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Any parent who can pay for private cord blood banking can do it. But major medical organizations, like the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, don't recommend it for most people.
The benefits are too unlikely, the storage cost at a private bank is high, and other treatments are often available. These same organizations do support donating your child's cord blood to a public bank for free, which will make it available to anyone who needs it.
If you're thinking about privately banking your child's cord blood, here are some questions you need to answer.
Do any diseases run in your family?Cord blood stem cells can be used to treat:
If you have a family history of any of these diseases, your children may be at higher risk of developing them. Talk to your healthcare provider about whether banking your newborn's cord blood makes sense.
Some parents choose to bank their child's blood if they don't know his or her medical background -- for instance, if a parent was adopted or the child was conceived with a sperm or egg donor.
Do you want to save your child's cord blood for his or her own use?When a person is treated with his or her own blood, it's called an autologous transplant. (A transplant from one person to another is called an allogeneic transplant.) With an autologous transplant, you never have to worry about rejection. The cord blood will be genetically identical to your child's.
The problem is that if your child ever becomes ill with a genetic disease like sickle cell anemia, the cord blood will also be contaminated. Whatever gave rise to the disease in your child may also be present in his or her cord blood, so it can't be used as treatment.
Autologous blood transplantation can be used for other diseases, such as some types of leukemia. But even in these cases, your healthcare provider may not want to use banked cord blood. As with a disease like sickle cell anemia, the cord blood may be contaminated.
Because autologous cord blood transplants have so many limitations -- and the diseases they treat are uncommon to begin with -- they are very rare. According to the Institute of Medicine, there may have only been 14 of these transplants ever worldwide. There have been about 6,000 allogeneic cord blood transplants since 1988.
Do you want to use your child's cord blood for a sibling or relative?If you already have a child or relative with any of these illnesses mentioned above, it's possible but unlikely that your newborn's cord blood could be used as a transplant. The first successful cord blood transplant was performed in 1988 between two siblings.
However, even in these cases, cord blood isn't always the best treatment. The odds that siblings will be a perfect genetic match for each other are only 25%. So the sibling may need a marrow or cord blood transplant from a different donor anyway.
Cord blood transplants are rarely used to help sick adults. The problem is that only a few ounces can be taken from the umbilical cord. That just isn't enough to treat most adults. Instead, they will probably get a bone marrow transplant.
Does your child's race or ethnicity reduce the chances of finding a donor?People are more likely to find a genetic match among stem cell donors with their own ethnic or racial background. In the U.S., the majority of public bone marrow and cord blood donors are white. So lots of people from other ethnic and racial groups have a harder time finding a match from a public bank. They include:
If your child is from one of these ethnic or racial backgrounds, ask your healthcare provider if banking his or her cord blood is a good idea.
Do you want to bank your child's cord blood as "insurance"?Many private banks argue that cord blood banking is a form of insurance. The odds are low that your child will ever need it, they say, but the cord blood is there if he or she ever does.
However, a lot of doctors and medical organizations disagree. In their most recent statement on the subject from 1999, the American Academy of Pediatrics stated that storing cord blood as a form of "biological insurance" is "unwise" because the benefits are too remote to justify the costs. Besides, cord blood is not the only treatment available for children who develop these diseases.
Of course, no one knows how stem cells will be used in the future. Researchers hope that they may be used to treat many conditions, like Alzheimer's, diabetes, heart failure, spinal cord damage, and other conditions.
It's possible that storing your child's cord blood cells now may be useful in combating these diseases one day. But for now, these treatments are only theoretical. It's also not clear if stem cells from cord blood -- as opposed to stem cells from other sources -- will be useful in these potential treatments.
Published July 2005.
SOURCES: Arthur Caplan, PhD, chairman, department of medical ethics; director, Center for Bioethics, University of Pennsylvania. Jeffrey Ecker, MD, high-risk obstetrician, Massachusetts General Hospital; assistant professor of obstetrics, gynecology, and reproductive biology, Harvard Medical School. Stephen Feig, MD, professor of pediatrics, UCLA. Ecker, J. and M. Greene. Obstetrics and Gynecology, June, 2005; vol 105: pp 1-3. Rottman, G. Pediatrics, 1997; vol 99: pp 475-476. Rogers I. and R. Casher, Human Reproduction Update, 2003; vol 9: pp 25-33. Institute of Medicine (E. A. Meyer, K. Hanna, and K. Gebbie, eds.): Cord Blood: Establishing a National Hematopoietic Stem Cell Bank Program, The National Academies Press, 2005. National Marrow Donor Program web site. American College of Obstetricians and Gynecologists web site. National Academy of Sciences web site. A Parent's Guide to Cord Blood Banks web site. WebMD Medical Reference from Healthwise: "Umbilical Cord Blood Stem Cells."