Stem Cell Research

INTRODUCTION

A child is born everyday and without realizing it, the material that is routinely discarded after the birth could one day be life saving for that person, someone else in the family, or even a complete stranger. This material is the umbilical cord, and the blood contained within their vessels.

One may wonder, why is this blood so important? Medical research has discovered that the residual umbilical cord blood contains stem cells. These cells are the building blocks that the body uses to create some of the key components of the human immune system, blood and bone marrow. Stem cells are essential for life, they carry oxygen, fight infections and platelets that form clots on injured body parts. So if they are damaged at any point in life, either from a malignant, non-malignant or genetic disease a stem cell transplant may be required for medical treatment. Treatment will give the patient the ability to make healthy new blood.

Until recently, bone marrow - which is the soft substance inside the bones; and peripheral blood - which comes from certain blood vessels, was the only source of stem cells available for transplant use. These choices both require extensive operational procedures and carry a lot of risk for the donor. Umbilical cord blood has been called "An effective alternative to bone marrow transplant therapy" by the New England cord blood bank in Boston (Broxmeyer, 2001).

HOW IT STARTS

Collecting umbilical cord blood begins with a signature - the signed consent of the expectant parents, to give a blood donation from what is left in their newborn baby's placenta and umbilical cord. They are whisked away immediately to the lab; there it hangs in an absorbent sling, suspended several feet above a lab table. Gravity drains the blood into a sterile collection bag (http://www.caner.umn.edu/page/research/cord2.html).

The collection process is very unpredictable, and is probably the biggest obstacle. Because the amount of blood collected in each birth varies, when it is performed, doctors and nurses hope for a "big collection", which for them is only about 2 ounces. The more blood collected, the more stem cells there are available to grow new blood in another person. Time is another crucial factor. Research shows that immediately after the cord is cut, blood can start clotting and this reduces the amount that can be collected. Small collections are only suitable for a small child. Large collections, can be used on larger patients. To date the procedure has been performed on a patient upwards of 230 pounds. (http://www.caner.umn.edu/page/research/cord2.html). The blood is then cryogenically stored at -385 degrees Fahrenheit in a private or public blood bank.

WHO BENEFITS

Once the blood is collected, what happens to it? Parents choose whether they want their child's blood reserved for "Directed donation" or "Public donation".

With Directed donation the blood collected from the newborn will only be used for treating a blood disease of a sibling or immediate family member. It will be labeled and stored until it is needed. If a parent chooses Public donation, their baby's cord blood will be donated to a general blood bank that anyone might use.

SOCIAL AND ETHICAL QUESTIONS RAISED

If parents choose a Directed donation, the blood will remain in a private blood bank at an average cost of $1500, plus an annual storage fee of about $100 (source: American college of Obstetrics and Gynecology). To some people, that may seem like a small price to pay for all the potential benefits cord blood can provide, but what are the chances that one of their children or a family member will ever need to use it?

Many private cord banks selling cord blood banking as a sort of "biological insurance" - just in case something happens. Experts in blood banking and bone marrow transplantation frown upon this; they argue that people are being frightened into wasting money on a service that they probably will never need. For a young couple to shell out $1500 plus testing cost, which can range from $700 to $1000 (source: Cord Blood Registry of America), in addition to a new baby can be a burden and not every family can afford this price tag. Families from the low-income sector and even some of the middle class cannot provide their loved ones with this type of "biological insurance". Are they then destined to suffer if they get sick? I'm sure the answer to this question is "no", but they will assuredly have the daunting and time consuming task of finding a donor and then making sure that there is a match; and like with many other diseases and the medical procedures associated with them, the rich people who have access to resources will be attended to quicker and have better chance of survival What it provides, is a peace of mind that the entire family can be protected from potential diseases.

A question that can be raised in this instance is, what if cord blood is stored for family, but no one ever gets sick to use it? Because cord blood banking is a fairly new technique, it is has not yet been determined what will happen to unused blood - will parents just keep paying for storage indefinitely? There is another alternative - Public donation. Unlike Directed donation, this one is free, but it does not guarantee the sample will be available if the donating family needs it and this creates a big debate of ownership. When a person donates blood to the American Red Cross, for example, that blood goes into a public bank where anyone who needs it, can use it. With more and more donated cord blood going into private banks, public access to cord blood is limited and it will become increasingly difficult to find a compatible donor for a patient in need.

The goal of private banks is to store enough cord blood to generate a variety