Navigating the Ethical and Practical Concerns of Cord Blood Banking: A Candid Exchange
As a health professional dedicated to supporting parents during one of the most critical times in their lives, I recently faced a challenging decision: whether to allow a cord blood banking company representative to speak with my clients or even leave flyers at my venue.
On one hand, I am a strong advocate for informed choice, believing that people should have access to all the options available to them. However, my reservations about the practice of private cord blood banking made this decision far from straightforward.
I struggled with the idea of “gatekeeping information,” knowing that it’s important for people to be aware of all their options. At the same time, I couldn’t ignore my concerns about the potential biases in the information provided by these companies.
The decision to bank your baby’s blood is one laden with hope, potential, and, unfortunately, controversy. While the idea of saving stem cells for future medical use seems appealing, it’s important to weigh the scientific evidence and ethical considerations before making a decision.
Notice I said “your baby’s blood’, not “cord blood”.
This is the first thing to remember because the blood taken is not extra blood in the cord, it is the baby’s blood. It is part of their total blood volume and plays a vital role in their immediate health after birth and their long-term health.
Here are the benefits of optimal cord clamping:
- Increased Blood Volume
- Enhanced Iron Stores
- Improved Circulation and Oxygenation
- Better Transition from Foetal to Newborn Circulation.
- Supports Brain Development
- Enhanced Stem Cell Transfer
- Supports Breastfeeding Success
In the end, I decided that I could not, in good conscience, be seen to endorse cord blood banking companies, given the ethical and scientific issues surrounding the practice, so I emailed the representative this response:
To be completely upfront with you, I must respectfully decline meeting with you, because I am not comfortable with being seen to endorse baby blood banking.
And I was going to leave it at that.
However, the rep replied to my email and said that while she respected my decision, she would like to know why I was hesitant and if I would share my concerns. She also offered to keep me updated on the latest research and trials in the field.
My Response: Raising Concerns About Baby Blood Banking
As those of you who know me will understand, I could not miss this opportunity to express my reservations.
Here is my response:
“Dear XXX
Dr. Rachel Reed’s blog addresses many concerns about Cord (Baby) Blood Banking in her excellent blog, Confessions Of a Vampire Midwife
My primary concern is the impact on optimal cord clamping, which I feel the Cell Care website misrepresents as “controversial.” Although the “Australian medical community does not have a definitive position on delayed cord clamping”, there is robust evidence as to its benefits, and at present, the potential long-term benefits of baby’s blood banking do not outweigh the proven, immediate benefits of optimal cord clamping.
I am also concerned about the volume of a newborn baby’s blood taken as per Dr. Reed’s article. Can you comment on this?
[“Paediatric guidelines state that ‘blood draws in infants and children should not exceed 5% of the total blood volume in any 24-hour period’. A 3.6kg newborn has a blood volume of around 280mls – so the maximum blood draw is 14mls. A collection bag holds a significant proportion of the baby’s blood The collection bags for ‘cord’ blood hold 250mls (35mls already taken up with anticoagulant fluid). The minimum amount of blood acceptable for collection is 45mls, and the maximum possible is 215mls.” Reed, 2022]
Here are some additional concerns that I would be interested in hearing your response to:
Low Probability of Use
The American Academy of Pediatrics (AAP) estimates that the likelihood of a child needing their own stored blood for treatment is between 1 in 1,000 and 1 in 200,000. This statistic highlights a key issue: many diseases that could be treated with stem cells from cord blood, such as certain leukaemias, cannot use the child’s own blood due to the presence of the same genetic mutations. In these cases, a matched, healthy donor’s blood is typically required, making private baby blood banking a costly and low-probability gamble.
High Costs and Financial Burden
Baby blood banking is an expensive process, often costing several thousand dollars for collection, initial processing, and the first year of storage, with additional annual fees thereafter. For many families, this represents a significant financial burden, especially given the low likelihood of the blood ever being used. I do note that your Cell Care Support Programs are going some way to address this for a specific subset of families.
Limited Medical Applications
While baby’s blood is rich in hematopoietic stem cells, which can be used to treat certain blood and immune system disorders, the range of diseases that can currently be treated with these cells is limited. Thus, banking baby’s blood for speculative future treatments may not be justified based on the current state of medical research.
Although there have been reports of stem cell therapy from siblings’ blood cells for cerebral palsy treatment, as per the RACP position statement “At the current time, the published controlled studies of cell-based interventions in CP vary in the methods used and the quality of trials. There is insufficient evidence to make conclusions about the clinical effects of such interventions. A large phase 3 clinical trial is required to determine the efficacy of stem cell treatments for children with CP. It is recommended that stem cells and other cell-based interventions for CP should only be used as part of well-designed clinical trials.”
I would be interested in hearing about future large phase 3 clinical trials.
Alternative Options: Public Banking and Donation
Another argument against private baby’s blood banks is the availability of public baby’s blood banks. Public banks collect, process, and store donated cord blood, making it available for use by anyone in need of a stem cell transplant. Donating baby’s blood to a public bank contributes to a communal resource that can potentially save lives without the cost and low utilisation rates associated with private banking. In this context, critics argue that encouraging public donations over private banking is a more ethical and socially responsible option.
Potential for Misuse and Misleading Marketing
The marketing practices of some private baby’s blood banks have come under scrutiny for being misleading or overly optimistic about the potential uses of stored cord blood. These companies often emphasise the possible future applications of stem cells in regenerative medicine and treatment of a wide array of conditions, many of which are still in the experimental stage and not approved for clinical use. This can create false hope among parents, leading them to invest in baby’s blood banking based on speculative and uncertain future benefits rather than current scientific evidence.
Limited Shelf Life and Uncertain Future Value
While baby’s blood can be stored for many years, there is still uncertainty about the maximum shelf life and the viability of stem cells after long-term storage. Some experts question whether the cells will still be effective decades after being banked, especially as medical technologies and treatment protocols continue to evolve. Does Cell Care let clients know about this issue?
I am happy for you to email me in the future if there are larger trials published in peer-reviewed journals, but I am not interested in any marketing materials, that only highlight case studies or feasibility studies.
Regards Pip “
Awaiting a Response
In closing my email, I let the rep know that I am open to receiving information on larger trials published in peer-reviewed journals. However, I made it clear that I am not interested in marketing materials.
As of now, I haven’t heard back from her, but I remain hopeful that this conversation will shed light on the complexities and ethical dilemmas surrounding baby’s blood banking.
It’s important for parents to make informed decisions based on evidence and to be aware of both the potential benefits and the significant limitations of this practice.
EDIT UPDATE: As I was finishing this blog, I received my monthly newsletter from Dr Sara Wickham, which had this paper published in the BMJ (British Medical Journal) highlighted:
Cord blood banking: Experts raise concern over claims made for stem cell applications
Article summary:
The paper discusses concerns about the marketing practices of private biobanks offering umbilical cord blood banking services. These services, which can be very expensive, are promoted as a way to preserve stem cells for future medical use. However, experts criticise the potentially misleading claims made by these companies, particularly regarding the effectiveness and scientific backing of their methods. For instance, Cells4Life, a major UK biobank, claims its technology produces more stem cells, but this claim is questioned by experts. Additionally, the journal that published supporting research has been accused of questionable practices, including listing editors who were unaware of their roles. Experts also argue that many of the therapeutic applications promoted by biobanks are exaggerated or unrealistic, and that alternatives, like using stem cells from adult sources, are often available. The Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives do not recommend commercial cord blood banking unless medically necessary. Ultimately, the decision is left to parents, but they are urged to consider the limitations and potential misleading information.
Kwan J. Cord blood banking: Experts raise concern over claims made for stem cell applications. BMJ. 2024 Jul 24;386:q1581. doi: 10.1136/bmj.q1581. PMID: 39048126.
