Umbilical cord blood -- the blood that remains in the placenta after birth -- is a rich source of stem cells.
Cord blood can be used as an alternative to a bone marrow transplant for the treatment of leukemia and immune disorders, at least in children. But its potential to treat a broad spectrum of illness has set many scientific minds a dreamin'.
Cord blood can be collected and stored frozen for years. Virtually no one disputes the merits of doing so, at least in some circumstances. But the real questions that need to be answered are: Whose cord blood should be collected, who should be doing the collecting and storing it, and to what end?
There are currently a handful of commercial cord-blood banks in Canada, and one that is public, the not-for-profit Alberta Cord Blood Bank.
Commercial ventures charge about $1,000 for the service, plus an annual maintenance fee of about $150. Glossy pamphlets extolling the virtues of this "biological insurance policy," and telling parents that cord blood is the best guarantee their child will survive leukemia, have created a receptive customer base.
(Leukemia patients are treated with powerful drugs that destroy the blood-producing cells in bone marrow. If stem cells from cord blood have been saved, they can be used to "repopulate" the bone marrow following cancer therapy.)
But the reality is that the chances a child will need a transfusion of stem cells are negligible -- less than one in 20,000, according to a recent article in the medical journal Public Library of Science.
Among the tens of thousands of frozen samples that have been stored in different facilities in Canada since the practice began in 1996, there have been fewer than a dozen transplants, and it is unclear how many of these involved high-risk children (with genetic conditions that predispose them to leukemia and other immune-system problems).
Critics argue that private storage of the cord blood of low-risk children is a waste of money, and that the emotional vulnerabilities of new parents are being exploited for purely mercantile purposes.
Proponents of the practice argue, however, that while the chances of a donor benefiting may currently be low, those odds could change dramatically in coming years. Stem cells --- and stem cells derived from cord blood are best for a number of reasons -- could potentially be used to repair spinal cord injuries, grow new heart muscle, regenerate brains in people with dementia and cure diabetes.
"You have a once-in-a-lifetime opportunity to save a key component to future medical care and to freeze a spare immune system" goes the refrain of private cord-blood banks.
The enthusiasm is misplaced.
If parents are concerned about the future health of their children, they should support the collection and storage of cord blood in altruistic, publicly accessible facilities like the Alberta Cord Blood Bank.
The name is a bit deceiving because the ACBB will accept donations from anywhere in Canada, and the cord blood stored there is available to any child in need of a stem-cell transplant. (High risk families can also store a newborn's cord blood free of charge if there is a sibling with a condition potentially treatable with a stem-cell transplant.)
The reality is that in Canada most cord blood is thrown away with other medical waste. If stem cells have just a fraction of their touted potential, that's a travesty.
The ACBB says its goal is to "turn waste into gold" for the public good. It's a laudable goal, worthy of public support similar to the way governments support the collection of blood for transfusion through Canadian Blood Services, and the Unrelated Bone Marrow Registry.
We don't expect Canadians to store their own blood in case they need surgery, and we don't ask them to privately collect bone marrow if they are in need of a transplant. These services are an integral part of the health system, delivered by regulated, not-for-profit groups.
And so it should be for umbilical cord blood.
Currently, the collection of cord blood is done willy-nilly. Quebec collects cord blood from every child born, but discards it after a year. Most other provinces collect a sample for genetic testing, but it is not easily retrievable if required.
Only the Alberta Cord Blood Bank collects stem cells for the express purpose of medical treatment, and parents must take the initiative to make this altruistic donation. (The process is painless for the mother and child, as blood is drawn from the placenta after birth. However, a donation requires some upfront paperwork, and it is a bother for health-care providers.)
Parents and children would, in the long run, be far better off donating to a central bank. In the unlikely event the stem cells are required, they will be there -- but they will also be there for others.
The $3,500 or so that well-meaning parents are willing to spend for freezing and storing a cord-blood sample throughout childhood would be better invested in a registered education savings plan. Because a good education will go a lot further in ensuring the long-term health of your child than a few frozen stem cells kept for private use.
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