Since 1996, UK cord blood banking of haemopoietic stem cells (HSC) from umbilical cord blood has been undertaken largely by NHS facilities within the National Blood Service (NBS), funded initially through research and development funding and currently through the Department of Health. Women in selected maternity units in the UK are approached during the antenatal period and offered the option to donate cord blood to the NHS Cord Blood Bank (NCBB). Appropriate consent is obtained by trained NBS staff and the blood is collected by trained NBS operatives.
These donations are sent to the NCBB for processing and storage for future potential use in unrelated transplantation, in a similar way to bone marrow donations. The donations are tested for a variety of parameters including markers of infection and for their tissue types (human leucocyte antigen, HLA). The tissue types of both unrelated cord blood and bone marrow donors are available for search for matches for any patient, anywhere in the world, for those who may require HSC transplantation.
This established non-directed or altruistic cord blood banking service is to be distinguished from directed family or autologous cord blood storage now being offered commercially by a number of companies trading in the UK.
Commercial services offer mothers the opportunity to store their own baby’s cord HSC long-term, in case that child or his/her siblings ever develop a metabolic, immunological or haematological disease that could only be treated by autologous or related cord blood stem cell transplantation. In addition, with the promise of stem cell therapy for cure or amelioration of degenerative diseases, commercial cord blood banks have added this potential benefit to the rationale given for personal storage of cord blood.
Advertising leaflets are distributed to antenatal clinics, to assisted conception units and to doctors’ surgeries and there is also considerable advertising in women’s magazines and on the worldwide web. The promotional literature for private cord blood banking appears persuasive: ‘stem cells can only be collected at the time of birth’; ‘unimaginable possibilities’; ‘a once in a lifetime opportunity’ that is ‘like freezing a spare immune system’; ‘saving the key components to future medical treatment’; ‘saving something that may conceivably save his or her life someday’.
Clinicians have been approached directly by these banks but, like midwives, they are also being confronted with this issue by parents who request that their baby’s cord blood be collected at the time of delivery and transported for storage.
The aim of this revised document is to provide advice on the scientific basis behind umbilical cord blood storage, current clinical use, the safety and legal implications of collection, the dilemma between personal and altruistic cord blood storage and on the likely utility of cord blood stem-cells in the future.