FAQs

Most of the stem cells in cord blood are blood-forming stem cells, also known as “hematopoietic” stem cells or HSC. The presence of HSC is what enables cord blood transplants to be used as a substitute for bone marrow transplants. However cord blood transplants have advantages and disadvantages compared to stem cell transplants from adult donors. The main advantage of cord blood is that it does not have to be exactly matched to the patient like transplants from an adult donor. The main disadvantages are that it is hard to collect enough cord blood to transplant an adult, and cord blood stem cells are slower to engraft.

Cord blood also has applications in regenerative medicine. This is due to a combination of additional types of stem cells in cord blood, plus the fact that the cells in cord blood release chemicals that signal the body to heal itself. These chemicals are called cytokines and the cell-to-cell signaling is called the paracrine effect. Cord blood has been used in clinical trials around the world as therapy for infants with cerebral palsy and other brain injuries. Published studies have shown that cord blood stem cells benefit young children with neurologic injury, even though the mechanism of action is not yet fully understood. Additional clinical trials are applying cord blood to neurologic conditions in adults, including stroke, multiple sclerosis, and spinal cord injury.

Cord blood banking refers to the whole process of collecting and preserving the stem cells that remain in the blood of the umbilical cord and the placenta after the birth of a baby. Today, many private cord blood banks also offer storage of newborn stem cells from the tissue of the umbilical cord and/or the placenta.

Within the United States, healthcare providers can order shipments of our printed parent brochures for free in both English and Spanish. Parent's Guide to Cord Blood Foundation has developed educational brochures for parents that cover both public donation and private banking in a balanced way. Our brochures are available for download from cordbloodeducation.org in over a dozen languages and dialects, with the content adjusted to the national situation in different countries. These brochures were approved by our Scientific and Medical Advisory Panel and within the United States they are updated annually to adjust prices and include new clinical trials.

Our Foundation has also developed several Fact Sheets for medical professionals that are available for download from doctorsguidecordblood.org.

The median size of cord blood collections in family banks is 60mL or 2 ounces. That small volume of blood 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 for cord blood banking. 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 100 mL or 3 ounces.

Reference:
Sun, JJ et al., Transfusion Sept. 2010; 50(9):1980-1987 doi:10.1111/j.1537-2995.2010.02720.x

Yes, you can have the best of both worlds, but only if you keep the clamping delay under one minute. The goal of delayed cord clamping, in full term healthy births, is to allow some of the blood in the umbilical cord to enter the newborn and boost the baby’s blood volume and iron supply^1,2.  This has some benefit for the baby, but it reduces the amount of cord blood that can be banked for the future health needs of the baby, the baby's siblings, and the baby's extended family.

Studies have shown that within the first minute after a healthy birth, the baby receives about 80% of the blood that will return from the umbilical cord, while at the same time the volume of cord blood that can be collected for banking is cut in half^3-5. To delay any longer gives little additional benefit to the baby, but prevents cord blood banking altogether. 

Medical societies of obstetricians and gynecologists do not recommend delaying cord clamping by more than a minute^6-11. The World Health Organization (WHO) is in favor of longer delays because iron deficiency is a serious problem in poorer nations, for example as of 2021 the prevalence of anaemia among young children in Africa was 60%^12,13. Midwives tend to be in favor of long delays, and advocate to “wait for white”, which means that the umbilical cord turns white because there is no blood in it¹⁴.

It is important for parents to make a decision about cord clamping time in advance of the birth, and talk to their healthcare provider clearly about their preferences. This Foundation has communicated with numerous parents who put a lot of effort into picking a cord blood bank, only to find that they did not have enough cord blood to bank, because at the time of delivery the responsible person waited too long before clamping the umbilical cord.

If you have an older child that needs cord blood for therapy, it becomes important to get a good-sized cord blood collection. Some situations where this might occur are an older sibling with Thalassemia, or an older sibling with Cerebral Palsy. In this case, parents should make certain that there is some one present at birth that understands the importance of the cord blood collection and has the necessary phlebotomy training to perform the collection correctly.

Donations to public cord blood banks must exceed a volume threshold in order to qualify for storage. This threshold is high, so that it is almost impossible to delay cord clamping and still collect enough cord blood for the donation to be accepted.

Additional Resources

• Delayed Cord Clamping evidence-based facts infographic
• VIDEO "What is Delayed Cord Clamping?"
• Web page https://parentsguidecordclamping

References

1. Hooper SB, Binder-Heschl C, Polglase GR, et al. The timing of umbilical cord clamping at birth: physiological considerations. Maternal Health, Neonatology and Perinatology 2016; 2:4.
2. Katheria AC, Lakshminrusimha S, Rabe H, McAdams R, Mercer JS. Placental transfusion: a review. Journal of Perinatology 2017; 37:105–111.
3. Allan DS, Scrivens N, Lawless T, et al. Delayed clamping of the umbilical cord after delivery and implications for public cord blood banking. Transfusion Mar 2016; 56(3):662-665. 
4. Rodica Ciubotariu, MD PhD. Timing of Umbilical Cord Clamping and Impact on Cord Blood Volume Collected for Banking. Dec. 2016 Parent's Guide to Cord Blood newsletter
5. Ciubotariu R, Scaradavou A, Ciubotariu I, et al. Impact of delayed umbilical cord clamping on public cord blood donations: can we help future patients and benefit infant donors? Transfusion 2018; 58(6):1427-1433.
6. RCOG: Royal College of Obstetricians and Gynaecologists. Clamping of the Umbilical Cord and Placental Transfusion. Scientific Impact Paper No.14 Published February 2015
7. SOGC: Armson BA, Allan DS, Casper RF. Umbilical Cord Blood: Counselling, Collection, and Banking. SOGC CLINICAL PRACTICE GUIDELINE No.328 Journal of Obstetrics and Gynaecology Canada 2015; 37(9):832-844.
8. FOGSI: Federation of Obstetric and Gynaecological Societies of India. FOGSI CLINICAL STANDARDS Published 2016
9. ACOG: American College of Obstetricians and Gynecologists. Delayed Umbilical Cord Clamping After Birth. ACOG Committee Opinion Number 814. Obstetrics & Gynecology 2020; 136(6):1238-1239.
10. FIGO: Bianchi A, Jacobsson B, Mol BW; on behalf of the FIGO Working Group for Preterm Birth. FIGO good practice recommendations on delayed umbilical cord clamping. Int J Gynecology Obstetrics 2021; 155(1):34-36.
11. ILCOR: Seidler AL, et al., ON BEHALF OF THE INTERNATIONAL LIAISON COMMITTEE ON RESUSCITATION NEONATAL LIFE SUPPORT TASK FORCE (ILCOR). Umbilical Cord Management for Newborns <34 Weeks' Gestation: A Meta-analysis. Pediatrics 2021; 147(3):e20200576.
12. WHO: World Health Organization. Guideline: Delayed umbilical cord clamping for improved maternal and infant health and nutrition outcomes. WHO Guidelines Published 2014
13. World Health Organization (WHO). Anaemia in women and children. WHO 2021 Edition
14. ACNM: American College of Nurse Midwives. Delayed Umbilical Cord Clamping. Position Statement Published 2014

No - cord blood that has already been stored in a family bank cannot be transfered to a public bank. When a public bank collects cord blood donations that will potentially be released to strangers, they are required to  perform a very detailed family health history and collect a sample of the mother's blood. This screening must be performed at the time of donation and it cannot be retroactively performed for cord blood in a family bank.

An additional issue is that any given cord blood bank is very reluctant to trust the processing and storage of another bank. It is almost impossible to transfer cord blood from one bank to another, even among family banks. They do not want to accept a cord blood unit that was processed by another organization due to liability concerns.

Within the United States, as of 2022 only one program provides parents with a collection kit that they can take to the hospital and then send a mail-in donation to a public cord blood bank or a research laboratory.

• Cord for Life (800-869-8608) - accepts cord blood donations if you register by week 34

Health requirement: The donor registry Be The Match has a short pre-screening questionnaire where you can learn if you can donate cord blood. Before the actual donation, the mother would have to undergo a more detailed maternal health screening. Here is another article about the health requirements from our Foundation's newsletter.

Location requirement: Less than 200 hospitals in the United Sates have programs to accept cord blood donations, and they are all large birthing centers located in communities with racially diverse populations. Those parents who are not delivering at a hospital that accepts donations can try to register for a mail-in donation.

Timing requirement: Most donation programs require the mother to register in advance, typically by week 34 of the pregnancy (the due date is at 40 weeks). A few donation programs will sign up mothers during labor for permission to collect the cord blood, then if the collection qualifies for public banking they will go back to the mother before she leaves the hospital to get a full informed consent.

Community Banking is a new sharing economy model of cord blood banking that was pioneered by LifeCell in India. Parents who choose to store their child's cord blood in a community bank will have access, in the event of medical need, to all of the other cord blood units in the community bank.  A community bank is like a public cord blood bank in that the members are supporting each other, but it is also like a private bank because the members pay for this service and outsiders cannot participate. 

Community banking can fill an unmet health need in a country like India, where there is no national network of public banks and the population has unique genetics that are not covered by banks elsewhere in the world. Scientists have calculated that a community bank holding 25,000 cord blood units would be able to match 96.4% of Indians close enough for a transplant.

Community banking is different from "hybrid" banking where both public and family banks share a laboratory, because in hybrid banks the pubic and family sides operate separately. In a community bank the public and family functions are blended.

Usually the answer is yes.  However... some hospitals have signed exclusive contracts requiring their patients to use certain family cord blood banks, so it is best to check in advance. 

Those hospitals that have exclusive partnerships with certain family cord blood banks will argue that it improves their level of care, because their staff train with and stock the collection kits for the banks they have approved.  The hospital probably has a financial incentive too.  However, for parents it means a lack of consumer choice.

You can preserve cord blood from twins in a family bank, but not in a public bank.

Public banks have a policy against accepting cord blood donations from twin births. One argument often heard is that the bank is afraid that the babies might be confused at birth. However obstetricians are trained to keep track of which baby is which in a multiple birth. The primary reason that public cord blood banks do not accept twin donations is that they have a size threshold for accepting donations. Twins tend to be smaller than single babies, hence they have less cord blood in the umbilical cord and the placenta, and in public banking it is crucial to get large donations. The chances are so low that both twins will have enough cord blood to meet the donation storage threshold that public banks just do not accept registrations from moms who are pregnant with twins.

Family banks have no problem accepting cord blood from twin births. Parents might have a problem paying for double cord blood banking, but almost every family cord blood bank offers special discounts for twin births. Some good news about banking from twins: the family bank Cryo-Cell ran a study which showed that their twins have enough cord blood for therapy.

Some parents ask if they should save the cord blood for both twins or only one? It is better biological insurance to save newborn stem cells from both twins. In the case of fraternal twins, the babies are distinct individuals with different DNA. In the case of identical twins, the babies have identical DNA. However, one identical twin may develop a genetic mutation later in life that causes a disease while the other twin does not. If that happens, then the healthy twin is the perfect matching stem cell donor, and there have been transplants where one identical twin donated cord blood to another.

It is best to store cord blood in the country where the baby is born, provided a quality bank is available. If you currently live in one country and plan to store cord blood in your home country, make sure that your family bank has a shipping container that is well insulated and carries a temperature logger.

The important thing to know is that fresh cord blood that is traveling into the bank has a shelf life, whereas when the bank sends out cryogenically frozen cord blood to a clinic it does not expire.

After birth, the cord blood is shipped to the laboratory at room temperature. Every hour that it spends in transit, stem cells are gradually dying. Ideally the cord blood should arrive at the laboratory and be processed within 48 hours of birth. Sending the cord blood on a long airplane flight or a series of connecting flights is an additional risk for cell loss, unless the blood travels in the passenger compartment and is protected by a well-insulated shipping container.

By comparison, if a day should come where you need to use the cryopreserved stem cells, they will be shipped to the treatment center frozen and only thawed upon arrival. So on the release side of banking, cord blood stem cells can travel anywhere in the world with no loss of viability because they travel frozen.

In order to protect the internal kit temperature during cord blood shipments, Parent's Guide to Cord Blood Foundation recommends that parents select a family cord blood bank that has a well insulated transportation container, preferably with a temperature logger.

The standard protocol for transporting fresh cord blood is to keep it near room temperature within the range from 15 °C (59 °F) to 25 °C (77 °F). Priority shipping services may guarantee the arrival time, but they do not guarantee the temperature conditions during transit. Ambient temperature can get too hot or too cold while the package is sitting in the back of a truck, on a loading dock, or in the cargo hold of an airplane. This is why a well insulated container, preferably one that has been validated to IATA standards, is important.

In the United States, the post 9/11 security requirements of the Transportation Security Administration (TSA) require that specialty medical couriers can only offer cord blood shipping through cord blood banks that are registered with the TSA as a "Known Shipper".  Before 9/11, specialty couriers could market their services directly to consumers, and in some countries this is still possible. Parents should check if their family bank offers specialty courier services before they sign a contract.

The three main components of cord blood, like any blood collection, can be separated by weight:  the heaviest layer is the red blood cells (RBC), the lightest is the plasma (a clear white liquid), and in the middle is a pinkish layer called the "buffy coat" which contains the white blood cells (WBC), including stem cells.  When banks process the cord blood, the final separated component that goes into storage is the buffy coat, even though only about 1% of the cells are actually stem cells.  There is no procedure to separate out the stem cells alone.

The vast majority of blood processing methods rely on the different density of the three main blood components.  They can be separated by sedimentation, or by centrifuge, or by a combination of the two techniques.  The procedure can be performed manually by trained technicians or by automated machine.

Manual processing is when cord blood is handled in the laboratory by trained technicians. These technicians should be wearing gowns and gloves and handling the cord blood inside a laminar flow cabinet. Automated processing is when the cord blood collection bag goes into a functionally closed device like the Sepax or the AXP systems. In automated processing the laboratory technicians do not handle the cord blood during processing. When processing is completed by either manual or automated methods, a technician will always manually transfers the final storage bag to a controlled rate freezer

Advantages and Disadvantages of Automated Processing:

• Advantage: There are less opportunities for technician errors or the introduction of contaminants during processing.
• Automated processing may be a better approach in countries where it is hard to train and retain experienced technicians.
• Disadvantage: Automated processing is much more expensive. First, the laboratory has to purchase two devices, in case one breaks. Second, the devices use disposable kits which add significantly to the operating expenses.
• Automated processing makes sense in busy laboratories that handle a higher volume of cord blood business.

Advantages and Disadvantages of Manual Processing:

• Advantage: Manual processing is much less expensive.
• Manual processing makes sense in countries where highly skilled labor is easily available and affordable.
• Advantage: Manual processing is better for processing the smallest family collections because the procedures can be customized as needed.

The earliest cord blood transplants were performed with whole cord blood. Thus, it is not absolutely necessary to process cord blood in order to save patient lives. There has never been a prospective randomized trial to compare transplant patient outcomes with whole cord blood versus processed cord blood.

Today almost all cord blood banks, both public and private, process cord blood before storage. The processing removes the plasma, so that the volume that goes into storage is reduced. The processing also removes the red blood cells, to avoid toxic effects from red cells that burst during freezing (see below). The final portion that is cryopreserved is called the "buffy coat"; it is the portion of the blood that holds both white blood cells and stem cells. 

Researchers consider it important to remove red blood cells before preserving cord blood stem cells, and we have a fact sheet on red blood cell depletion. Red blood cells are removed because they tend to burst during freezing, which releases iron from the hemoglobin, and the iron can be toxic to patients. The alternate to removing the red cells before freezing is to wash any broken cells out of the cord blood unit upon thaw, but this washing step causes some loss of valuable cells.

• Is the cord blood laboratory accredited by an agency that has specific standards for cord blood banks and conducts inspections? (ex: AABB, FACT)
• If you live in one of the US states that license cord blood banks (CA, IL, MD, NJ, NY) then you can only use a family bank that has your state license.
• Does the lab process cord blood around the clock, or only on selected shifts?
• What tests does the lab perform on maternal blood?  
• What tests does the lab perform for infectious disease markers?
• What tests does the lab perform for contamination?
• Does the lab ever reject cord blood collections on the basis of the tests of maternal blood, infectious diseases, or contamination? 
• Does the lab maintain a "quarantine tank" for the storage of blood while they are waiting for tests of infectious disease markers?
• What tests does the lab perform to measure the stem cell count of the processed cord blood and the stem cell viability?
• Does the bank inform parents, prior to storage, if the collection is too small for a transplant, and give them the option not to save it?
• Does the bank offer parents a refund if the cord blood collection has certain problems (contamination, low volume)?  These refunds are typically only offered if the bank performed the collection as part of their service.
• What information will parents receive in the final report about their stored cord blood?

• What instructional tools are provided in the kit for the physician and delivery staff?
• Will the family banking provider actively contact the labor and delivery staff for you?  
• Does the hospital have designated staff that are trained to collect cord blood?
• What collection method does the bank use: gravity drip or blood draw?
• Is the collection blood bag sterile, both inside and out, so that it can be used in the operating room for a C-section?
• Does the bank provide the option of collecting additional stem cells from the tissue of the umbilical cord or the placenta?

• Is the cost of shipping included in the contract? 
• Does the shipping company offer bed-side pick-up?  
• Has the shipping container been tested for temperature stability?
• Does the shipping container include a temperature logger?
• On weekends, are the laboratory staff in-house or on-call?
• Does the bank guarantee to get the blood to the laboratory and processed within a certain time window?
• If the bank uses a medical courier, does the courier have possession of the cord blood throughout transit?  (Sometimes the courier sub-contracts to another shipping company that is not a medical courier)

In general sibling donors are better than unrelated donors for stem cell transplants. The exact comparison depends on the patient's diagnosis and the stage of disease.

The two important measures of patient outcome after a stem cell transplant are: long-term survival, and the amount of graft-versus-host disease (GvHD) that the patient suffers. Sibling donors trigger less GvHD, so that quality of life is better post-transplant. 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.

Some case by case studies: For many adult cancers the outcomes of transplants from siblings versus unrelated donors are comparable, although sibling donors have a slight edge. One large 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%. However, in pediatric transplants for hereditary disorders, sibling donors have a distinct advantage. The European Blood and Marrow Transplantation Group (EBMT) reported in 2011 that three year survival rates were 95% from a sibling donor vs. 61% from an unrelated donor.

The donor registry Be The Match has a section of their clinical website which reviews this topic here.

References:
Weisdorf, D.J. et al. Blood 2002; 99:1971-1977. doi:10.1182/blood.V99.6.1971
Bizzetto, R. et al. (EBMT) Haematologica 2011; 96(01):134-141 doi:10.3324/haematol.2010.027839

Childhood cancers are rare, and make up less than 1% of all cancers diagnosed each year¹.  It is even rarer for a child to require a stem cell transplant for cancer. In the US, the probability of a child having a stem cell transplant over the years from birth to age 20 is only 3 in 5000 or 0.06%².  This probability includes all 80+ of the diseases treated with cord blood.

Children that have a solid tumor have been treated with their own cord blood. This includes diagnoses such as neuroblastoma, medulloblastoma, and retinoblastoma. The very first case in the world where a child was given a transplant of her own cord blood happened in 1998 for a girl in Brazil who had neuroblastoma³.

Blood cancers such as the various forms of leukemia are the most common cancers in children. In the US, acute leukemia is one of the leading causes of death in children under 15 years of age⁴. Pediatric leukemia has been backtracked to birth^5,6. Researchers have discovered that in most cases of pediatric leukemia the genetic mutation which triggered the leukemia started in utero, before the child was even born, and is present in the cord blood. In fact, researchers are now studying cord blood to learn which children are at risk for pediatric leukemia and how it can be prevented^7,8.

Children should not be transplanted with their own cord blood if they have a pediatric blood cancer like leukemia, or a hereditary blood disorder like Thalassemia Major or Sickle Cell Anemia. All of these diseases have a genetic basis and they will be present in the child’s cord blood, so it is not safe to use that cord blood for transplant. Children with hematologic (blood) disease in need of transplant should receive stem cells from a donor. The ideal donor is a matched sibling donor.

References:

1. American Cancer Society - Key statistics for childhood cancers
2. Nietfeld JJ, Pasquini MC, Logan, BR, Verter, F, Horowitz MM. Lifetime Probabilities of Hematopoietic Stem Cell Transplantation in the U.S. BBMT 2008; 14(3)316–322. 
3. Ferreira E et al. 1999; Autologous cord blood transplantation. Bone Marrow Transplantation 24(9):1041. 
4. NIH Reporter. Backtracking Leukemia-Typical Somatic Alterations in Cord Blood at Single-cell Resolution. Project Number 1R01CA262012-01
5. Ford AM, Bennett CA, Price CM,  Bruin MCA, Van Wering ER, Greaves M. Fetal origins of the TEL-AML1 fusion gene in identical twins with leukemia. PNAS 1998; 95(8):4584-4588.
6. The Institute of Cancer Research (ICR). Pioneering scientist Mel Greaves is knighted after research to unveil cause of childhood leukaemia. News archive Published 2018-12-28
7. Marcotte EL, Spector LG, Mendes-de-Almeida DP, Nelson HH. The Prenatal Origin of Childhood Leukemia: Potential Applications for Epidemiology and Newborn Screening. Frontiers Pediatrics 2021; 9:639479.
8. Spector L. Studying Cord Blood to Prevent Childhood Leukemia. Parent's Guide to Cord Blood Foundation News Published 2022-07 

Yes, stem cell transplants with cord blood have been used to cure both children and adults with leukemia since the early 1990's. To date, there have been over 35,000 cord blood transplants world-wide, and most of them were for leukemias and other blood disorders (Ballen Verter Kurtzberg 2015). A study published in the New England Journal of Medicine (NEJM) in Sept 2016 compared cord blood transplants versus bone marrow transplants for leukemia patients. The two groups had comparable survival post-transplant, but the cord blood patients tended to live longer and most importantly the cord blood patients were less likely to relapse.

The important caveat is that children with leukemia or another blood disorder must receive a cord blood transplant from a donor, NOT their own cord blood. It turns out that when children and even adolescents develop leukemia, they were born with the genetic defect that triggered the leukemia... hence it is not safe to give them a transplant with their own cord blood because it probably carries the mutation for leukemia.

References:
Backtracking leukemia to birth: Gale KB et al. 1997; Proc Natl Acad Sci USA. 94(25):13950-4. PMID:9391133
Backtracking leukemia to birth: Janet D. Rowley 1998; Nature Medicine 4:150-1 PMID:9461182
Ballen KK, Verter F, Kurtzberg J 2015; Bone Marrow Transplantation 50(10):1271-8. doi:10.1038/bmt.2015.124
HealthDay article describing study in Sept 2016 NEJM: Cord Blood Transplants Show Promise in Leukemia Treatment
Filippo Milano, et al. 2016; NEJM 375:944-953. DOI:10.1056/NEJMoa1602074

Indefinitely.  From an economic perspective, it does not make sense to invest in the up-front processing fee and pay for years of annual storage, and then throw out the investment.  That would be like buying life insurance and then cancelling it because you have not died yet.  Especially given that the probability of some one in the immediate family needing a transplant increases with age.  Even if the cord blood collection was small, and the child becomes too large to use it for a transplant, it could still be enough cells for a regenerative medicine therapy. Stem cells which have been cryogenically preserved remain viable for decades.  It has been confirmed that cord blood stem cells were still viable after being frozen 23+ years.

References:
Broxmeyer, H.E. Cell Stem Cell 2010; 6(1):21-24
Mazur, P. Science 1970; 168(3934):939-949
Nietfeld, J.J. et al. BBMT 2008; 14:316-322

All the reasons that you banked for the first child are still valid for additional children. 
1. If you want the baby to have the option of using his/her own cells, then you need to bank them. 
2. If you are banking as a form of "biological insurance" for siblings, then the ability to use cord blood from one child for another depends on whether they have matching HLA type.  Two full siblings have a 25% chance of being a perfect match, a 50% chance of being a half match, and a 25% chance of not matching at all.  The more siblings with banked cord blood, the more chance that they cover each other for possible transplants or other therapies for which sibling stem cells are an option.

Reference:
Odds of sibling match are based on haplotype inheritence: that the child will receive 3 HLA types as a group from each parent.

Some family banks provide cord blood insurance. In case your child gets sick and needs therapy, your national or personal health insurance may not cover all the expenses. The cord blood insurance provides extra security that the family will be able to afford a cord blood transplant or participation in a cord blood clinical trial.

Some cord blood banks offer insurance as part of their standard services. This is one of the features parents might consider when shopping for a bank. Otherwise parents can purchase a separate policy. There are specialized insurance policies providing cord blood insurance to families that have previously stored their baby’s stem cells or are about to store stem cells for a baby they are expecting.

The term "cord tissue" refers to the rest of the umbilical cord, other than the blood. A normal umbilical cord contains two arteries, one vein, an outer skin, and it is filled with a gelatinous material called Wharton’s Jelly.  Umbilical cords can vary widely in length, but the average cord is about 61 cm (24 inches) long and weighs 40 gm.

Reference:
Percy Malpas 1964; British Medical Journal 1:673–674.

Cord blood banking has become mostly standardized over the past 25 years, but cord tissue banking is still an evolving field and industry standards are still being developed. For example, in cord blood banking the standard method of processing is to separate the component of the blood that holds stem cells and cryogenically freeze the isolated cells. 

Over half of family cord blood banks also offer cord tissue storage, but their methods of processing the tissue differ widely. Some banks merely freeze the cord intact with no attempt to process it. The majority of banks that offer cord tissue banking do process the cord, but the final biological product that they store may be either a tissue product (for example very small pieces of cord), or a cellular product of isolated cells (the same as cord blood storage), or both. The Parent’s Guide to Cord Blood Foundation is working to develop educational materials to help both parents and professionals navigate this rapidly evolving field.

References:

• Silva Couto P. Storage of Mesenchymal Stem/Stromal cells in family stem cell banks: What do they offer? Parent's Guide to Cord Blood Newsletter May 2014
• Parent's Guide to Cord Blood Foundation 2016; poster #1606 at International Cord Blood Symposium, Transfusion doi:10.1111/trf.13686
• Bapat A, Silva Couto P, Verter, F. Buyer Beware: Parents should demand quality testing of umbilical cord tissue storage. PGCB Newsletter Jan 2018

Just like cord blood banking for the family, cord tissue banking is a form of biological insurance, where parents bank their baby’s stem cells for future therapies.

The two main benefits of banking both cord blood and cord tissue are: (1) to have more stem cells from the same child and (2) to have different types of cells. 

However, parents should not feel obligated to spend extra money to bank cord tissue. The reason is that, unlike cord blood, therapies with cord tissue do not require matching the donor and patient. Should you or your child ever need a treatment with cells from cord tissue, it will be easier and less expensive to purchase an off-the-shelf cell therapy product, rather than try to make a custom therapy from you child's cells. There will not be any advantage to having your own cells, since the cells do not need to be matched.

Medical researchers agree that, when properly prepared, it is safe to use MSC therapy products that are “off-the-shelf”, from completely unrelated, unmatched donors.

The mesenchymal stromal cells (MSC) that are extracted from cord tissue do not require an HLA match between donor and patient like the stem cells in cord blood. Not only will MSC not trigger Graft versus Host Disease (GvHD), but MSC are known to calm the immune system and physicians often give MSC to patients suffering from GvHD to help them recover.

During the past decade, over a thousand clinical trials have given a variety of MSC from different sources to over 55 thousand patients. The rate of complications from these treatments has been very low and the complications were mostly mild.  

Nonetheless, parents and patients should be cautious when shopping for MSC therapies from commercial clinics because not all companies that manufacture MSC therapies follow the same standards. In the United States, the FDA has issued “warning letters” to a number of clinics that supposedly give injections of MSC from birth tissues. Oftentimes their product does not actually contain live stem cells, or even worse they may be contaminated with bacteria. Buyers should beware to check the credentials and quality control practices of any clinic and their suppliers before purchasing MSC therapy.

References:

• CellTrials.org MSC Trials 2011-2019
• Ankrum JA, Ong JF, and Karp  JM. Nature Biotechnology 2014; 32:252–260. Mesenchymal stem cells: immune evasive, not immune privileged
• FDA: For Consumers - FDA Warns About Stem Cell Therapies

All cord blood banks in the United States are required by law to be registered with the FDA. The FDA conducts surprise inspections of facilities on this list. So yes, family cord blood banks are inspected by the FDA, and they never know when it will happen, so they must adhere to standards at all times.

The short answer is NO, the typical consumer does not have the technical knowledge to properly evaluate companies that provide biobanking services.

Newborn stem cell banking is a healthcare service and you should pick a bank based on the healthcare quality metrics that we explain on this website: whether the laboratory is accredited for cord blood or cord tissue banking, has experience providing therapies to patients, and is financially stable.

Parents should be wary that most “consumer ratings” type websites are rigged to give the highest ratings to companies that pay the most for advertising.  Another problem is that the reviews on consumer websites may not have been written by real customers.

Parent’s Guide to Cord Blood Foundation does not endorse banks. We do favor our donors by placing their descriptions at the top of the list of banks in their country. However we do not allow banks to make any claims in their descriptions unless they can be substantiated.

This claim is mis-leading. The exact wording of their advertising is "up to twice as many" stem cells compared to other cord blood banks. Quite frankly, if it really were true that their processing method is so efficient, then the other cord blood laboratories would have rushed to copy it.

The bank in question is a marketing company that does not operate their own laboratory; they sub-contract laboratory services to an independent company. Moreover, they have switched laboratories multiple times. It is very hard to believe that their methods are twice as good as the proprietary services that established banks have developed with in-house research.