Umbilical
cord blood (UCB) contains haematopoietic stem cells, which can be used for the
treatment of several lethal disorders, including leukaemia
and several types of anaemia. Other sources of haematopoietic stem cells are bone marrow and ordinary peripheral
blood. Unlike bone marrow donation, which requires general anaesthesia, UCB
donation does not cause any inconvenience or significant risks for the donor. Peripheral
blood contains very few stem cells. Another major advantage of using UCB stem
cells is that less genetic similarity is required between donor and recipient.
This increases the chance of finding a ‘match’ and thus of the transplantation
being successful.
Collecting
UCB blood is a simple procedure. After the baby is born blood from the umbilical
cord and placenta is collected in a sterile bag. Once the mother’s blood has
been tested for infectious diseases, what is called the ‘cord blood unit’ is
delivered to a cord blood bank where it is stored in nitrogen freezers. Storage in a public cord blood bank is free. Collected
units are available for all those in need of a UCB transplant. Private cord blood banks demand a fee of around
£1600 from the donor. The collected UCB units are available to the donors or
their family only. Whereas private cord blood banks are very inefficient and
expensive, public cord blood banks are much more efficient and can save many
lives as the stem cells are available to a wider range of people.
Many women give their informed
consent to donate UCB to a public cord blood bank. But in order to provide
therapies for each patient in need of a haematopoietic stem cell transplant many
more donations are needed. Finding
suitable donors is especially difficult for ethnic minorities. The more genetic
diverse the UCB units in the cord blood bank, the higher the chances of finding
a suitable donor. Not everyone is eligible to donate, for example women who have
HIV-AIDS, diabetes or other health problems, or are at risk for having such
problems (e.g. a recent tattoo) are not eligible. Others choose to store the
UCB in private banks and some people simply don’t give their consent.
If UCB donations
can save many lives and if it is true that there are no significant risks for
the donors, then why not introduce an opt-out system similar to that used for
deceased donor organ donation in Belgium and Spain? Women would still have the
choice to donate their UCB unit to a private bank or to have it discarded (or
for that matter to eat it, or to bury it in the soil and plant a tree on it…). UCB donation doesn’t raise the same
controversial issues as organ donation, where some find dismantling the body of
their deceased loved ones objectionable. In the case of UCB donation, the
mother and the baby remain intact. Before UCB transplantation was possible, the
cord blood and the placenta were treated by most parents as waste. Now they can
save lives – especially if obtained in large numbers.
At a stem
cell seminar last week, I learnt that in the US, one day of UCB collection is
lost because the public cord blood banks are closed on Sunday. So one day in
seven is lost. Though not working on Sundays might be holy for Christians, is
it more important than saving lives?
If we want to increase the number of UCB donors,
moving to an opt-out system and keeping cord blood banks open on Sunday might
at least be worth considering!