RCOG advice on Umbilical Cord Blood Banking and Storage

The Scientific Advisory Committee of the Royal College of Obstetricians and Gynaecologists (RCOG) has produced advice for its members on umbilical cord blood collection and banking in response to the increasing number of requests from mothers to store cord blood at the birth of their baby.

A significant number of private companies are now heavily marketing their cord blood storage services through GP surgeries, antenatal clinics and directly to the public. In response, obstetricians, midwives and other practitioners requested guidance from the College on how to respond to these requests. In particular, medical practitioners wanted guidance on:

• the validity of some of the advertising claims
• the necessity for such storage
• the alternatives for storage
• the safety issues inherent during collection and storage
• and the obligation on care providers to comply with parental requests for storage

A summary of the advice and recommendations based on the committee's findings are as follows:

1. Collection of non-directed donations and directed donations for at risk families are acceptable procedures through established public sector cord blood banks.
2. There is still insufficient evidence to recommend directed commercial cord blood collection and stem-cell storage in low risk families.
3. Future non-haematopoietic stem cell use is still speculative, but it is understandable that some patients who can afford to do so may wish to avail themselves of commercial services offered. However if this is done it needs to be undertaken safely and will be dependent on the resources of the hospital in which the birth takes place.
4. Each Trust or hospital providing intra partum care needs to develop its own policy on how to respond to prenatal requests for cord blood storage through commercial providers, including full economic cost recovery. Because some patients may incur financial obligations by registering with commercial providers before telling their doctors, we advise that this policy should be made available to prospective patients at an early stage. Written advice setting out the hospital's policy should be made available to all patients when they book for maternity services.
5. The RCOG offers the following specific recommendations to Trusts who do decide to support cord blood collection:
   
   1. There should be no alteration in “usual management” of the third stage.
   2. To maximise safety for the mother and infant, collection should be made from the ex-utero separated placenta.
   3. Collection should be by a trained third party, (that is, not by the attending obstetrician/midwife) using methods and facilities appropriate to meet the European Tissues and Cells Directive.
   4. The service should not be made available in cases where the attending clinician believes it to be contra-indicated: this will be likely to include all premature births, and cases where there appear to the attendants to be specific contraindications such as nuchal cord or maternal haemorrhage.
   5. The details of the hospital's policy should be made available to all patients.
6. The NHS should consider an improved funding infrastructure for unrelated non-directed cord blood banking in the UK, and directed donations for families with genetic disorders, or for families with a member with an acquired disease treatable by HSC transplantation, in order to provide a broad coverage and equitable access for those in need of the benefits that stem cell transplantation can achieve now, and those that may be available in the future.
7. The RCOG recommends that research is performed to understand better the short and long-term neonatal effects of third stage practices.

Ends

For more information about the RCOG Opinion Paper 2: Umbilical Cord Blood banking (June 2006), please contact Gerald Chan, RCOG Head of Communications & External Affairs on email gchan@rcog.org.uk or call 020 7772 6446.

NOTES TO EDITORS:

These new guidelines replace advice originally produced in 2001.

In 2004, the College set up set up a panel to consider issues surrounding cord blood collection and banking. The committee was made up of experts in blood and tissue banking, stem cells, paediatric and haematological malignancy, obstetrics and midwifery care, neonatal care, law and ethics. The group met four times during 2005 and 2006, to gather and discuss the most up to date information from the literature, and from other professional bodies. Their draft report was peer reviewed by experts from the Anthony Nolan Trust and the NHS Cord Blood Bank, the Human Tissue Authority, as well as internationally renowned experts in haematology, stem cell use and neonatology.

In light of the formation of the Human Tissue Authority, and the requirement to comply with the EU Cells and Tissue Directive, the RCOG believes that this revised Opinion Paper is timely.

The major clinical use of cord blood has been for haematological malignancy, mainly in children. Cord blood contains haemopoietic stem cells (HSC), which can be used successfully as an alternative to bone marrow for transplants. Over 6,000 cord blood transplants have been performed in adults and children. Non-directed cord blood donations (from donors unrelated to those receiving the blood) stored in public sector banks have been the main source of cells for these successful treatments.

Some families are at particular risk from rare genetic disorders. For these women, directed donation (specifically from related persons) for personal banking may provide an easier route to find a stem cell match which may be needed in their family. Arrangements can only be made by their health care professionals through the NHS Cord Blood Bank (NHS CBB) for their blood to be collected and stored.

Members of the public and many clinicians are unaware of the availability of cord blood for transplantation through the NHS CBB and through an international collaboration of agencies dedicated to storage of cord blood and registering suitable bone marrow donors. There are over 7,000 cord blood units stored by the NHS CBB, and over 85,000 available through Netcord. Cord blood collection for banking for the NHS Cord Blood Bank is undertaken only at certain hospitals. These are: Northwick Park Hospital in Harrow, Barnet General Hospital and Luton and Dunstable NHS Trusts, by trained operatives who are independent of the care of the woman in childbirth.

The committee found that research in the area of non-haemopoietic uses of stem cells is still preliminary and many claims for the finding of other types of cord stem cells have not been repeated, and any therapeutic benefit has not been substantiated. This is in common with many other purported uses of stem cells. Research continues in this area. The interest generated by the potential of UCB, and parental guilt of not storing their child's stem cells, is a potent driver to commercial storage.