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Public or private? The dilemma of cord blood banking

Cord blood — collected from the umbilical cord at birth — is rich in blood-forming stem cells, and can be used as a replacement for bone marrow in bone marrow transplants.

Prospective parents can either pay for a private bank to collect and store the cord blood in case the child (or a family member) needs it in the future, or donate their cord blood to a public cord blood bank, making it available to people from around the world looking for a bone marrow transplant match.

A rapidly growing number of parents are paying thousands of dollars for the services of private cord blood banks, following the trend set by celebrity mums, such as Australian media personality Rebecca Judd and US actor Tori Spelling. But is it a necessity, or a very expensive insurance policy?

In Australia, public cord blood banking started more than 20 years ago. Ngaire Elwood is director of the Bone Marrow Donor Institute Cord Blood Bank in Melbourne, one of Australia’s three public cord blood banks, and where more than 13,000 cord blood units are stored.

“We answer phone calls every day from people wanting to know whether they should bank privately or publicly, and the differences between the two,” Elwood says. “There is a lot of confusion out there, and a lot of misinformation.”

Elwood warns that only a very small portion of the cord blood units stored privately are ever used.

“It’s very expensive to collect and store cord blood,” she says. “Private banks charge a collection fee and an annual storage fee up to 18 years. It varies between banks, but that blood can only ever be used for that child or a family member.”

Generally, it costs $3000 to $4000 to have cord blood collected and stored for a period of 18 years; or $5000 to $6000 to have both cord blood and tissue collected and stored.

“In Australia, we’re fortunate,” notes Elwood. “The handful of private cord blood banks we have are pretty good because they’re regulated. I have inspected cord blood banks around the world where they are happy to take people’s money to bank 10 millilitres of cord blood, which is nothing!”

She says there are some instances where banking a child’s cord blood for potential use in a transplant may be worthwhile. For example, a family with a child with leukaemia may wish to save the cord blood from a subsequent pregnancy.

“However,” she adds, “you have to keep in mind there’s a chance people won’t be a tissue match with their sibling. Also, with hereditary conditions like thalassaemia and aplastic anaemia, you can’t assume the baby doesn’t have the condition the older sibling has.

“Or if your child developed leukaemia, for example, you wouldn’t want to be using their own cord blood because it’s likely to have the leukaemic clone.”

Public cord blood donation is free, and is done by specially trained collectors in a handful of participating hospitals. Collected blood is taken to a processing lab at the children’s hospital. The red blood cells and plasma are removed, leaving the ‘buffy coat’, which is rich in blood stem cells, then carefully frozen and stored until needed for transplant.

The number of cells in the unit are counted and the human leukocyte antigen (HLA) tissue type is checked, which is used for blood matching in transplants. This information is put into an international registry.

“One of the fantastic things about cord blood is that, unlike bone marrow, you don’t need a perfect HLA match. The cells in cord blood are still quite naïve; there’s a little bit of leeway,” says Elwood, who is also head of the Cord Blood Stem Cell Research Program at Melbourne’s Murdoch Children’s Research Institute.

“Nearly everyone who needs a bone marrow transplant will be able to find a suitable cord blood donor in one of the public cord blood banks around the world.”

Melbourne’s cord blood bank has released more than 540 units to children and adults, both in Australia and overseas. It’s part of an international network of public cord blood banks.

For more information about public cord blood donation, visit: www.abmdr.org.au/public-cord-blood-donation/

Originally prepared for the National Stem Cell Foundation of Australia, and used here with permission.

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