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If you’re thinking about banking your baby’s cord blood stem cells, one question you’ve probably considered is whether to choose a private or public cord blood bank. As with any major decision in your life, it pays to do your research so you can make the best choice for your family about the future of your baby’s cord blood.
Chloe Savannah Metz’ mother donated her baby girl’s cord blood to the NCBP in December 2000. “Many thanks to the New York Blood Center for giving us the opportunity to donate our cord — we hope to give someone a second chance!” – Christine Metz
Graft-versus-host disease (GVHD) is a common complication after an allogeneic transplant (from a source other than the patient) where the patient’s immune system recognizes the cells as “foreign” and attacks the newly transplanted cells. This can be a potentially life threatening complication. The risk for developing GVHD is lower with cord blood transplants than with marrow or peripheral blood transplants. Patients who do develop GVHD after a cord blood transplant typically do not develop as severe of a case of GVHD. Cord blood also is less likely to transmit certain viruses such as cytomegalovirus (CMV), which poses serious risks for transplant patients with compromised immune systems.
While donating cord blood is honorable, there is a lot people do not know about the public option. Most public cord blood banks have a limited number of collection sites, and they only retain a small number of collections because of volume and other criteria that must be met. Once cord blood is donated, it is highly unlikely that the donation can ever be attained by the donor or his or her family if the need arises. In addition, it may be hard to find another viable match from what is publically available. While donating is free, retreiving a cord blood sample from a public cord blood bank is not and pales in comparison to the overall cost of privately banking cord blood. These are just some of the reasons why privately banking cord blood may be a better option for some families.
Today, many conditions may be treatable with cord blood as part of a stem cell transplant, including various cancers and blood, immune, and metabolic disorders. Preserving these cells now may provide your family potential treatment options in the future.
Cord blood, which is harvested from the umbilical cord right after a baby is born, is marketed as a treatment for diseases such as leukemia and sickle cell disease, and as a potential source of cells for regenerative medicine – a cutting-edge field of medicine studying how to repair tissues damaged by everything from heart disease to cerebral palsy.
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When the medical courier delivers the cord blood collection kit to the cord blood bank, it is quickly processed to ensure the continued viability of the stem cells and immune system cells found in the cord blood. Firstly, a sample of the cord blood is tested for microbiological contamination, and the mother’s blood is tested for infectious diseases. As these tests are being conducted, the cord blood is processed to reduce the number of red blood cells and its total volume and isolate the stem cells and immune cells.
^ Caseiro, AR; Pereira, T; Ivanova, G; Luís, AL; Maurício, AC (2016). “Neuromuscular Regeneration: Perspective on the Application of Mesenchymal Stem Cells and Their Secretion Products”. Stem Cells International. 2016: 9756973. doi:10.1155/2016/9756973. PMC 4736584 . PMID 26880998.
Tissue is typed and listed on the registry of the C.W. Bill Young Cell Transplantation Program, also called the Be The Match Registry®. (The registry is a listing of potential marrow donors and donated cord blood units. When a patient needs a transplant, the registry is searched to find a matching marrow donor or cord blood unit.) It’s frozen in a liquid nitrogen freezer and stored, so if the unit is selected as a match for a patient needing a transplant, it will be available.
Private cord blood banking costs $2,000 to $3,000 for the initial fee, and around another $100 per year for storage. While that may seem like a hefty price tag, many expectant parents may see it as an investment in their child’s long-term health.
Our processing fees include the first year of storage. After the first year, you can continue to pay for the storage annually or pre-pay for storage at a significantly discounted price. Our annual storage fees are fixed for the life of your contract.
However, cord blood transplants also have limitations. Treatment of adults with cord blood typically requires two units of cord blood to treat one adult. Clinical trials using “double cord blood transplantation” for adults have demonstrated outcomes similar to use of other sources of HSCs, such as bone marrow or mobilized peripheral blood. Current studies are being done to expand a single cord blood unit for use in adults. Cord blood can also only be used to treat blood diseases. No therapies for non-blood-related diseases have yet been developed using HSCs from either cord blood or adult bone marrow.
The therapuetic potential of cord blood continues to grow. Over the last few years cord blood use has expanded into an area known as regenerative medicine. Regenerative medicine is the science of living cells being used to potentially regenerate or facilitate the repair of cells damaged by disease, genetics, injury or simply aging. Research is underway with the hope that cord blood stem cells may prove beneficial in young patients facing life-changing medical conditions once thought untreatable – such as autism and cerebral palsy.
The European Group on Ethics in Science and New Technologies (EGE) has also adopted a position on the ethical aspects of umbilical cord blood banking. The EGE is of the opinion that “support for public cord blood banks for allogeneic transplantations should be increased and long term functioning should be assured.” They further stated that “the legitimacy of commercial cord blood banks for autologous use should be questioned as they sell a service which has presently no real use regarding therapeutic options.”
In this way, cord blood offers a useful alternative to bone marrow transplants for some patients. It is easier to collect than bone marrow and can be stored frozen until it is needed. It also seems to be less likely than bone marrow to cause immune rejection or complications such as Graft versus Host Disease. This means that cord blood does not need to be as perfectly matched to the patient as bone marrow (though some matching is still necessary).
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Taking time to consider helping another person when you are already busy planning for the birth of your child is greatly appreciated. A gift of cord blood may someday give someone a second chance at life.
Not surprisingly, this emotional pitch is working — especially because the seemingly unlimited potential of stem cells has dominated the news in recent years. From 2003 to 2004, for example, the number of couples opting to use a private bank increased by 55 percent to 271,000. The three biggest companies — who have the majority of the approximately $250 million market — are vying for business.
Cord blood donation doesn’t cost anything for parents. Public cord blood banks pay for everything which includes the collection, testing, and storing of umbilical cord blood. This means that cord blood donation is not possible in every hospital.
“Raising a family is expensive enough,” says Jeffrey Ecker, MD, director of obstetrical clinical research at Massachusetts General Hospital, in Boston, and a member of ACOG’s ethics committee. “There’s no reason for parents to take on this additional financial burden when there’s little chance of a child ever using his own cord blood.”
If you’re looking to attain cord blood from a public bank, be aware that matched cord blood, as with bone marrow, can be difficult to obtain through a public cord blood bank. Once a match is ascertained, it may take valuable weeks, even months, to retrieve the match, and the cost of acquiring the cord blood from a public bank can be upwards of $40,000. When the newborn’s umbilical cord blood is banked privately, they can be retrieved quickly, and since the parents own the cord blood, banks can perform the retrieval free of charge. Learn more about public versus private cord blood banking here.
In a report to the HRSA Advisory Council, scientists estimated that the chances of a pediatric patient finding a cord blood donor in the existing Be the Match registry are over 90 percent for almost all ethnic groups.
Cord blood in public banks is available to unrelated patients who need haematopoietic stem cell transplants. Some banks, such as the NHS bank in the UK, also collect and store umbilical cord blood from children born into families affected by or at risk of a disease for which haematopoietic stem cell transplants may be necessary – either for the child, a sibling or a family member. It is also possible to pay to store cord blood in a private bank for use by your own family only.
In fact, the AAP does encourage parents to keep their child’s cord blood if a family member has already been diagnosed with a stem-cell-treatable disease. But a family won’t have to foot the bill: The Children’s Hospital Oakland Research Institute, in California, will bank a baby’s cord blood for free if a family member needs it at the time of the baby’s birth. Some private banks, such as Cord Blood Registry, Cryo-Cell, and ViaCord, have similar programs.
Donors to public banks must be screened for blood or immune system disorders or other problems. With a cord blood donation, the mother’s blood is tested for genetic disorders and infections, and the cord blood also is tested after it is collected. Once it arrives at the blood bank, the cord blood is “typed.” It is tracked by a computer so that it can be found quickly for any person who matches when needed.
Until now, however, it hasn’t always been easy for couples to donate their baby’s cord blood to a public bank. The 28 public banks currently in operation work with only about 100 hospitals in the U.S. (find the list at parentsguidetocordblood.com). If you don’t deliver at one of these hospitals, you can contact either Cryobanks International or LifebankUSA, commercial organizations that store both private and public units. These banks pick up the tab for your donation (minus the physician’s collection fee).
On average, the transport time for stem cells from the hospital to CBR’s lab is 19 hours. CBR partners with Quick International, a private medical courier service with 30 years of experience in the transportation of blood and tissue for transplant and research.
While all three stem cell sources are used in similar procedures, they each have advantages and drawbacks. Bone marrow transplants are the traditional form of therapy, but peripheral blood cells are becoming more popular, since doctors often get more stem cells from the bloodstream.
Families have the additional option of storing a section of the umbilical cord, which is rich in unique and powerful stem cells that may help repair and heal the body in different ways than stem cells derived from cord blood.
In addition to hematopoietic cells, Mesenchymal cells derived from Wharton’s jelly are useful as feeder layers for the propagation of other stem cell types. For example, equine embryonic stem cell-like cells derived from the inner cell mass were propagated successfully for more than 350 divisions on a feeder layer derived from stem cells isolated from Wharton’s jelly of equine umbilical cords (74). The equine ES-like cells could be maintained without leukemia inhibitory factor (LIF) as long as they were on the cord matrix cells.
It’s now possible to preserve up to twice the number of stem cells – exclusively available through cord blood banking with Americord®. With Cord Blood 2.0™, you now have the opportunity to treat your child into adolescence and even adulthood. Learn more >
The parents who make the decision to store their baby’s cord blood and cord tissue are thinking ahead, wanting to do right from the start (even before the start), and taking steps to do whatever they can to protect their baby down the road. Today, many conscientious parents are also considering delayed cord clamping (DCC), a practice in which the umbilical cord is not clamped immediately but rather after it continues to pulse for an average of 30 seconds to 180 seconds. Many parents don’t realize that they can delay the clamping of the cord and still bank their baby’s cord blood. As noted early, our premium processing method, PrepaCyte-CB, is able to capture more immune system cells and reduce the greatest number of red blood cell contaminants. This makes it go hand in hand with delayed cord clamping because it is not as affected by volume, effectively making up for the smaller quantity with a superior quality. You can read more about delayed cord clamping vs. cord blood banking here.
Since 1988, cord blood transplants have been used to treat over 80 diseases in hospitals around the world. Inherited blood disorders such as sickle cell disease and thalassemia can be cured by cord blood transplant. Over the past decade, clinical trials have been developing cord blood therapies for conditions that affect brain development in early childhood, such as cerebral palsy and autism.
Banked cord blood is most abundant in white blood cells and stem cells. While a lot of attention is paid to the stem cells, there are approximately 10 times more total nucleated cells (TNCs) than stem cells in any cord blood collection. TNCs are basically white blood cells, or leukocytes; they are the cells of the immune system that protect the body. Despite stem cells comprising one-tenth of most collections, cord blood is still considered a rich source of hematopoietic (he-mah-toe-po-ee-tic) stem cells (HSCs). HSCs are often designated by the marker CD34+. Hematopoietic stem cells can become two categories of cells: myeloid and lymphoid cells. Myeloid cells go on to form your red blood cells, platelets, and other cells of the blood. Lymphoid cells go on to become the B cells and T cells and are the basis for the immune system. Cord blood also contains mesenchymal (meh-sen-ki-mal) stem cells (MSCs), but they are much more abundant in cord tissue, which we will discuss in a minute.
Banking cord blood is a new type of medical protection, and there are a lot of questions that parents may want to ask. The Parent’s Guide to Cord Blood organization even has questions it believes all parents should ask their cord blood banks. We have answers to these and other frequently asked cord blood questions in our FAQs. If you can’t find the answer for which you are looking, please feel free to engage one of our cord blood educators through the website’s chat interface.
For families who wish to donate cord blood to a public bank, the biggest hurdle may be finding a nearby hospital that collects cord blood for donation. Most public banks only work with select hospitals in their community. In the U.S., there are only about 200 hospitals that collect cord blood donations. Find out if there is a donation hospital near you.
Our annual storage fee is due every year on the birth date of the child and covers the cost of storage until the following birthday. The fee is fixed upon enrollment for 18 years and will not increase during that span of time. If the stem cells are preserved after the 18th year, preservation may then fall under the new pricing structure.
If everyone donated cord blood to public registries for the ‘common good’ this would increase the chances of someone benefiting from a double cord blood transplant. This far outweights the actual probability of the person who donated the sample being able to usefully use it for themself.