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Banking on Umbilical Cord Blood

Big Hope for Cord Blood

Better Safe Than Sorry?

Harris, who has banked cord blood for his own children, says that on the basis of current capabilities, the chances of a person needing stem cells is in the range of 1 in 2,000.

Yet that is surely on the low end of estimates. In 1999, the American Academy of Pediatrics (AAP) released a statement recommending private banking of cord blood only when there is a family member with a current or potential need to undergo a stem cell transplant.

"The range of estimates [for likelihood of using stored stem cells] is from 1 in 1,000 to 1 in 200,000," according to the AAP statement. "Given the difficulty in estimating the need for using one's own cord blood cells for transplantation, private storage of cord blood as biological insurance is unwise."

The AAP does recommend philanthropic donation of cord blood to public banks.

Yet as Harris points out, private companies will store cord blood shipped from anywhere in the world, but public banking is accessible only at hospitals and centers that provide the service.

Lilja says he never considered the option of using public banks -- because he was unaware they existed.

While private banking companies have sprung up around the country -- with a number going out of business in recent years -- public banks have been slower to develop. There are currently just eight public cord blood banks in the National Marrow Donor Program (NMDP) registry.

The NMDP web site lists some 17 centers around the country that also accept cord blood donations but which are not members of the registry.

People who donate cord blood can, theoretically, retrieve their own donation should they need it before the units have already been used for transplantation, points out Vicki Slone, PhD, manager of the cord blood bank at Children's Hospital of Orange County, Calif. And because donation is free, it is liable to be a more accessible option for poorer families and those from diverse ethnic backgrounds -- thereby increasing the pool of transplantable stem cells for those groups, Slone says.

Questions of Ethics -- and Law

Although it's never been firmly established in a courtroom, most legal experts consider cord blood to be the property of the baby -- and the parents are guardians of this potentially lifesaving material. Upon deciding to bank cord blood privately, some parents have drawn up legal documents in which they designate that upon reaching age 18, the child can take over guardianship of the cells.

Legal issues also arise with respect to the collection process. In contracts with parents, private blood banks usually try to absolve themselves from any responsibility if, for instance, the cord blood isn't collected during the baby's delivery, or if the blood sample isn't usable when it's needed.

There is also the question of who has access to the cord blood's hidden information -- the diseases and genetic traits shared by both infant and parents. Parents should find out what the bank's policy is in regard to screening cord blood and ask whether all identifiers are stripped from the blood samples in order to protect the donor's privacy. Many physicians will advise their patients against donating cord blood to a blood bank that retains patient identifiers.

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