Ethical Issues in Umbilical Cord Blood Banking

Umbilical cord blood contains stem cells, which may be valuable for treating conditions such as blood disorders and certain cancers. Since umbilical cord blood is generally discarded after a baby is born, these stem cells are free from many of the ethical issues that embryonic stem cells have. However, cord blood banking remains controversial, with a number of ethical considerations.

Time Frame

• An important concern surrounding umbilical cord blood banking involves when it is collected. Many kits recommend collecting the cord blood after the birth of the baby and before the delivery of the placenta. While this maximizes the amount of cord blood available for collection, delaying umbilical cord clamping and cutting may benefit the baby, since transfer of oxygen and blood cells from the placenta to the baby may continue for several minutes after birth. Although the timing of umbilical cord clamping and cutting remains controversial, cord blood banks agree that collecting cord blood is safe, and does not harm the baby.

Types

• Most ethical issues in umbilical cord blood banking center around private cord blood banks. These banks market their services to expectant parents, and charge families to collect and store cord blood for potential use in their own baby, or a family member. In contrast, public banks match those who need transplants with donated cord blood. When people use private cord blood banking rather than public, fewer cord blood units may be available to recipients who need it, while most of the privately banked cord blood goes unused.

Misconceptions

• One of the key controversies surrounding private cord blood banking has to do with how companies market their services to parents. These companies often compare banking cord blood to insurance, in case the baby ever develops certain medical conditions. However, in most cases, doctors cannot use a baby's own cord blood for treatment, since it may already contain the same disease. Also, most cord blood units are not large enough for adult transplants, and many are not large enough even for children. While private banks promote the potential benefits of cord blood banking, not all of them give realistic information about cord blood use, and may play on parents' fears.

Significance

• Public banks do not charge donors for cord blood banking, although some do not cover any fees the hospital may charge for collecting it. These costs, along with the fact that most public banks are not available in all areas, may make some families unable or unwilling to donate cord blood. Private banks typically charge families several thousand dollars in collection and storage fees. This limits the number of parents who can afford to bank cord blood for their children. Most people of minority or mixed racial backgrounds have more difficulty finding a match from a public bank, and costs may make their families less likely to have private cord blood available.

Geography

• Private cord blood banking without specific medical cause is banned in France and Italy. The European Group on Ethics in Science and New Technologies issued a statement against it in 2004, based on the opinion that there was little evidence that private cord blood banking could achieve the benefits it claimed to offer. In 2007, the American Academy of Pediatrics (AAP) issued a statement supporting public cord blood banking only, and discouraging private banking unless there is a sibling who has a disease treatable with cord blood. The American College of Obstetricians and Gynecologists (ACOG) and the American Society for Blood and Marrow Transplantation have similar policies. Worldwide, laws and opinions of cord blood banking may continue to change as new treatments develop.