Cord Blood: Private vs Public Banking
As new or soon-to-be parents, one of the first decisions you’ll make is whether to bank your child’s umbilical cord blood. Cord blood is one of the richest and easiest sources of stem cells, a promising basis of treatments for a range of conditions (more on this in Part 1).
Despite the fact that stem cell science is highly experimental today, with known cures only for a handful of chronic and rare diseases, many experts expect it to have a major impact on health care in the future.
“Just as penicillin was once considered a precious and rare drug, but is available over the counter today, medical specialists predict that stem cell therapy will be a dynamic, over-the-counter treatment, changing the way health care operates in the years to come,” says Stalin Mascarenhas, a former employee at a private stem cell bank and currently branch operational manager at Portea Medical Services.
But when science is mid-leap, as it is with stem cell therapy – and business is lock-step in monetizing it – ethical concerns abound. For cord blood banking, price and pressure are the two gray areas. Private cord blood banks have proliferated on the scene in recent years, all charging parents high fees for a service portrayed as the only responsible, loving choice for ensuring the wellbeing of a child. But is it?
A lot of false hope is being generated on what is essentially a very nascent technology, says Rochelle Carvalho, scientist at Sigma Aldrich, Bangalore.
Read on for more information on cord blood banking that these companies – and sometimes even doctors – will never present.
Private cord blood banks are companies like LifeCell, Relicord, CordLife, Cryobanks, BabyCell and more, which charge money for the collection and exclusive preservation of the stem cells in your cord blood for 20 years to a lifetime.
One of the biggest pros of banking your cord blood stem cells with a private player is that you have immediate and exclusive access to them if/when your child needs them. Even better, the stem cells are, of course, a 100% HLA tissue type (genetic) match for your child. This means that if your child needs a stem cell transplant in the future, there is neither the wait for nor the worry about tissue-matching donor (assuming, of course, that the sample has been properly preserved with an accredited company). An HLA tissue type match refers to a combination of six blood proteins that you inherit from each of your parents. While it is entirely possible for a strangers in any corner of the world to have the same HLA type, the chances of locating one when your child needs urgent treatment are slim.
“It’s rather like investing in an insurance policy,” Mascarenhas says of private cord blood banking. “You make the payments, but you know you may never really use it.”
The price of private cord blood banking, relative to the likelihood you’ll need to use the sample, is what raises doubts for many parents. Most companies charge a one-time processing fee, usually in the range of Rs 20,000, after which you have the option of annual installments or a deposit of Rs 40-60,000. It’s a great deal of money that not all families can afford for a medical treatment that’s not the miracle cure-all it’s touted to be—many of the diseases treatable and potentially curable with stem cell therapy are extremely rare. Most doctors advise parents to opt for private cord blood banking only if there’s a family history of certain cancers, leukemia, sickle cell anemia and thalassemia.
There’s also the chance of being drawn in by business practices that don’t necessarily have your best interests in mind.
One powerfully misleading “success story” generated by cord blood companies is that of desperate parents who have a second child solely to use the cord blood stem cells to treat their firstborn, who is struck down by a rare and chronic illness.
“If you’re thinking of banking stem cells as potential insurance of one of your older children, you should be aware that the possibility of a HLA tissue match is only 25%,” says Mascarenhas.
If you’re considering banking your younger children’s cord blood to be equable, after having already banked for older siblings, it’s still wise to think again. Private cord banking companies should do an HLA type test to see if your older child(ren)’s banked blood is a match for your younger child(ren) before allowing you to bank more—but often don’t, Mascarenhas says.
“For commercial reasons, private cord blood banking companies don’t mention this in their literature and they make a gain from every subsequent pregnancy,” says Mascarenhas.
Banking umbilical cord tissue, which contains a different type of stem cell, is an alternative that costs only Rs 5000-10,000, says Nidhish Nath, microbiologist and stem cell consultant. Currently, many cord blood banks include this option only as part as of a bigger, and more expensive, cord blood banking package.
Public banks are free-of-charge, as the cord blood you submit for storage is considered a donation. If needed, anyone can draw on the bank’s supply – including your own donation – as long as they are an HLA type match and can afford the purchase.
There is no collection or preservation fee, so you won’t be paying for a service that your child is not likely to need. It’s a comforting thought that, even if your child doesn’t need to use the cord blood, it will be on hand to help someone else. Also, the more people who donate to public banks around the world, the greater likelihood of finding a HLA type match if/when your child does need treatment, says Mascarenhas.
There are only two, but they are steep. In the event that your child does need cord blood for stem cell therapy, there is no guarantee that an HLA-type match will be available. Even if you have donated your own cord blood to a public banking facility, there are no assurances that you will be able to draw on it if/when your child needs it for treatment.
But even if you do find a match, there is still a drawback. The cost to purchase cord blood stem cells from a public bank are prohibitive—currently in the range of Rs 5 lakh. This is because, while the process of storage is free, public banks recover these costs only when they release stored cord blood for transplants.
As more people donate to public banks and as stem cell therapies are refined and expanded, these costs will likely fall in the future or perhaps be partially defrayed by insurance. But for the time being, the fees you’ll pay to withdraw from a public bank will be as great as your need.
Government involvement will be the biggest game-changer when it comes to public banking, Nath says, as nearly all current public banks are run by private cord blood companies in partnership with hospital chains, keeping the focus on bottom lines, not public health.
Mothers of premature babies (or sometimes multiple babies that share a placenta) may not be able to bank at all, as these babies tend to have a low volume of cord blood. In one study of babies born at 27 to 34 weeks, the average volume of cord blood and stem cells collected was 40 percent less than that of full-term babies (the volume of cord tissue and stem cells therein, however, was similar or greater). Also, mothers with a variety of infections, including herpes and genital warts, may contaminate cord blood and tissue, making it unbank-able. Consult your doctor for more guidance on cord blood banking in these scenarios.
Of course, there is always the choice not to bank at all.
“If you can’t afford it or aren’t entirely convinced of the opportunity that it could afford in the future, this doesn’t make you a bad parent,” says Carvalho.
Whatever your choice, let it be an informed one.