FAQs

Cord blood is in use today in hospitals around the world. There are over 80 diseases treated with cord blood as a standard of medical care, although admittedly many of these are rare disorders. Clinical trials with cord blood are developing therapies for more common childhood disorders. Cord blood can be donated to public banks for patients seeking donors, or stored in family banks for future use by the baby’s family.

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We are the world's only organization dedicated to cord blood education that can claim all of the following:

• we are incorporated as a non-profit,
• we cover both public donation and private storage in a balanced way,
• our content is written by scientists,
• we are supervised by an Advisory Panel of leading scientists and physicians,
• and we are accredited by Health on the Net Foundation (HON).

Our website contains numerous unique cord blood resources:

• World's only complete searchable maps of family banks, public banks, FACT banks, AABB banks
• Within the United States, the only complete searchable map of hospitals accepting cord blood donations

The phrase "delayed cord clamping" means to wait before clamping the umbilical cord after birth.

Prior to birth, the baby relies on the umbilical cord blood for oxygen and nutrition. In the moments after birth, the baby takes its first breathe. At that moment of the first breathe, the baby's lungs call for more blood supply and some blood from the umbilical cord vein enters the baby. But at the same time, when the baby starts to breathe, the arteries that carry blood from the baby to the umbilical cord constrict. Hence the blood circuit between the baby and the placenta shuts down once the baby breathes. Some blood may continue to flow from the umbilical cord to the baby if uterine contractions put pressure on the placenta. Medical research shows that any time after the first breathe is an OK time to clamp the umbilical cord. We have a table of medical society recommendations for delayed cord clamping.

An important caveat is that, when a baby is born prematurely, the baby may not spontaneously breathe. In this case the baby will not spontaneously draw blood from the umbilical cord. We have a news article about cord milking as an alternative to delayed cord clamping, and whether it is safe for premature babies.

It literally only takes minutes to save the stem cells in cord blood.  Once the umbilical cord is clamped, it is wiped with antiseptic and a needle is inserted into the vein in the umbilical cord to withdraw a few ounces of blood.

There are three methods of collection in common use. One is to hang a blood bag lower than the mother and let gravity draw blood down the tube into the bag.  This method is used in most countries of the world, because it has the fewest steps, and therefore the fewest opportunities for mistakes or contamination.

The second method is to actively draw the blood out, just like when a person has a blood draw for a medical test.  The draw can be done with a standard syringe or with a bulb in the tubing of the blood bag that creates suction. Studies have shown that actively drawing the blood will collect a larger volume faster.

Third, some banks collect cord blood "ex utero" which means "outside the uterus". They wait until the placenta is delivered, and then a trained technician takes it into another room and puts it on a high shelf so that all of the blood in the umbilical cord and some from the placenta can be drained.

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

The crucial thing is not the volume of the cord blood collection, but the number of stem cells it contains. Transplant doctors develop recommendations based on the Total Nucleated Cell count, or TNC, because it is the easiest measure to reproduce between different labs.  

When treating cancer, the transplant dose should be at least 25 million TNC per kilogram of patient body weight (1 kilogram equals 2.2 pounds).  The average cord blood collection holds 8.6 million TNC per mL.  Thus, the optimal transplant dose requires harvesting:
1.3 mL of cord blood for every pound of patient weight, -or-
2.9 mL of cord blood for every kg of patient weight

References:
Reed, W et al., Blood 2003;101(1):351 doi:10.1182/blood-2002-02-0394
Barker, JN et al., Blood 2005;105:1343-1347 doi:10.1182/blood-2004-07-2717
Eapen, M et al. Lancet 2007;369:1947-54 doi:10.1016/S0140-6736(07)60915-5
Rocha & Gluckman Brit. J. Haematology 2009;147(2):262-274 doi:10.1111/j.1365-2141.2009.07883.x

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 donor registry Be The Match explains the role of HLA Typing and Matching in stem cell transplants on their clinical website.

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 cord blood donations 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.

Over the past decade, there have been over three dozen clinical trials treating cerebral palsy with stem cells. Several of these trials had outcomes, published in peer-reviewed medical journals, which showed that cerebral palsy patients who received stem cells had a significant improvement compared to patients in control groups. It is hard to compare one trial against another, because a variety of stem cell types have been tested, and the trials differed in how and when they measured patient responses. Nonetheless, a 2023 meta analysis of multiple trials showed that there is statistically significant benefit from cord blood therapy for cerebral palsy.

Despite these successful reports, no one understands the “mechanism of action” by which the stem cells provide a benefit.  Both cord blood stem cells and cord tissue MSC are known to suppress inflammation. Researchers at Duke have argued that a trace component of the cells in cord blood may enable re-myelination of neurons in the brain. It is presumed that stem cell therapy probably also benefits other conditions that are similar to cerebral palsy, such as hypoxic ischemic encephalopathy. Bear in mind these benefits were proven for groups of patients and individual outcomes will vary. While some children have had dramatic improvements, for example Adriana or Asia, others have not improved at all. There are many open questions about stem cell therapy for cerebral palsy that have not yet been answered by the existing research. It is not clear what type of stem cells are the “best” for this therapy, and there is also some debate over the optimum method of administering the stem cells (intravenous drip versus intrathecal injection).

On the basis of the available evidence, Duke University has received permission from the FDA to offer expanded access to cord blood therapy for cerebral palsy and other pediatric brain injuries. Any family that has a child with an acquired (not hereditary) brain injury, and has that child’s cord blood or a sibling’s cord blood in storage, is eligible for this therapy. 

An important caveat for parents is that while stem cell therapy may improve a child’s cerebral palsy symptoms, it is not a cure all and does not replace other supports, such as physical and occupational therapy, tutoring, etc. Please remember that the website of Parent’s Guide to Cord Blood Foundation is not a substitute for medical advice from a physician.

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. See How long can cord blood be stored?

References:
Mazur, P. Science 1970; 168(3934):939-949
Nietfeld, J.J. et al. BBMT 2008; 14:316-322
Broxmeyer, H.E. Stem Cells Translational Medicine. 2023; 12(S1)

In general, NO. The obligation of family banks is to store the cord blood. The contract between the parents and the bank does not cover the costs of therapy. In some countries the costs of a cord blood transplant are covered by the national health service. If you live in a country where these treatments are not free or would like to have the option to have them done abroad, we recommend searching for a bank that has an insurance partner providing cord blood insurance, or perhaps you can purchase a separate insurance policy for this coverage.

When parents want to treat their child with cord blood, the out-of-pocket cost can vary enormously, depending on the diagnosis being treated and the institution where they get the treatment.

Generally, if your child has one of the 80+ standard diagnoses that are treated by stem cell transplant, the cost of treatment should be covered by your health insurance. You would either by covered by your national healthcare program (for example in European countries) or by your personal health insurance (for example in the United States). If you are enrolled in a "Community" cord blood bank (for example in India) then your customer service package includes a lump sum payment for therapy. When cord blood transplants are considered one of the standard care options for the diagnosis, you can usually rely on your healthcare provider for a referral to a treatment program. In some hospitals, doctors will not consider cord blood transplants because they are not trained to perform them. If parents have doubts about why their doctor is steering them to one therapy choice over another, it is always a good idea to get a second opinion from a specialty center.

If your child is diagnosed with a condition where cord blood therapy is not yet a standard of care (such as cerebral palsy and other complications of prematurity) then finding affordable treatment gets more difficult. If you enroll in a clinical trial that is being conducted by a research center, then the cost of the therapy will be covered by the trial. However, parents still have to pay for travel and lodging costs associated with the trial, unless they can find a charitable program to help with these expenses (for example, Ronald McDonald House).

If parents want to try an experimental program at a commercial clinic (for example cord blood or MSC for autism), they can expect to pay thousands of dollars out of pocket. Regardless of whether the clinic has registered the treatment as a "clinical trial", if the clinic is commercial in nature and not a research institution then the parents have to cover all the costs. There are a number of support groups (for example on Facebook) where parents compare notes on the cost of various commercial clinics and how many cells you get for the price.

Like cord blood, the umbilical cord tissue is a rich source of progenitor cells. However, they are a different population of cells from the ones in cord blood. While most of the stem cells in cord blood are blood-forming or hematopoietic stem cells (HSC), most of the cells in cord tissue are mesenchymal stromal cells (MSC).  The MSC are not distributed uniformly in the cord, but are mostly clustered around the walls of the blood vessels. The typical umbilical cord is estimated to hold 11 million MSC per gram of tissue.

While MSC can be found in many parts of the adult human body, MSC from the umbilical cord or UC-MSC are the most commonly used in clinical trials of regenerative medicine. It is well established that they can modulate the immune system and suppress inflammation.

Reference:
Schugar RC et al. 2009; Journal of Biomedicine and Biotechnology 2009:789526 (open access)

The tissue of the umbilical cord is rich in the primitive mesenchymal stromal cells (MSC). These cells can differentiate to bone, cartilage, and fat. More importantly, MSC send signals that modulate the patient's immune system and suppress inflammation. Infusions and injections of MSC are frequently used to treat orthopedic conditions, chronic pain, and auto-immune disorders. Clinical trials with MSC from cord tissue are available for many different disorders.

Reference:
Arnold Caplan PhD & Diego Correa, MD PhD. THE MSC: AN INJURY DRUGSTORE  Cell Stem Cell. 2011; 9(1):11–15.

The tissue of the umbilical cord and the placenta are rich sources of mesenchymal stromal cells (MSC). Currently MSC are the most popular form of cells that are being used in regenerative medicine and appear in many papers of published  research. MSC show great promise for treating a wide variety of auto-immune disorders and treating injuries to muscle or bone (heart disease, sports injuries). The MSC from birth sources, such as cord tissue and the placenta, grow faster than MSC from adult donors and have never been exposed to disease.

References:
Perinatal Stem Cells 2^nd edition 2013; book published by Wiley
Perinatal Stem Cells 3^rd edition 2018; book published by Elsevier

Therapies with mesenchymal stromal cells (MSC) from all sources are still under research, so the optimum dose has not been established for any diagnosis.

As of August 2020, only two papers have been published that summarized the MSC cell doses used in clinical trials.  The first paper, by Couto et al. 2019, looked at the first decade of clinical trials with MSC from umbilical cord tissue (UC-MSC), over the years 2007-2017, and collected trials from everywhere in the world. The trials were divided between those that gave local injections of UC-MSC versus systemic administration into the blood stream. Their figure 4 showing number of trials versus total cell dose is repeated below. Please note that there are breaks in the dose axis to accommodate the very wide range of cell doses.

Clinical applications that employ systemic administration tend to have higher cell doses. It is not possible to give large doses locally, such as injecting a single arthritic joint or injecting the spinal cord. The few trials that achieved high total cell dose with local administration were trials that gave multiple doses. In this graph, the median total dose of the studies with local administration was 18.75 million cells, while the median total dose of the systemic administration studies was 80 million cells.

A second paper published by Kabat et al. 2020 did the same type of analysis with a different data set of clinical trials. They looked at clinical trials with any type of MSC (from bone marrow, fat tissue, umbilical cord tissue, etc.), over the years 2004-2018, but only the trials registered in the United States. Within their data, they divided the route of administration into six different groups. They looked at route of administration versus trial phase, cell dose, and patient diagnosis (see their figures 5A – 5C). The most common method of delivery was intravenous (systemic) administration and the median dose by that route was 100 million cells.

References

• Couto PS, Shatirishvili G, Bersenev A, and Verter F. 2019; Regenerative Medicine 14(4):309-319. First decade of clinical trials and published studies with mesenchymal stromal cells from from umbilical cord tissue
• Kabat M, Bobkov I, Kumar S, Grumet M. 2020; Stem Cells Translational Medicine 9(1):17-27. Trends in mesenchymal stem cell clinical trials 2004‐2018: Is efficacy optimal in a narrow dose range?

Within the United States, some states have licensing requirements for cord blood banks. These requirements apply to any cord blood bank that operates within the state, accepts collections from the state, or distributes cord blood units to the state.

If you are a parent who lives in a state with a licensing requirement, then only those cord blood banks that are licensed by your state can legally do business with you. Licenses are required for the states of California, Illinois, Maryland, New Jersey, and New York.

The states California and New York have the strictest licensing standards. These states have inspectors that visit cord blood banks to confirm compliance with the licensing requirements.

These rumors are totally false. In fact, our 2015 Cord Blood Industry Report found that the majority of family cord blood banks in the United States and Canada are processing cord blood manually with hespan. Hespan or HES is a brand name for the chemical hydroxyethyl starch. It is commonly used in most laboratories that handle blood.

The source of the rumors about hespan is the following: Up until recently, it was a standard procedure in emergency rooms to give a large infusion of hespan to patients who were going into shock from loss of blood pressure. The idea was to briefly replace their blood volume with hespan while the ER doctors were rushing to fix whatever problem had caused a rapid loss of blood pressure, and while waiting for a matching transfusion from the nearest blood bank. However, retrospective studies have recently found that patients who survived this experience were likely to develop kidney failure later. Hence, doctors now realize that infusing large volumes of hespan intravenously is not safe. However, the use of small volumes of hespan in cord blood processing is still perfectly safe.

Reference:
Zarychanski R. et al. 2013; JAMA 309(7):678-88. doi:10.1001/jama.2013.430.