Typically, when patients in Canada have needed stem-cell transplants, huge sums have had to be spent to find matching donors from international registries: Cord-blood stem cells can cost as much as $43,000 per unit, and since most units are small, usually two must be purchased at a time. Finding donors domestically would save the health-care system a lot of money.
So Canadian Blood Services is now working to get its new national cord-blood registry up and running – collections will start in Ottawa next year, followed by Vancouver, Toronto and Edmonton in 2014. (Focusing on big cities with diverse populations maximizes the potential for finding matches later.)
Many private cord-blood banks are preparing for the competition. Clifford Librach, director of the CReATe cord-blood clinic in Toronto, argues the private option may still be best for many families. He warns that public banks throw away many donations, and that parents who sign away their child’s cord blood may not be able to get it back.
It’s true, Ms. Smith of Canadian Blood Services explains, that public donations have to meet certain standards, or else they won’t be banked. But as CancerCare Manitoba’s Dr. Wall points out, given the slim chance a child will ever use their own stem cells, a public bank is a better option: The more people who donate, the better the chance that patients will find a match.
Private banks will continue to promote themselves as a viable alternative. But parents are not necessarily getting unbiased information. Many clinics, such as Insception and CReATe, pay doctors to provide cord-blood units. Insception also has a partnership with Mount Sinai Hospital and the Scarborough Hospital, in which Insception pays for office space, sponsors research or offers collection fees to doctors.
CReATe’s Dr. Librach says the payment is only to reimburse doctors for their time, as cord collection isn’t covered by the provincial health plan. And Richard Lockie, CEO of Insception, says that establishing relationships ensures better collection and better potential outcomes.
But such links between doctors, hospitals and for-profit clinics look problematic to Victor Han, the Canada Research Chair in maternal and fetal health in the Children’s Health Research Institute at the University of Western Ontario. He compares it to baby-formula companies being permitted to hand out free samples on the maternity ward.
“It is quite a lucrative business for them,” he says, “and I think if I were a parent, then I would probably … have to think twice.”
For all of the hype, however, visions of what stem cells might do in the future may not be entirely unfounded. There’s no telling what scientific breakthroughs may come – some promising clinical trials are already under way. But it will take time.
“[It’s]very hard for me to be emphatic and say with 100 per cent certainty that in the future, this product will never be used,” Dr. Wall says. “There’s nothing in life you can say ‘never’ with.”