus around $100 to $175 for an annual storing fee. However, these rates can vary widely.

Private cord blood banking makes the most sense in families with children who have diseases that might be corrected with transplantation, says Joanne Kurtzberg, M.D., director of the pediatric bone marrow and stem cell transplant program at Duke University.

"That's a small minority of cases. An example would be another child in the family with leukemia, sickle-cell anemia, or an immune deficiency. In a family where everyone's healthy, there's no evidence that it will be useful," says Dr. Kurtzberg. (Also, there's only a 25% chance that a sibling will be a genetic match for sharing their cord blood).

How Cord Blood Banking Works

You must decide before the birth if you want to donate cord blood. In fact, the AAP recommends making these arrangements by the 34th week of pregnancy. If you choose to bank, the cord blood will be collected in the hospital almost immediately after you give birth—ideally before you deliver the placenta. If using a private bank, they will send you a collection kit before your due date; your doctor, midwife, or nurse uses this to collect the blood. With a public donation, the process is handled directly by the hospital.

"After the baby is born, the umbilical cord is cut and clamped. Blood is drawn from the cord with a needle that has a bag attached. The process takes about 10 minutes," explains the American College of Obstetricians and Gynecologists.

Next, a courier sent by the bank typically comes to the hospital to pick up the kit and take it to the bank, where it's processed and stored in a bag or vial that's frozen in liquid nitrogen. There is no risk to the new parent or baby in collecting the cord blood cells, which would otherwise be discarded.

Note that some hospitals don't accept public donations. The AAP recommends checking whether yours does on the Be the Match list, as well as the guide to USA Donation Hospitals compiled by Parent's Guide to Cord Blood Foundation, a nonprofit dedicated to educating parents about cord blood donation and cord blood therapists.

If your hospital doesn't collect donations, you can still bank your cord blood by contacting a lab that offers a mail-in delivery program. After you've passed the lab's screening process, they'll send you a kit that you can ask your medical providers to use to package your blood and mail it in, explains Frances Verter, Ph.D., founder and director of Parent's Guide to Cord Blood Foundation.

Limitations of Private Cord Blood Banking

While some families see security in banking their own family members' cord blood for an emergency, the AAP advises against it. Instead, the AAP encourages families to donate to public banks for people in need. The Academy also cautions against viewing a private cord blood registry as a backup plan, stating that there aren't compelling or accurate statistics on the likelihood of children needing their own stored cells one day.

Available estimates range from 1 in 400 to 1 in 200,000. And if your baby has a genetic condition (like muscular dystrophy or spina bifida), their stem cells would also have that condition, which often rules out using them in a potential treatment.

Another limitation of privately banking cord blood is that there might not be enough cells stored for a transplant. Usually, only 50 to 200 milliliters of blood is collected from each umbilical cord. This small amount is enough to treat a sick child, but not an adult unless multiple units of matched cord blood are used, says Dr. Shearer. So, you'd need to rely on stem cells from a public bank anyway.

It's also not clear how long cord blood cells are viable when stored. "The only data we have is for 15 years," says Zbigniew M. Szczepiorkowski, M.D., Ph.D., co-director of the Blood Bank and Transfusion Service, and director of the Cellular Therapy Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.

"But the way we store cord blood now may be better than it was 10 years ago," says Dr. Szczepiorkowski. Indeed, according to the University of Rochester Medical Center, some experts believe cord blood lasts at least 21 years.

Additionally, not all new parents can donate their cord blood. For example, you generally aren't eligible if you're younger than 18 years old, have a history of cancer or having chemotherapy, or received treatment for a blood disease such as HIV or hepatitis. It might also not be possible to donate cord blood with a premature baby or multiples, as there may not be enough blood to collect.

Whether you use a public or private bank, you'll still need to be tested for various infections (such as hepatitis and HIV). If tests come back positive for disease or infection, you will not be able to store your cord blood.

"People should know that if they can't [privately bank their cord blood] because they can't afford it, or for some other reason, they haven't denied their child a chance at a transplant," says Dr. Kurtzberg. "Public banks have enough units, and in many cases, it's not essential to have a related donor." In other words, parents aren't shortchanging their kids' health if they don't do private cord blood banking.

Evaluating Cord Blood Banking Facilities

If you decide to do private cord blood banking, do some research to find a bank that suits your needs. The Association for the Advancement of Blood and Biotherapies (formerly called the American Association of Blood Banks), evaluates and accredits many of the nation's private and public cord blood banks. So, checking for accreditation is a good first step.

Dr. Szczepiorkowski also suggests asking the following questions to potential cord blood banks before signing up:

Are you accredited by AABB or some other accrediting body?

Accreditation is not required for cord blood banks to operate, Dr. Szczepiorkowski notes. However, 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. However, remember that you can always donate to a public bank at no cost. He also notes that higher-priced banks are not necessarily better in quality. In fact, according to the AAP, public banks, which are free, offer the highest standard because they are tightly regulated.

How quickly does the cord blood arrive at the bank?

Find out how long it takes for the cord blood to be transported to the facility. The quicker the better, says Dr. 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.

The Bottom Line

Research into the benefits of cord blood banking is ongoing. Cord blood banking is an entirely optional, personal decision that parents-to-be can research and choose to do or not. That said, donating your cord blood to a public bank is free, easy, and can save a life. Talk to your obstetrician to find out more about whether it's right for your family.