Whose Cord Blood is it Anyway?
by Jeffrey P. Kahn, Ph.D., M.P.H.
Director, Center for Bioethics
University of Minnesota
Recent medical reports tell of promising results in treating cancers like leukemia by using cells taken from the placenta and umbilical cord of recently delivered babies. Such cord blood transplants involve sorting out the so-called "stem"cells from which all other blood cells can grow. Transfusions with these isolated stem cells -- even from less than perfectly matched individuals -- seem to work nearly as well as bone marrow transplants from matched donors. This technique offers lifesaving treatment options for patients who would otherwise wait for a suitable bone marrow donor that might never appear.
The promise of stem cell transplants creates the need for more cord blood. Until the science advances to allow stem cells to be grown in culture, the useful cells that can be harvested from one umbilical cord/placenta are only enough to treat a single patient. So while the placenta was historically discarded, and later collected for use in the manufacture of cosmetics, it is now highly prized for the potentially lifesaving cells it contains.
In addition to its medical applications, a few entrepreneurs saw financial promise in cord blood transplants and created commercial cord blood storage programs. These programs offer parents the opportunity to pay for their child's cord blood to be collected and frozen for the future-- in case of the horrible, but extremely unlikely, event that they ever need to use it. The medical advantages of having stored stem cells available are compelling, as is the question parents are asked: Isn't insuring the health of your child worth the cost of banking?Personal insurance or community resource?
Of course we all want what is best for our children, but there is a choice that avoids having to make a decision at all. Instead of storing the cord blood of individuals, cord blood can be collected from every baby born and stored in a community bank. Patients in need could make a suitably matched 'withdrawal', much as patients receive blood from blood banks. To create a community cord blood bank, we should collect cord blood from all births, with the consent of parents. This model is beginning to catch on, with community banks recently opened in some cities.
Lessons from blood banking
Blood banking created a system that has inspired community confidence that blood will be available to anyone who needs it, such that there is very little talk of personal banking of "autologous"blood. The exception came when AIDS was first thought to be transmitted by transfusion, but before testing for HIV was available. Patients preparing for elective surgery might elect to give a unit or two of blood in advance of the surgery to assure that any transfusion would use their own blood. Since the terms of the donation were often that any blood not used while the patient was in the hospital would revert to the general pool. The unused blood this practice created led to a short-term increase in the blood supply.
No such increase will exist with personal cord blood banking since the selling point of storage is that it will remain available throughout the individual's life. Instead of reverting to a community supply, unused cord blood would remain frozen and effectively wasted.
Personal cord blood banking is a classic example of "me first" thinking, but it is wrong headed. Community cord blood banks will serve our collective interests without asking individuals to sacrifice theirs, and save many lives in the process. These are the ultimate goals of any public policy, and they are well within reach. Only those profiting by trading on the worst fears of parents will see their interests undermined, but those are interests not worth promoting.
"Ethics Matters" Archive
where you'll find other columns from Jeffrey Kahn
on a wide range of bioethics topics.
Center for Bioethics and CNN Interactive.
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