The moment of birth not only means the delivery of a new life into the world but also presents a onetime opportunity to save another person’s life or have a direct impact on the future of medical research through the donation of umbilical cord blood stem cells. Unfortunately, these lifesaving cells are routinely discarded following the birth of a child, often regarded as medical waste. So what are umbilical cord stem cells, and why aren’t more families aware of their significance?
The Beginning of the Story
The placenta, or afterbirth, is an organ that develops during pregnancy. It takes oxygen and nutrients from the mother’s blood and delivers them via the umbilical cord to the growing fetus. Conversely, waste products from the fetus travel through the umbilical cord to the placenta, where they are then transported to the mother’s blood to be appropriately eliminated.
Almost immediately following the delivery of a newborn child, the umbilical cord is clamped and cut as the newborn is able to survive without being physically connected to its mother. Minutes later, during what is sometimes referred to as the third stage of labor, the mother expels the placenta. Together the
umbilical cord and the placenta, which are still filled with blood from the baby, are generally discarded as medical waste.
Within the fetal blood of the placenta and the umbilical cord itself, however, exists one of the richest sources of stem cells.
What Are Stem Cells?
Simply stated, stem cells are immature cells that have the ability to mature into different types of functioning cells as needed by the body. Different stem cells may develop into specific types of mature cells. For example, the rich umbilical cord blood stem cells can easily mature into all common types of blood cells, which can be used to treat and cure many diseases of the blood.
In 1989 Dr. Hal Broxmeyer, a member of the American Society of Hematology, and his colleagues discovered the presence of stem cells in umbilical cord blood; and in 1993 the first successful blood stem cell transplant utilizing stem cells collected from umbilical cord blood was performed. Since then several thousand stem cell transplants using umbilical cord blood stem cells have been performed. The use of such cells for stem cell transplantation is a relatively new and growing field. As such there is much work being done to raise public awareness—to encourage umbilical cord blood stem cell donation and to create a centralized database that all physicians can access to look for umbilical cord blood stem cells with which they can treat their patients and further the research on using stem cells to treat disease.
The Cancer Connection
Stem cells collected from the umbilical cord have been used to treat more than 70 hematologic (blood-related) diseases, including leukemia and certain types of anemia. Treatment for diseases such as leukemia often involves high-dose chemotherapy and/or radiation therapy. These high doses, although more effective at killing leukemia cells, also kill healthy cells—a consequence that can be associated with severe and life-threatening side effects.
To optimize the delivery of full-dose chemotherapy and radiation and to reduce the associated risks of low levels of blood cells, stem cells may be delivered to the patient following the chemotherapy and radiation. This is known as a stem cell transplant. These infused stem cells can grow in the patient’s body and replace the patient’s own stem cells that were destroyed by the chemo-radiation therapy, resulting in a new line of white blood cells, red blood cells, or platelets that the patient will need to survive.
In addition to restoring low levels of a patient’s stem cells following therapy, donor stem cells may also attack the patient’s cancer cells, providing an additional source of anticancer activity. Unfortunately, the donor stem cells may also attack a patient’s healthy tissues, a condition referred to as graft-versus-host-disease (GVHD). Due to the potential severity of GVHD, researchers try to use stem cell donors who are either related to the patient and/or have specific proteins of the stem cell called HLA proteins that are matched as closely as possible. Unfortunately, many patients will die from their disease while searching for an appropriately matched donor.
The stem cells required for a stem cell transplant were historically collected from the bone marrow (spongy material inside large bones) or the circulating blood of patients or donors. Some patients, however, are unable to produce enough stem cells for a transplant or cannot find an appropriate donor. Umbilical cord blood stem cells can be used in patients who don’t produce enough stem cells to support a transplant and thereby expand the pool of available donors.
Umbilical cord blood stem cells are also used in the direct treatment of several other hematologic diseases. Early research indicates that certain stem cells from the umbilical cord also show promise in treating diseases other than those related to the blood and may actually have properties similar to those of embryonic stem cells. Although future studies are necessary to further these findings, the potential implications of these early results are providing hope among scientists and healthcare providers.
Public Versus Private Collection
Umbilical cord blood stem cells may be collected for public donation or private storage. Public donation refers to collection that is sent to a cord blood banking facility for public use. These facilities receive the donated cord blood, test it for abnormalities, store it through freezing methods, and make the stem cells available to patients around the world. The donated stem cells are managed with a computer database, so any physician can look for appropriate stem cell matches for patients who need a stem cell transplant and have turned to umbilical cord blood stem cells as an option. If a physician believes that his or her patient is a match for certain umbilical cord blood stem cells in the database, the cells can be transported to where the patient will undergo his or her transplant. If for some reason the collection of stem cells cannot be used for a transplant (not enough cells were collected, for example), they may be used for medical research.
Private storage of umbilical cord blood stem cells involves the same collection process but refers to an individual or a family storing the collected cord blood at a banking facility to be used specifically for their own use (or at the family’s discretion) should the need arise. Private storage of umbilical cord blood typically incurs an initial cost of approximately $1,000 - $2000, followed by an annual fee for maintenance (these fees vary by facility). Families may decide to collect and store umbilical cord blood stem cells so that their relatives will have matched stem cells available in case of a future illness that could be treated with stem cells. Families who already have a member who may benefit from a cord blood transplant, or those who are at high risk of having a child with an illness who may benefit from the use of cord blood, should speak with their physician regarding the potential benefits of private storage of umbilical cord blood.
The Sibling Donor Cord Blood Program at the Children’s Hospital Oakland Research Institute has a program for the free collection and storage of umbilical cord blood stem cells for newborns who have full siblings who may benefit from stem cell transplantation. Here are the eligibility requirements for this program:
- You give birth in the United States.
- Your physician agrees that cord blood collection would be of value to you.
- You currently have a child with a transplant-treatable condition.
- The child you are expecting will be a full sibling (same parents) of the affected child.
There has been recent controversy over the private storage of umbilical cord blood stem cells for families who have no known risk factors. This is because the actual rate at which individuals may need their own stem cells is extremely low. Furthermore, patients diagnosed with certain diseases such as cancer may not be able to receive their own umbilical cord blood stem cells because the cells themselves may be precursors of the disease. The decision to store a child’s cord blood for private use remains a personal decision for the family, however, and may provide emotional comfort for some.
Because of these issues The American Academy of Pediatrics issued a policy statement regarding public and private umbilical cord blood collection. The policy statement includes the following:
- “Cord blood donation should be discouraged when cord blood stored in a bank is to be directed for later personal or family use, because most conditions that might be helped by cord blood stem cells already exist in the infant’s cord blood (i.e., premalignant changes in stem cells). Physicians should be aware of the unsubstantiated claims of private cord blood banks made to future parents that promise to insure infants or family members against serious illnesses in the future by use of the stem cells contained in cord blood. Although not standard of care, directed cord blood banking should be encouraged when there is knowledge of a full sibling in the family with a medical condition (malignant or genetic) that could potentially benefit from cord blood transplantation.
- “Cord blood donation should be encouraged when the cord blood is stored in a bank for public use. Parents should recognize that genetic (e.g., chromosomal abnormalities) and infectious disease testing is performed on the cord blood and that if abnormalities are identified, they will be notified. Parents should also be informed that the cord blood banked in a public program may not be accessible for future private use.
- “Because there are no scientific data at the present time to support autologous cord blood banking and given the difficulty of making an accurate estimate of the need for autologous transplantation and the ready availability of allogeneic transplantation, private storage of cord blood as “biological insurance” should be discouraged. Cord blood banks should comply with national accreditation standards developed by the Foundation for the Accreditation of Cellular Therapy (FACT), the U.S. Food and Drug Administration (FDA), the Federal Trade Commission, and similar state agencies. At a minimum, physicians involved in procurement of cord blood should be aware of cord blood collection, processing, and storage procedures.”
Need for Public Donation from Ethnic Minorities
The National Marrow Donor Program (NMDP®)—the largest cord blood bank listings center in the world—along with other organizations that accept cord blood donations is trying to raise awareness of the fact that non-White ethnic groups have a disproportionately lower rate of cord blood donations and therefore a smaller supply of cord blood stem cells. Patients tend to have better matches of stem cells when paired with donors from their own ethnic group; ethnic minorities should speak with their physician about the possibility of donating their umbilical cord blood.
The Process of Collection
The collection of umbilical cord stem cells is surprisingly easy.
- First, pregnant women should ask their physician or healthcare provider about the collection of stem cells as early in their pregnancy as possible.
- Pregnant women can make a toll-free phone call to one of several cord blood banking facilities if there are no local banks. Several large hospitals around the nation have a close affiliation with a cord blood bank.
- For patients who do not plan to give birth at a large hospital that has its own cord blood collection resources, the blood bank will send a packet of information and consent forms, including questions regarding the medical history of the mother and the father, to make certain the stem cells are appropriate for donation. The package will also include a consent form for the physician, nurse, or midwife to sign. The form is returned to the blood bank in a self-addressed, stamped envelope. (The forms can also be given to the healthcare provider or delivered physically if the bank is near or affiliated with the medical center in which the birth occurs.)
- Depending on the blood bank, you will likely receive a small package to bring with you to the hospital or birthing center (or to keep at home if you are planning a home birth) that contains everything the healthcare provider requires for the collection. The blood bank may instead send the package directly to the hospital or birthing center prior to your due date.
- After the delivery of the baby, whether a vaginal birth or a cesarean section, the cord is clamped and cut so that it is no longer attached to the newborn. Typically, the healthcare provider sterilizes the umbilical cord, inserts a needle into one of the blood vessels in the cord (in which there is no feeling), and draws a blood sample.
- A blood sample is also taken from the mother to be tested for specific types of infection or disease, such as HIV, that may render the stem cells ineligible for transplant to another person. It is generally collected from the IV already in place.
- These samples are placed in the self-addressed, stamped package and sent back to the cord blood bank.
- If abnormalities are found in the blood samples obtained from the umbilical cord or the mother that may affect
future healthcare decisions, the family will be notified.
There is no charge for this collection if you choose public donation (although a few physicians may charge their own fee for collection). All information remains confidential. The cord blood is usually used for the treatment of a patient or for research purposes.
From a Physician’s Point of View
According to Dr. Joseph Rodriguez, a practicing gynecologist the collection process of umbilical cord blood stem cells itself is “easy” and takes approximately five minutes. When asked if he considers the collection process safe for both the mother and baby, he does not hesitate to answer yes. He goes on to explain that if there are any complications during delivery, or if some rare medical conditions exist—such as placental abnormalities and/or rare types of cancers that may occur during pregnancy—cord blood will most likely not be obtained as attention to the health of the mother and the baby are paramount. The collection procedure itself will not put mother or baby in harm’s way.
What the Future Holds
The use of umbilical cord blood stem cells as a therapeutic option against disease is relatively new, and there remain hurdles to overcome in the use of this technology. The potential, however, particularly with new research indicating that umbilical stem cells may be used to fight several types of diseases besides those affecting the blood, provides hope to countless patients and their families. Collection is easy, safe, and free if stem cells are publicly donated. Through raising awareness of public umbilical cord donation, the hope is that more families will choose to donate so that ultimately more patients can be treated with umbilical cord blood stem cells at the same time that research utilizing these cells progresses.