Take it to the Bank

Should you store your baby's cord blood?

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When Danni Dean was expecting her son, Luke, four years ago, a friend who was due around the same time mentioned that she was planning to bank her baby's umbilical cord blood. Dean, who lives in Hailey, Idaho, knew little about cord-blood banking, but after researching it, she and her husband decided they wanted to bank their baby's blood, too. "We were compelled by the idea of having a store of potentially 'magic' cells at our disposal," Dean says.

Dean and her husband are among the roughly 300,000 couples who have privately stored their baby's umbilical cord blood over the past decade or so for possible future use as a medical treatment. Question is, is banking your baby's umbilical cord blood a decision that could someday save your child's life—or a waste of money?

The stem-cell connection In healthy people, stem cells serve as a sort of repair system for the body, dividing without limit to replenish other cells in the blood and the immune system. If a disease such as leukemia or a medical treatment such as chemotherapy damages the stem cells, the body needs new ones. These stem cells can come from bone-marrow transplants from a donor who has matching tissue types. Or, they can be found in the blood that remains in a baby's umbilical cord after it has been cut.

The stem cells in cord blood are different from those that are harvested from embryos: Cord-blood stem cells can be used to generate new blood cells, whereas embryonic stem cells can be used to generate various kinds of organ and tissue cells. Stem cells are currently being used to treat more than 75 diseases, including certain cancers and blood disorders, such as leukemia and lymphoma. In addition, there is emerging clinical evidence that stem cells have the potential to treat diseases and injuries of the heart, brain and spine.

"I don't think we've explored fully the potential that cord blood really has," says Mary Halet, cord-blood program manager at the National Marrow Donor Program (NMDP), a nonprofit organization that maintains the largest public listing of umbilical cord blood available for transplantation in the United States. A study published earlier in The New England Journal of Medicine cites evidence that umbilical stem cells have the ability to reverse brain damage in babies born with rare genetic disorders.

"My medical background had nearly everything to do with my decision to privately bank my daughter's cord blood," says Carol L. Kornmehl, M.D., a radiation oncologist at Passaic Beth Israel Regional Medical center in Passaic, N.J. She feels that cord-blood banking is the right choice because, unlike bone-marrow transplants, collection is a risk-free procedure. Plus, umbilical cord cells are less likely to cause graft vs. host disease, a major complication of bone-marrow transplants in which the body rejects the transplanted stem cells.

"Given the fact that my father succumbed to acute leukemia, I wonder whether he might have benefited from this technology had it been available at that time," Kornmehl says.

Who benefits most? Not everyone agrees that it makes sense to collect a baby's cord blood and store it for the rest of her life. "The chance of actually needing to use the cord blood is low—one in several thousands," says George A. Macones, M.D., head of the department of obstetrics and gynecology at Washington University School of Medicine in St. Louis. In fact, most families have only about 1 in 10,000 chances of needing a stem-cell transplant, according to the March of Dimes. However, families with a history of certain genetic diseases and blood disorders, such as severe anemias, immune-system disorders and some kinds of cancer, are more likely to need stem cells. A genetic counselor can help you determine whether your family is at increased risk.

Worldwide, about 6,000 people have received cord-blood cell transplants. But in the vast majority of these cases, the recipients were people other than the babies from whom the blood cells were collected. Cord blood is used most often in children because an adult usually needs more blood than can be collected from an umbilical cord.

Researchers say more study is needed before they can recommend that a person be given her own stem cells if she has a disease such as leukemia because of the possibility that her own transplanted stem cells would simply give rise to a new crop of cancerous blood cells.

Banking a baby's cord blood is a simple procedure: After your baby is born, the umbilical cord is clamped and 3 to 5 ounces of blood are drained from the cord and placenta. The blood is collected using a kit provided by the bank, then is sent to the bank, where it is tested for signs of infection and stored in a liquid-nitrogen freezer. So far, cord blood has been successfully stored for 10 years, and researchers say it may last indefinitely.

Private vs. Public Banks

If you decide to store your baby's cord blood, the next step is choosing a private or a public bank. Private collection of blood costs approximately $1,420 to $1,925, plus a storage fee of about $125 per year thereafter, and it provides you with exclusive access to your child's cord blood. The most compelling benefit of privately storing your baby's blood is that it will be there if you or your baby's sibling needs it (see "One Family's Story," left).

There is no charge to donate cord blood at a public bank, but it is available to anyone who needs it (so you won't have exclusive access to your baby's cord blood). For instance, when someone needs a stem-cell transplant, there's a 75 percent chance that no family member will have matching cells. In that case, the person could go to a public bank, which collects and stores cord blood from donors across the country. Public banks are funded by philanthropic donations and by revenues from patients who use them. On average, a patient pays between $18,000 and $28,700 for cord blood from a public bank, according to the NMDP. Check with your health insurance provider to see if they cover part of that fee. If you do need cord blood from a public facility, some banks may waive the customary fee if you've donated to them in the past.

Even with fees and donations, public cord-blood banks lack the resources to fund their operation. "The banks have really struggled," Halet says. However, NMDP recently committed $8 million to expand its cord-blood banking program. In late December, 2006, the federal government authorized $79 million toward the collection and maintenance of cord-blood stem cells for patients and research.

African-Americans, Hispanics and other non-Caucasians are urged to donate cord blood to public banks because non-Caucasians have a harder time finding a donor match.

If you opt to donate your baby's cord blood, contact a public blood bank by the 34th week of your pregnancy. You will fill out a questionnaire similar to one you receive when donating blood. The questionnaire will ask about your pregnancy and medical history. You'll also be required to sign a consent form. Cord-blood donations are collected in about 70 hospitals in the United States, and there are approximately 27 public cord-blood banks, 18 of which are networked with NMDP.

Visit www.fitpregnancy.com/hospitals to find out if there is a participating hospital in your area. To learn more about cord-blood donation and whether there is a public cord-blood bank near you, contact NMDP at 800-627-7692 or www.marrow.org.