During the course of a pregnancy, expectant parents have many decisions to make. Should they undergo prenatal testing? Should mom breast-feed? Should a son be circumcised?
Add a new consideration to the list: Should the parents save their infant’s umbilical cord blood? In a few hospitals and clinics, that question is becoming a routine part of the discussions between obstetricians or nurse-midwives and their patients. And if the International Cord Blood Foundation is successful in its new venture, every mother-to-be will eventually be asked to consider saving cord blood.
“Our position is that every expecting mother deserves to be informed about the properties of cord blood and that it is up to the mother to make an informed choice: to save it for themselves, donate it for the public good or throw it away,” says Larry Andreini, executive director of the San Mateo-based foundation.
The nonprofit organization was founded last year to develop a cord blood bank from unrelated volunteer donors. Its goal is to serve as a resource for anyone needing transplantable stem cells, the disease-fighting cells extracted from the umbilical cord after birth.
When transplanted, cord blood cells can help cure various types of cancers and immune system disorders, similar to bone-marrow transplants. But most umbilical cords are simply discarded after birth.
“Cord blood has come a long way just in the last three or four years,” Andreini says. “Out of the 200 cord blood transplants, 100 were done last year. So there is an accelerated interest and belief in cord blood.”
Most of the cord blood banked so far has been for the donor family’s own use. The family pays the cost of collecting and storing the blood.
In addition to the ICBF public bank, the federal government is also setting up a smaller bank through the National Heart, Lung and Blood Institute.
“It’s a win-win situation,” says Dr. Richard Schwarz, past president of the American Academy of Obstetrics and Gynecology and a professor at the State University of New York Health Science Center at Brooklyn. “There is not much of a downside because the cord blood is usually discarded with the placenta.”
According to ICBF, every pregnant woman, her partner and the obstetrician or midwife should discuss saving the cord blood by the second trimester of pregnancy. At least two months before childbirth, the mother would provide ICBF with her medical history and a blood sample to check for infectious diseases.
This information is confidential. If the mother is a suitable donor, she is given a collection kit to bring to her delivery. ICBF informs the mother’s obstetrician or midwife that she has opted to save the cord blood, and the medical team is briefed on how and when to collect the blood, which averages about 3 ounces.
If parents wish to store the blood for their own use, they would pay about $1,000 for collection and about $100 per year in storage fees.
“The odds that someone would need it are low,” Andreini says. “This is protection in the event of a catastrophic event. But a family with a history of leukemia, for example, would be alerted to save it for themselves.”
The family pays nothing if they opt to donate the blood to the public bank. ICBF solicits corporate donations and holds fund-raising drives to pay for the costs of public donation and storage.
Not everyone is certain the public is ready to respond to the issue with their gifts of blood or money. While there is widespread agreement on the vast potential of cord blood transplants to treat a variety of conditions, some people think more transplants and studies are needed.
“I think that the public needs to learn about this. But there are enough questions remaining that I don’t think it’s ready for prime time. It’s not ready for routine use,” says Dr. Paul McCurdy, director of the blood resources program for the National Heart, Lung and Blood Institute in Bethesda, Md.
McCurdy says protocols need to be established on how to choose donors who are free of transmittable disease and how and when to remove the blood. He says it is not clear whether a cord blood unit is plentiful enough to be used in adults in need of transplants. Most of the transplants have been in children.
Questions also remain about how precise a match is needed between the donor’s cells and the recipient’s cells.
“There are some questions about how much of a mismatch you can tolerate without getting (severe) graft vs. host disease,” in which the recipient’s body rejects the donor cells, McCurdy says.
The federal program already has one public blood bank in New York. Other transplant centers and two to four collection points are scheduled to be added to the program later this year.
The goal is to collect 20,000 units for the public bank within four years.
McCurdy says his office will submit data to the Food and Drug Administration for review on the safety and effectiveness of volunteer donation and transplants.
Andreini says he is confident that public banking also will aid adults in need of transplants because some studies already have shown a high enough number of cells are contained within the small blood sample.
The benefits of cord blood transfers to children with various types of cancer and immune system diseases have been well established. That is reason enough for the public to get behind the movement, says Tim Cady, a medical education specialist with the Cord Blood Registry.
His job is to educate obstetricians, midwives and childbirth educators about cord blood donation. But Cady thinks it will be altruistic-minded consumers who will push the issue into the limelight.
“This will be a patient-driven issue,” he says. “In Southern California, this is already spreading like crazy. It’s becoming cocktail party conversation.
“If someone is pregnant, people are saying, ‘Have you heard about cord blood?”’