Motivations for Banking Cord Blood

1.  Why bank cord blood?

2.  Why doesn't everybody bank cord blood?

3.  Cord Blood Transplants

4.  Photos of a child receiving a stem cell transplant

5.  Your Heritage and Cord Blood

6. Tables and Charts of ethnic diversity in US donor registries

7. Banking decisions for your family

Click on this logo to view a 12 minute web-based tutorial on cord blood banking.  The access code will appear automatically, but you must enter a birthday of January 1, 1970.  This film was developed by Emmi Solutions, in collaboration with Kim Petrella, R.N.  Mrs. Petrella is one of the Scientific & Medical Advisors to the Parent's Guide to Cord Blood Foundation.

Birth is a one-time opportunity to help society by donating your child's cord blood to a public bank.  Cord blood contains stem cells that can save lives.  Patients requiring a stem cell transplant will receive cells from one of three sources: bone marrow, circulating blood, or umbilical cord blood.  The first two exist in all healthy adults, but cord blood can only be harvested and stored at birth.  The section on cord blood transplants explains that it is easier to match transplant patients with cord blood than with the two sources of adult blood.  Hence, establishing public banks of cord blood from donors with diverse tissue types can save many lives. 

Birth is also a one-time opportunity to help your own family by saving your child's cord blood.  Transplant patients recover better when they receive stem cells from a related donor, instead of an unrelated donor.  In the future, if there are regenerative medicine advances which can repair the body with the patient's own stem cells, then children whose parents saved their cord blood will have better access to those treatments.

There is virtually no reason not to save your child's cord blood.  The only cautionary remarks which can be made about cord blood banking is that the cord should not be clamped too soon after birth.

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Because it costs money.  Whereas a bone marrow registry is based upon a computer data base of potential donors, a cord blood bank is based upon a laboratory where staff process the cord blood, freeze it in liquid nitrogen, and monitor the freezers. 

Only a limited number of institutions have the funding to maintain public banks which take donations for free.  This web site has a page which explains the types of cord blood banks, and another which tells you how to find a public bank in the US to accept your donation.

For most parents, cord blood donation is not an option because the number of locations served by public banks is very limited. In that case, parents have to decide if they want to and can afford to pay a private bank to process the cord blood and preserve it for the family.

Fortunately, there are financial assistance programs to help families which have a case of medical need, where a family member is at risk of needing a stem cell transplant.

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Advantages of Cord Blood Transplants  versus
Bone Marrow Transplants (BMT) or Peripheral Blood Stem Cells (PBSC)

• Harvesting umbilical cord blood poses no risk to mother or child, whereas a bone marrow donor must undergo a surgical procedure.
• Stored cord blood is ready for use as soon as it is needed, whereas the process of contacting and testing donors listed in a registry takes weeks to months.
  
• For transplants, the primary advantage of cord blood stem cells over stem cells from adults is that they cause much less graft versus host disease (GvHD).  In order to safely transplant adult stem cells, the patient and donor must match over at least 10 of 12 tissue types called Human Leukocyte Antigens (HLA), or 83% HLA match.  By comparison, medical outcomes are just as good with cord blood that has a 4 out of 6 or 67% HLA match.                   (Reference: V Rocha, et al, 2000; NEJM 342:1846)

Disadvantages of CBT versus BMT or PBSCT:

• The main disadvantage of cord blood transplants is that they take at least a week longer to "engraft", which means repopulate the patient's blood supply so that cell counts reach minimum acceptable levels.  The longer engraftment time is a risk because it leaves the patient vulnerable to a fatal infection for a longer time.
  
• A typical cord blood collection only contains enough stem cells to transplant a large child or small adult.  This web site has a page explaining the optimum transplant dose.  At one time it was believed that cell dose limitations restricted the use of cord blood transplants to children.  In recent years growing numbers of adults are also receiving cord blood transplants, either by growing the cells in a lab prior to transplant, or by transplanting more than one cord blood unit at a time.  More information about these trials is available on the web page about Research on Cord Blood Transplants.

The web page on Odds of Use reviews the probability that an individual in the United States will have a stem cell transplant over the course of a lifetime.

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• A successful transplant requires that the patient and the donor have matching HLA types.
• HLA types are inherited, half from your mother and half from your father.  The probability that two siblings will have a perfect 6/6 match desired for a bone marrow transplant is 25%, whereas the probability that they will have the 4/6 match required for a cord blood transplant is 39%.
  
• Given that HLA types are inherited, you certainly expect that your relatives will match you more closely than a stranger.
• In fact, HLA typing tends to run in ethnic groups, so that patients are more likely (but not guaranteed!) to find a match among donors of the same ethnic background.
• Africans have more genetic diversity than any other ethnic group.  The NMDP estimates that even if the number of African-Americans in the United States who registered as adult donors were doubled or tripled, they still could not match all the African-American patients.
• Another group which is not well represented in the registry of adult donors is multi-racial Americans, most of whom are not yet adults.

Cord blood holds hope for all patients with hard-to-match HLA types, because cord blood transplants only require a 4/6 match, not a perfect match.

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Table 1. Cross Race Probabilities for HLA matching

This table displays the mean probability that patients of the indicated race will find a 6/6 HLA-A,B,DR match from amongst a registry of 500,000 donors composed entirely of the indicated race. Reference: copied from the article, "Impact of racial genetic polymorphism upon the probability of finding an HLA-matched donor", by PG Beatty, M Mori, & E Milford, Transplantation 1995; 60(8):778-83

Donor / Patient	Caucasian	African- American	Asian- American	Hispanic	Native American
Caucasian	.77	.52	.43	.68	.70
Afr.-American	.18	.61	.08	.26	.20
Asian-American	.29	.15	.78	.30	.32
Hispanic	.54	.42	.35	.69	.57
Native American	.61	.49	.53	.71	.76

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Parents often ask, should they donate or bank privately?  First, before agonizing over this decision, find out if you are eligible to donate.  In order to donate cord blood, you must:

• deliver at one of the hospitals that has a donation program
• sign up months before your due date
• pass a medical screening

Please read the page on public banks in the US.  If you do have the choice to either donate or bank for your family, there is no single correct decision.  There is only the decision which is right for your family and your values; do not let anyone pressure you.  You should take into account your family medical history, in particular whether any diseases run in your family which might be treated with stem cells in the near future.  You should also consider your heritage, and the important role which heritage plays in matching transplant patients.

Another question which parents often wonder about is, if they banked privately for one child, should they bank for additional children.  In this situation, unless you happen to know the HLA tissue types of your children, you do not know which children match each other, and the best insurance to have a match is to bank again, if it is affordable.

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