Seventeen years after the first successful transplantation of stem cells harvested from the umbilical cord, the use of cord blood as a viable alternative to bone marrow as a source of stem cells is gaining importance. The cord blood that remains in the placenta after birth is routinely discarded as waste despite the fact that it has a sufficient quantity of stem cells capable of curing diseases. Although precise data are not available, it is thought that 5,000 to 6,000 cord blood transplantations have been performed worldwide. With the number of births in India running into several million a year, the potential to fight disease and save lives is immense even if the cord blood from a small fraction of newborns can be collected and preserved. There are compelling reasons for saving cord blood — the avoidance of the need for a perfect tissue match required in bone marrow transplants, the low rate of viral contamination, and ready availability. The scope for using the cord blood later in the event of the child suffering from certain diseases is also a major attraction.
It is this unique feature that has prompted some private companies in India, as in the developed countries, to set up facilities to collect and store cord blood, for a huge fee of course. Like their counterparts in the West, most of them resort to emotional marketing to sell the concept of cord blood serving as a `biological insurance’ for use by the same child or another family member at a later date. How wise or relevant is it to save the newborn’s cord blood in private banks? The answer is not clear as no reliable estimates of the demand for stored cord blood are available. Empirical data on such contingencies are also scarce. According to the American Academy of Pediatrics, the chances of a child needing his or her own cord blood to treat a disease vary from 1 in 1000 to 1 in 200,000. While medicine as it is currently practised does not allow use of a child’s cord blood in the treatment of his or her genetic disease or leukaemia, it does have its uses in treating other diseases. Private cord blood banking is much more relevant where a member of the family may have a current or potential need for stem cell transplantation.
There is no disputing the scientific fact that cord blood is a potential weapon to treat many diseases; and the number of diseases so treatable is likely to increase in future. A good strategy might be to have several publicly funded cord blood banks co-existing with private banks. Modelled along the lines of blood banks, the public cord blood banks can draw on altruism to get voluntary donations; and since cord blood is far more expensive to process than blood, it can be made available to suitable recipients on payment of a reasonable collection, processing, and storage charge. At least one private cord blood bank relying on voluntary donations is in place. Priority must be given to the training of doctors and staff in the proper collection techniques. This is of paramount importance as the time of clamping the umbilical cord to collect cord blood is critical. Clamping the cord too early will increase the volume of cord blood collected but leave the newborn with a reduced blood volume and an increased risk of anaemia in later life. To prevent exploitation of poor and vulnerable people, getting the written consent of parents for cord blood collection as well as the institution of in-house ethics committees must be made mandatory, and the legal requirement strictly enforced.