After the baby is born and separated from the umbilical cord, blood remains in the blood vessels of the placenta and in the section of the umbilical cord that remains attached to it. This blood is called cord blood, or for short – cord blood.
Cord blood is rich in hematopoietic stem cells, which can be transplanted into patients with blood diseases and diseases of the immune system.
The decision to donate your infant’s cord blood to a public cord blood bank or keep it in a private cord blood bank, if any, is personal and free.
What is umbilical cord blood?
- Red blood cells that carry oxygen throughout the body.
- White blood cells are part of the immune system and are involved in protecting the body from infectious diseases and foreign agents (bacteria, viruses, parasites, foreign particles and tumors).
- The participation of platelets in the physiological process of stopping bleeding (coagulation).
Why is cord blood used?
Advantages of using umbilical cord blood
- It requires a lower level of tissue matching (HLA) between the donor and the recipient compared to a stem cell transplant from bone marrow or peripheral blood, and therefore there is a lower risk that the patient will develop “graft versus host disease” (GvHD). That the donor cells attack the patient’s body.
- Cord blood meals are stored and immediately available in case the patient needs a transplant urgently. But a bone marrow meal is not immediately available and requires a procedure that includes a number of steps. The procedure for donating bone marrow and peripheral blood stem cells only begins with a special request.
Disadvantages of using umbilical cord blood
- Since cord blood meal has fewer cells compared to stem cell meal which is sourced from bone marrow or peripheral blood, hematopoietic system recovery is slower and as a result there is a greater tendency for infection.
- Absence of the possibility of giving the patient white blood cells of the same type of lymphocytes after transplantation, which can improve the results of transplantation in certain cases.
- Cord blood cannot be used for transplantation in cases where the donor baby (where the umbilical cord blood was collected at birth) has been reported to have a genetic disease.
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Cord blood donation in public cord blood banks compared to private preservation
Donate to a public cord blood bank
- The donation to a public cord blood bank is made for the benefit of the general public and has a real life-saving potential for every person for whom the meal will be appropriate. This is a source of hope for patients for whom we do not find a suitable bone marrow donor within their families or in international databases.
- During the past two decades, far fewer than 1,000 cord blood autologous cell transplants have been performed in the world, compared to more than 30,000 cord blood transplants from foreign donors who donated to public cord blood banks, as an alternative to bone marrow transplants.
- Many international organizations in the world and certain regulatory bodies oppose the trade in preserving umbilical cord blood in private banks. Instead, they promote and encourage altruistic donations of cord blood to public cord blood banks, which have saved thousands of lives worldwide.
- A donation of cord blood to a public bank contributes to international human solidarity, and is the most effective way to preserve stem cells from cord blood. These cells will be available to patients suffering from diseases and medical conditions that are known to have no other solution, which is why they are saving lives
- It is important to know that in some diseases, such as types of leukemia, the use of a cord blood meal is not recommended, due to the risk that cells in the cord blood already contain disease agents.
- It could be a case where a meal kept in a private bank would be unsuitable for hematopoietic transplants if they needed it when needed, due to the quality of the meal.
- Currently, any use of cord blood that is not intended for hematopoietic stem cell transplantation is in the stages of basic research or clinical trials. Private banks that keep meals for family use deploy possibilities for future use to treat a variety of diseases such as diabetes, heart disease, cerebral palsy, autism and more. To date, there is not enough evidence to support these claims. Perhaps in the future, it will be possible to treat these diseases in additional innovative ways, not only with cord blood cells but also with stem cells from another source. At the moment there is no knowledge about the requirements that these cells have to meet (type of cells, number of cells, etc.) and the true potential for their use for these purposes.
- If cord blood is kept in a private bank, it will not be possible in the future to transfer it to a public cord blood bank for the benefit of the general patient population.
Supervision of public and private cord blood banks
Cord blood banks for public use
- Low cell count and unsuitable for hematopoietic transplantation;
- Presence of pollutants originating in the collection or treatment process;
- Reduced cell life, due to collection, transport or processing.
Factors that affect the ability to donate cord blood to a cord blood bank
The decision to donate cord blood for the public good is a personal decision of the mother and father of the newborn (to the extent of his knowledge, and if there is a reasonable possibility of identifying him, to find him or know his opinion at the time). It is important that this decision is based on reliable information and professional advice from a professional in this field such as the attending physician.
- Cesarean section – In principle, umbilical cord blood can also be donated in caesarean section deliveries. The collection policy for caesarean section varies between public cord blood banks and it is therefore advisable to check the bank’s policy before delivery.
- Surrogacy/surrogacy – requires the consent of the mother (pregnant mother – surrogate) for the cord blood collection. It is the intended parents (who will grow/bring the child) who will decide whether the cord blood can be donated to a public bank, kept privately or not at all.
Procedures accompanying the donation
- After receiving explanations, the mother is asked to sign an informed consent form.
- The mother should answer questions about her medical history and other family members of the newborn, related to hereditary diseases such as thalassemia, and exposure to infectious diseases such as hepatitis, HTLV, HIV and syphilis.
- Also, the mother should give a blood sample to be tested for the absence of infectious pathogens (such as hepatitis, HIV, HTLV and syphilis), according to the updated guidelines on this subject.
Maintaining a personalized cord blood meal
Cord blood banks for private use (family)
Questions to ask before deciding whether to keep cord blood in a private cord blood bank
- Does the bank have a valid permit from the Ministry of Health?
- Does the bank have a valid agreement with the hospital where the delivery is planned?
- In the event that the bank closes or declares bankruptcy – what will happen to the cord blood meals? Does the bank propose a mechanism that will ensure the continuity of keeping meals in the event that the bank stops working for any reason? If yes, what is the mechanism?
- Does the Bank propose, in addition to conservation, insurance for agriculture as well? If yes, in which insurance company? What are the terms of the policy, who is the beneficiary of the policy and how do we activate it? How is payment guaranteed to the insurance company?
- How long does the company work in cord blood preservation?
- Who is the medical director of the cord blood bank?
- How much cord blood meal is actually kept privately in the bank?
- Does the bank also have a wing that collects for public preservation?
- What are the factors that affect the ability to store umbilical cord blood in a private cord blood bank?
- Until what week of pregnancy can join the service?
- In premature labour – what is the lowest week of pregnancy it will not be possible to do a meal combination?
- What are the cases in which it is not possible to collect the meal during childbirth?
- What are the procedures accompanying the collection of umbilical cord blood?
- Were blood samples taken from the mother? If yes, by whom and when?What tests are performed with these samples?
- Will and how will the results of tests conducted in cord blood and in the mother’s blood be delivered?
- What collection equipment will be provided on occasion/at birth? Do they include special instructions for medical staff?
- Which endorsement will be given regarding the meal deposit? What information is included in the certification and how will it be passed on to the birth’s parents?
- What documents are kept in the bank regarding the meal and how can I obtain a copy of it?
- What are the means taken by the bank to maintain the privacy of customers?
- Will the bank use the customers’ details for marketing, mail or any other matter not related to the bank’s business?
- Does the Bank reserve the right to unilaterally change the agreement on the details of any of the details detailed above? How will the bank report the change?
- In the case of a periodic payment – can the payment change over time or is it fixed?
- Under what conditions can a partial refund be obtained for a meal that was found to be unsuitable for preservation?
- Is there a different price for keeping meals for more than one newborn in the same birth or meals for other babies in the future?
- How will the meals go from the hospital to the bank after the birth and is the transportation included in the price?
- Are there special instructions for collection and transportation over the weekend?
- What happens if a meal is infected in the process of transportation?
- What is the collection and storage method used in the bank (test bags/tubes)?
- Do you store the meal as one unit or several individual meals?
- Where is the meal prep site?
- If the meals are kept outside Israel – what are the legal requirements for cord blood to be kept in the same country? How is it guaranteed that the meal will be returned to Israel when needed?
- Are meals kept in a separate freezer or together with biological samples of other species?
- In which laboratory are the tests performed for the meal and which tests are carried out?
- What is the minimum number of cells per serving (compared to the accepted standard)? Are there other conditions that will lead the bank to rule that the meals are not fit for preservation?
- Does the bank agree to keep meals identified as unfit for preservation? If yes, what are the conditions?
- Are meals found with contamination kept separate from all meals (quarantine)?
- Does the bank use part of the meal to ensure quality or for other purposes?
- What is the bank’s policy regarding spoiled meals (eg due to non-payment)?
Cost of keeping in a private cord blood bank