Jennie Haw explains how Canada’s National Public Cord Blood Bank can benefit all Canadians.
The National Public Cord Blood Bank is now collecting cord blood in the first of four cities across Canada. Some women giving birth in Ottawa now have the option of donating cord blood to the national public bank and by mid-2014 cord blood donations will be accepted in Brampton (Greater Toronto Area), Vancouver, and Edmonton. This is the culmination of over a decade of effort by the proponents of public umbilical cord blood banking, (here and here; behind paywall).
Blood-forming stem cells, called hematopoietic stem cells, can be derived from cord blood and used to treat certain cancers and immune system disorders. In 1989, Dr. Eliane Gluckman and colleagues reported the first successful treatment of Fanconi’s anemia using stem cells derived from cord blood, here. Hematopoietic stem cells derived from the umbilical cord are thought to be clinically advantageous to hematopoietic stem cells derived from bone marrow or peripheral blood. They are more immunologically naïve than hematopoietic stem cells from other tissues and therefore, they are less likely to trigger graft-versus-host disease, they are less likely to carry transmissible viruses or infections, and they can be collected with minimal medical intervention.
The creation of the National Public Cord Blood Bank profoundly changes the landscape of cord blood banking in Canada. Since 1996, when the first cord blood bank opened in Canada, private, for-profit banks have been the dominant players in cord blood banking. Private cord blood banks charge women and couples a fee to store their infant’s cord blood and hold it for the family’s future use. Public cord blood banks do not charge a fee to store donated cord blood and cord blood units in the bank are available to all patients in need of unrelated cord blood stem cells for transplantation. Prior to the opening of the National Public Cord Blood Bank, there were 9 private banks and 3 public banks (one provincial public bank in Quebec managed by Hema-Quebec and 2 much smaller public banks each affiliated with a private bank, one in Ontario and the other in Alberta). As such, until now, with few exceptions, Canadians interested in donating cord blood to a public bank had very limited options. The National Public Cord Blood Bank effectively addresses this limitation and offers a valuable and viable option for women and couples who are considering donating cord blood.
The National Public Cord Blood Bank also addresses several concerns regarding the private, for-profit cord blood bank industry. First, the option of private cord blood banking (with future access to “one’s own” cord blood stem cells for transplant) is dependent on one’s income; thus, it is inaccessible to those who cannot afford the fees. Initial processing fees range from $860-$1125 and annual storage fees range from $110-$125. The National Public Cord Blood Bank does not tie access to blood stem cells for transplant to income.
Second, many private cord blood banks market their service by encouraging women and couples to imagine that their child will become sick and emphasizing the potential and speculative clinical uses of cord blood stem cells. Meanwhile, many clinicians have long argued against private cord blood banking because of the very low probability that privately banked cord blood will be used and the lack of clinical indications for autologous use (i.e. when stem cells are taken from and then used to treat the same person). Cord blood donated to the public bank will be used in proven clinical therapies and will be available to anyone who needs blood stem cells for transplant. The goal of the public bank will be to move cord blood units in and out, rather than to store units for an indefinite period of time.
Third, privately banked cord blood raises concerns about the commodification of bodily tissues. Private cord blood banks aim to generate profit through the processing and storage of cord blood. This practice links to broader concerns about the commodification of tissues such as gametes and, more recently, blood plasma. The national public bank provides people with the option to donate cord blood and demonstrate social solidarity rather than contributing to a commercial, for-profit industry.
While the opening of the National Public Cord Blood Bank is a move in the right direction, it also raises ethical and social questions that must be addressed. Doing so requires situating cord blood banking within broader debates about the research and clinical uses of bodily tissues and, specifically, female reproductive tissues. Women’s reproductive tissues are used in research to advance stem cell science (e.g. ova are critical for somatic cell nuclear transplant research), and in clinical interventions for sub- or infertility. Over the years myriad concerns have been raised about this, not only with respect to payment, but also with respect to informed consent. Being mindful of this, it is critical that questions related to consent (including the provision of accurate and thorough information regarding the benefits and limitations of both public and private banking and the possible use of unbanked cord blood in research), as well as concerns about confidentiality and recruitment be rigorously addressed.
To end, I join the many who support the opening of Canada’s National Public Cord Blood Bank. It offers more women and couples the option to donate cord blood and it will benefit patients who need a blood stem cell transplant.
Jennie Haw is a PhD Candidate in the Department of Sociology at York University, Toronto, Canada.