Making a case for public cord blood banking

Cord blood banking, an alien concept till a few years ago in India is becoming popular, courtesy a few private companies that have begun operations. Cord blood harvested at the time of baby’s birth is one of the sources of stem cells. The stem cells in cord blood have the potential to treat many diseases (The Hindu, October 14, 2004).

The rationale

Private cord blood banking centres are built around the possibility of use either by the same child at a later date or by siblings who are either already sick or may require cord blood in case they have genetic, haematologic or oncology disorders.

Storing cord blood in these private cord blood banks as a `biological insurance’ for its possible use by the same child or by its siblings, comes at a price. It would cost Rs.60,000 to store cord blood for 21 years in liquid nitrogen facilities.

Public cord blood banking is another option where parents `donate’ the cord blood of their baby to a central facility for use by anybody who needs it. The child or its family members no longer have the right to claim it when the need arises and have to pay like any other individual.

Better sense

It works on the same principle of blood banking — individuals donate blood for altruistic reasons but have to pay if they require blood to meet the expenses towards testing and storage.

Despite the need for payment by an individual who has donated cord blood, public cord blood banking makes better sense. In an editorial published in the reputed journal Obstetrics & Gynaecology (June 2005), Jeffrey L. Ecker and Michael F. Greene point out that public cord blood banking scores over private cord blood banking on several counts.

“We argue for public umbilical cord blood banking as a matter of good public health and economic sense,” they underlined. “We foresee a day in which most patients will volunteer their cord blood to such banks. Those who do so will value real public benefits against the sometimes, exaggerated claims of individual benefits advanced by private cord blood banks.”

Emotional marketing

The emotional marketing resorted to by private cord blood banks perforce compels them not to reveal the many shortcomings or disadvantages. For instance, the private companies that dangle the `biological insurance’ carrot while selling the concept to expectant parents never reveal the chances of a child ever needing cord blood at a later date.

“No accurate estimates exist of the likelihood of children needing their own stored cells. The range of available estimates is from 1:1,000 to 1:2,00,000. Empirical evidence that children will need their own cord blood for future use is lacking,” the American Academy of Pediatrics’ Work group on cord blood banking noted in the journal Pediatrics (July 1999). “… Private storage of cord blood as `biological insurance’ is unwise.”

Apart from the possibility of self-use, there is another area that is hardly revealed to parents by private companies. “As medicine is currently practised, a child’s own cord blood cannot be used if the child is born with a genetic disease or develops leukaemia,” according to The New England Journal of Medicine (November 2004).

An article published in The Journal of Clinical Investigation (October 2005) also stresses on the same point.

It becomes relevant when a family member already has a current or potential need for stem cell transplantation (Editorial, The Hindu, March 9, 2005).

All these build a strong case for setting up public cord blood banks. The public bank run by Reliance Life Sciences in Mumbai is the only one of its kind. There are 14 such banks in the U.S. and 30 or more worldwide.

Question of revenue

Public cord blood banking has its own share of problems. The banks suffer financially as the revenues generated from the sale of cord blood to third parties falls short of the expenses to run such a facility (The Journal of Clinical Investigation).

This may be a transient phase till such time when large-scale donation and use of cord blood becomes a reality. One solution may be to combine public and private banking under one roof.

The need to know the health status of donors, particularly genetic diseases, before giving away their cord blood to others is needed.

A public banking that can cater to the needs of Indians living abroad would be able to overcome this challenge. This becomes amply clear as cited by the NEJM article. “… Public banks have seen their growth hindered by a shortage of stored blood … ” it pointed out. “It remains difficult to find full matches for some patients — in particular, for blacks and Asians.”

It is time the Government and not-for-profit institutions take up public cord blood banking seriously. Treating genetic or other diseases using cord blood may become a reality in the future.

“But for now the available evidence argues for the promotion of public rather than private cord blood banking,” the Obstetrics & Gynaecology journal concludes.

Published in The Hindu on November 24, 2005

 

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