Editorial: Cord blood in public banks

Published in The Hindu on February 16, 2007

Nearly eight years after it issued a set of guidelines for banking cord blood, the American Academy of Pediatrics has come out with a new set of recommendations to help guide physicians in providing parents with correct information on the issue of cord blood banking and the different kinds of banking systems  —    private and public.  The recommendations, much like the one made in 1999, make a strong case for public cord blood banking.  The Academy clearly states that storing cord blood for self-use or for use by a family member at a later date should be “discouraged.” According to it, the chances of self-use when stored in private banks are slim  —   1 in 1000 to more than 1 in 2,00,000.  Banking newborns’ cord blood in private banks may be appropriate only when one of the older siblings is already suffering from a disease that can be cured by using cord blood stem cells.   Also, from a purely medical point of view, it states, “Most conditions that might be helped by [using] cord blood stem cells already exist in the infant’s cord blood.”  Treating certain kinds of disorders using cord blood stem cells that are already pre-conditioned is not possible. For the same reason, the recommendations put the onus on the parents to prevent the use of their child’s cord blood donated to public banks in the event of the child developing certain disorders later.

Contrary to private banks’ promotional campaigns, the Academy discourages storing cord blood for self-use as a form of “biological insurance.” Unlike the difficulty in harvesting stem cells from embryos, the sufficient number of stem cells found in cord blood, ready and plentiful availability, and smaller risk of graft-versus-host disease make cord blood banking attractive.  Promoting public cord blood banks, which work on the same principle of blood banks, where accessibility by anyone suffering from specific disorders is simple and possible becomes important.  Apart from its potential therapeutic value, cord blood stem cells are a good source material for research. Unlike embryonic stem cells, harvesting stem cells from cord blood is not fraught with ethical issues.  Unfortunately, dedicated public cord blood banks are yet to come up in India. With the huge investments required and the need to run them on a not-for-profit basis, financial support from the government is essential to make public cord blood banking a reality. With millions of births taking place every year in the country, the benefits that will accrue to science and the society are limited only by the lack of cord blood storage facilities. There is clearly a strong case for the government taking on a  more proactive role.