Umbilical Cord Blood Storage (Banking)

by Stacey A. Wood, Jr., MD

Just mention the word “stem cell” and you are instantly ready to enter into the debate about the ethics of their use or else your eyes roll into the back of your head because you are weary of the debate.  The use of a bone marrow transplant can be a life-saving procedure in the treatment of certain blood diseases and malignancies particularly of childhood. Bone marrow contains cells referred to as “stem cells” or progenitor cells that the body uses to make the various blood cells that carry oxygen and fight infection.  However, the availability of bone marrow for transplantation is very limited.  Many individuals who could benefit from a bone marrow transplant die while awaiting a donor.

A potential source of stem and progenitor cells is human fetal cord blood. Early results from about hundreds of transplants of human cord blood stem cells in children with certain childhood malignancies have been encouraging.  These early reports have generated considerable enthusiasm because the 4 million births per year in the United States would seem to provide a large supply of potentially transplantable cells.  At this time the large majority of cord blood is discarded at the time of delivery.

The use of this technology raises a number of scientific, legal, and ethical issues.  These include the following (and many others):

1. Should cord blood be collected and banked centrally in a way similar to the way that we now handle blood (a la Red Cross), or should parents bank their own child’s blood (at considerable cost) at the time of birth for potential future use?
2. What are the chances that a child will ever need his/her own cord blood? If that need is 18 years later will the cells still be viable?
3. All specimens collected would need to be tested for infections and genetic diseases.  Should the parents be informed about the results of these tests?  What if the results reveal non-paternity??
4. Is the availability of umbilical cord blood stem cells a right (like the current availability of whole blood for transfusion) or a privilege (like cosmetic surgery)?

Privately owned for-profit companies have formed to bank cord blood samples for potential future use by a family. The costs of utilizing one of these companies is substantial: approx $1500 initially and $150/year thereafter.  With the chance of needing a stem cell transplant estimated at being between 1 in 1,000 and 1 in 200,000 and the with the many unanswered questions about the successful use of these cells, the question becomes…is this a reasonable investment?  Once, they are banked, to whom do the cells belong? Can the parents decide to use them for a different child? Can they sell the cells? What happens if the parents disagree?

There are clearly many questions and unresolved issue that are unanswered and unsolved regarding cord blood storage and stem cells usage.  Parents are currently being sold these services without having a full understanding of all of the issues.  Private cord blood banking companies often appear to be making parents feel guilty about not doing “everything possible” to ensure the future health of their children. Until more of the questions surrounding cord blood banking can be answered, deciding on whether this is a wise use of one’s money is difficult.