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 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 future use.
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 diseases that harm the blood and immune system. These 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 Children's Hospital of New York-Presbyterian at Columbia University.
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., medical director of the March of Dimes. "It's not experimental; cord blood transplants have been in use for [several years], and they're accepted for childhood leukemia and other kinds of disorders." Plus, scientists are still studying ways to treat more diseases with cord blood, including heart disease, stroke, diabetes, spinal cord injuries, and more.
It's important to note that cord blood stem cells are not the same thing as embryonic stem cells, which are controversial because obtaining them requires a human embryo to be destroyed. Experts say cord blood cells have much the same potential as embryonic stem cells without the ethical concerns.
Keep reading to learn more about cord blood banking, including the pros and cons, the difference between public and private banking, and more.
Public vs. Private Cord Blood Banking
Cord blood banking means storing cord blood (and its valuable stem cells) for 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. There's a 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., 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.
"Cord blood from public blood banks is used more often than privately banked cord blood," according to the American Academy of Pediatrics (AAP). "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 their registry by encouraging more minorities 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. This could potentially eliminate the need to search for an unrelated donor through the national registry of potential donors. Private banks charge $1,400 to $2,300 for collecting, testing, and registering, plus around $100 for an annual storing fee. 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." (Also, there's only a 25 percent chance that a sibling will be a genetic match when using cord blood).
How Cord Blood Banking Works
You must decide before the birth if you want to donate cord blood. In fact, the AAP says it should be arranged 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. The bank will send you a collection kit before your due date; your doctor, midwife, or a nurse uses this to collect the blood. "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 (ACOG).
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 mother or baby in collecting the cord blood cells, which would otherwise be discarded.
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 contact 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 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 members' cord blood for an emergency, the American Academy of Pediatrics advises against it, instead encouraging 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 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), the stem cells would also have that condition, which often rules out using their stored cord blood cells.
Another limitation of privately banking cord blood is that it's possible 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.
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." Indeed, according to the University of Rochester Medical Center, some experts believe cord blood lasts at least 21 years.
Additionally, not all moms 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 received chemotherapy, or received treatment for a blood disease such as HIV or hepatitis. (Learn more about eligibility here). It might also not be possible to donate cord blood with premature a baby or multiples, as there may not be enough blood to collect.
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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. People shouldn't be made to feel that they haven't done everything they could for their child."
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 also suggests a number of questions parents might ask:
Are you accredited by AABB or some other accrediting body? Accreditation is not required, Dr. 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 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 personal decision that parents-to-be need to research thoroughly. Talk to your obstetrician to find out whether it's right for your family.