Frequently Asked Questions

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Donate Cord Blood

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How do I pick a public bank?
You rarely get to pick a public bank.  If you are having your baby at a hospital that accepts donations, then you are one of the lucky few.  The only way you could have a choice in the matter is if you are choosing a mail in donation program.
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How much blood and stem cells does a typical umbilical cord hold?
The median size of cord blood collections in family banks is 60mL or 2 ounces.  That small volume of liquid corresponds to 470 million Total Nucleated Cells (TNC) or 1.8 million cells that test positive for the stem cell marker CD34.  Thus, most healthy full-term babies have over a million blood-forming stem cells in their umbilical cord blood.   By comparison, most public cord blood banks will only keep collections that are much bigger than average, and throw out the donations that are below a threshold of a billion TNC, corresponding to a blood volume of about 90-100 mL or 3 ounces.

Reference:
Sun, JJ et al., Transfusion Sept. 2010; 50(9):1980-1987
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What fraction of cord blood donations get accepted?
Between a half and three quarters of donations are discarded.  The primary reason is that the collection volume is too small.  Public banks will only save a collection that is big enough to transplant a large child or small adult.
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Who is able to donate cord blood?
In theory, any expectant mother who passes the medical screening is eligible to donate.  In practice, the biggest hurdle faced by families who wish to donate is finding a bank to accept their donation.  There are only about 200 hospitals in the US that collect cord blood donations from births, and most of them require you to register for donation weeks ahead of the birth.  The handful of programs that accept mail-in donations are opening this opportunity to the rest of the American public.
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Are related donors better for transplants?
The overall answer is yes, but this is a complex topic.

The two important measures of patient outcome are: long-term survival, and the  impact on quality of life from graft-versus-host disease (GvHD). Sibling donors tend to trigger less GvHD.  Also, sibling donors are available faster than searching for an unrelated donor, and patients have better survival when they go to transplant faster after diagnosis.

The exact comparison of outcome between sibling or unrelated donor varies with the patient diagnosis.  The NMDP website has a page on this, with numerous references.  For many cancers the outcomes are comparable, although sibling donors have a slight edge. The largest study was by Weisdorf et al. 2002, for over 2900 patients with CML leukemia.  When correcting for all other factors, the survival with sibling donor vs unrelated donor was 68% vs. 61%. Sibling donors show a significant improvement for pediatric cord blood transplants of hereditary disorders.  The European Blood and Marrow Transplantation Group (EBMT) reported 3 year survival rates of 95% from a sibling donor vs. 61% from an unrelated donor.

References:
Weisdorf, D.J. et al. Blood 2002; 99:1971-1977.
Bizzetto, R. et al. (EBMT) Haematologica 2011; 96(01):134-141

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If I donate my baby's cord blood, will that child have free access to cord blood for a transplant?
No.  When a mother signs the Informed Consent to donate cord blood, she gives up any guaranteed access to that blood.  The blood may not be banked, and if it is banked, it may be released to some one else.  There have been cases where families needed their child's cord blood and got it back from a public bank, but it is important to realize there are no guarantees of access to donated cord blood.  Cord blood donors also do not receive guarantees of priority treatment or waived fees if your child later needs a donor.  The reward for donating cord blood is the possibility that your baby may Be The Match that saves a life.
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What is HLA Type and how is it used?
The term "HLA" is short for Human Leukocyte Antigens, and these are proteins in the immune system that determine whether a patient will react against a donor transplant.  A very good basic tutorial about HLA types is on the Stanford Website, and the national Be The Match program (aka NMDP) has more info on the role of HLA type in transplants of stem cells from bone marrow or cord blood.

Briefly, there are 6 HLA types that are important for stem cell transplants: in a bone marrow transplant the patient and donor must match at all 6 (100% match), whereas a cord blood transplant is just as effective at curing patients with only a 4 out of 6 match (67% match) between donor and patient.  This is the reason that donations to the national cord blood inventory managed by NMDP are so important to help patients who come from minority or mixed racial backgrounds.

The HLA type of cord blood is always measured by public banks, and then the type is listed on a registry that can be searched by patients seeking a transplant.  Family banks typically do not measure the HLA type at the time of banking, because it is an expensive lab test and and can always be checked later from a testing segment of the stored cells.