Cord Blood Banking
The long-term preservation
Significant progress has been made in umbilical cord blood banking, i.e., in the cryo-preservation and thawing techniques, to ensure the viability of hematopoietic stem cells issued from bone marrow, peripheral blood and Umbilical Cord Blood (UCB). The UCB is cry-preserved in liquid nitrogen, but we do not always know with certainty, the cord blood viability duration allowed by the use of actual cryo-preservation techniques.
Most published data available about umbilical cord blood banking, suggest that UCB can be kept frozen during 10 to 15 years, while allowing the recovery of highly efficient, viable and functional cells (which are necessary for the success of a transplant). Most units of UCB which have so far been used clinically, were cryo-preserved for a period of six years or less. However, the engraftment capacity of blood units preserved for long periods will be evaluated only when there will be clinical results demonstrating the long-term success of engraftment of such units.
Security issues surrounding umbilical cord blood banking
Once harvested, the umbilical cord blood units are labeled and shipped to the bank, where they will be subject to safety tests, HLA typing and cryo-preservation. In general, public banks adopt rules that are consistent with the established standards for cord blood banking (American Association of Blood Banks. Standards for hematopoietic progenitor cell services, 2e éd., Bethesda, MD : American Association of Blood Banks, 2000). On the other side, the transfer modalities (from the hospital or birth center to private banks) of the UCB are much less controlled and defined.
The testing of UCB and maternal blood in order to detect infectious agents (HIV, cytomegalovirus, human lymphotropic virus, hepatitis and syphilis) is required by public banks. The blood units are first placed in quarantine until the end of testing. When new units obtain negative results, they are placed in banks for the long-term conservation. For each of these units, public banks will also provide a detailed maternal and familial history regarding genetic diseases, details of possible travels made by the mother in countries with high rates of transmissible infections, and other information on maternal high risk behaviors involving the use of intravenous drugs and sexual activity.
The screening for infectious diseases implemented by private cord blood banks is variable and poorly defined.
Ethical Issues in Umbilical Cord Blood Banking
Many ethical questions remain unanswered regarding the clinical and experimental use of umbilical cord blood. Among these issues we find the development of ethical processes for donor recruitment, and obtaining a well informed consent regarding cord blood banking, or donating UCB to public banks, private banks as well as for research purposes.
The legal and ethical issues related to respect for privacy, confidentiality and ownership of cord blood units are complex and controversial. The question whether the information on the donor must be associated with individual units of cord blood, and whether donors should be informed of infections or genetic abnormalities detected remains also, controversial.
Finally, the ethical aspects of commercial cord blood banking, particularly with respect to the availability of this potentially valuable resource for clinical or experimental purposes, are the subject of considerable debate.
The parents of a child in gestation wish their best for him and are therefore sensitive to the promotional and advertising campaigns pumping potential benefits of umbilical cord blood banking. Private banks sell the collection of UCB as police biological insurance and argue the benefits (of UCB collection and storage ) that are not based on satisfactory scientific data.
Commercial banks have various methods of communication (including Internet, direct mail and video) that use a striking and passionate speech to describe the transplantation of umbilical cord blood as being "of vital importance" or even "miraculous". Public banks rather encourage pregnant women to think about donating for altruistic reasons.
To ensure fair recruitment, families and care providers must have accurate and impartial information about the benefits and the potential risks associated with umbilical cord blood banking. Messages seeking to create a sense of guilt among parents who choose not to bank the UCB should be denounced, and, so to preserve the decisional autonomy of parents. Moreover, the use among ethnic minorities, of coercive strategies for the recruitment of umbilical cord blood donors, should not be allowed.