Q: Can you describe what cord blood banking is? What's the difference between a private and public storage method?
A: Cord blood banking is the process of collecting and storing the blood that's left over in the umbilical cord after the baby is born. Once the baby is with the mom and being tended to by the medical staff, there's residual blood left over, and that blood has valuable cells in it. What cord blood banking does is collect that, which is a very simple procedure. And then it gets sent to a facility where it can be processed and stored and kept safe in a bank. Now, the amount of blood collected is highly variable. My background before working in banking was in obstetrics and labor and delivery. Some umbilical cords are tiny and very short & skinny, and some of them are very long. There's no way to know how much you're going to get. We just ask that the collector does the best job possible with whatever they're presented.
There are different methods and formats for banking: public or private. Public banking is when a family decides to donate their cord blood after delivery, and it can be given to a public facility that can evaluate it and decide whether it can become part of their registry (and can be searchable). If it's donated, the family no longer has any rights to it.
Family cord blood banking (or private) is when a family decides that they would like to make the investment to have that cord blood banked for their family. The process is very similar, but the only people who have access to that would be within that family.
Q: Are there any regulations or rules that you have to donate to this public storage fund if later down the road your child needed that cord blood? Did you have to donate into it to be able to use it? Or is it case by case?
A: It is constrained by the fact that you have to deliver at certain hospitals that have relationships with these public banks. There's been various programs over time to try to facilitate more people to be able to give to that public system. Family banking on the other hand, you can be anywhere. It doesn't matter what hospital, you could deliver at home, you can deliver wherever.
Q: Say, if I had a child and they needed the cord blood for whatever reason, do they still have access to the cord blood in a public bank?
A: Technically, no. When you donate cord blood to a public bank, you are relinquishing your rights to it. You are giving it up and it's a fabulous thing to do. I wish we had more public banks so that everyone had that option. I cannot say that it would be impossible to get it back if it was stored, but that's not how it's set up. The way that is set up is that when you agree—when you sign—you agree to donate.
Q: Could you give us background information on cord blood banking: when did this first start and why?
A: Sure. The cord blood banking industry was really born after the first cord blood transplant. I think the more common terminology people might be familiar with is a bone marrow transplant. Bone marrow transplants have been going on for decades. And basically, researchers and scientists realized that there are stem cells within umbilical cord blood that are the same to what you find in bone marrow. In 1988, the first sibling cord blood transplant occurred and then this real-life proof existed. It spawned an entire industry. Stem cells can come from bone marrow or from cord blood and having access to it could be valuable for that family.
Q: How many people have decided to bank their cord blood, either privately or publicly?
A: In the private banks alone, I know there's over one million. And of course, that number is constantly changing. The public system is a little bit different. They don't necessarily want to have the largest bank in the world. They want to have the most diverse bank in the world. But when you're using cells, they need to match. You just can't throw anyone's cells into somebody else. What a public system does, is it tries to have a very diverse and broad bank…they don’t necessarily want it to be huge and deep, but they want it to be very diverse and wide, so that anyone coming to that registry would be able to find a match.
Q: After banking privately, can you make a decision to donate it to a public bank instead?
A: If you banked your cord blood privately, you are not able to then change it to a public registry. There’s a different set of regulations that’s used for public and private banking. Lots of overlap, but enough of a difference that basically once it's been collected for one type of storage, it will stay that way. Now, if families decide that they no longer want to privately bank, they do have options to donate for research.
Q: How is cord blood stored and for how long?
A: It's stored frozen using a very technically sound method that's been validated over many, many years. It’s an exact science on how to ensure that once the cells are frozen, they will be viable. That’s really the most important part. There's no expiration date because if you freeze them correctly, time stops for those cells … the cells don't know if it's been one minute or one hundred years.
There are publications that came out looking at cells after being frozen for five years, 10, and 15. I think there was one that was twenty-six and a half years, all by the same researcher that had the foresight to take cord blood and bank it into little aliquots. And then after five years took one out and looked at it, 10 years took it out and looked at it, and showed that there was no change in the viability of the cells, then actually took them and grafted them to show that they actually functioned correctly. There’s really good proof that time is not the thing that matters. It's the expertise.
Q: Are there differences in the process if you had a C-section versus a natural vaginal birth?
A: Whether you delivered by cesarean or vaginal delivery, the collection process is the same, but the amount of time you have to do the collection is Mother Nature's decision—once the cord is cut and then after a certain amount of time, the blood clots. It's what blood does. It's not something that you need to go back and do later. It kind of fits in the flow of the delivery to do it at that time.
Q: What are the benefits?
A: I'd start off by saying this is a once in a lifetime opportunity. These cells, if they are in this blood, if it's not collected right, then it becomes medical waste and it's going in the trash. It’s an opportunity to capture these cells that are very young; that are very easily accessible. Everyone's born with an umbilical cord. And the process of draining the blood into a bag is painless and simple and much, much simpler than having to do a bone marrow transplant. Another benefit has to do with matching.
If you’re going to use the cells clinically, specifically for transplant, having matching cells is very important. The best place you're going to find a match is within your family because you share those genes. And so having a source that is in the bank can be called upon right away. And it's already been processed. You already have all the background testing done.
Q: Say my parents decided to donate or harvest my cord blood, would that be a guaranteed match for myself? Is it guaranteed that if we did it privately, those cells would definitely work for me?
A: Yes, if it's my umbilical cord blood, it's going to match me because it came from me. So that's an absolute. When you talk about your brothers and sisters, the way that it works out roughly is 25% of the time it's an exact match, about 50% of the time it's a partial match, and 25% of the time it's not going to match at all. Now, having it be your own or a sibling’s and being able to use it depends on what you're using it for. If I have a genetic blood disorder, I'm not going to want to use my own stem cells. Because my stem cells have the disorder. So, in certain situations, you want to use a sibling's cord blood for transplant.
Q: What factors might tie into a parent's decision to decide to bank cord blood?
A: Every family is unique. some of the common themes we hear are therapeutic potential, in other words, what do they think that cord blood can be used for? We know that the cord blood can be used for transplantation—a bone marrow transplant or a stem cell transplant. That's kind of the bedrock of the cord blood banking industry. But a lot of families, I think, decide to bank because of future potential.
Science is moving forward and there's research saying, OK, little cells, what else can you do? Can we apply you to other things? It can be because of the family's belief in the future of science. And then family history, too. There's a lot of things that are unique to the family that may motivate them to say, you know what, I think my family is at higher risk than average, and I really want to make sure that we have this resource banked for that child or potential other members as well.
Q: Are you able to elaborate on what some of those risks are?
A: In the transplant setting, there's nearly 80 different conditions where a transplant is a potential therapeutic option. And in those categories, there are certain types of cancer where you can use a transplant. There are hemoglobinopathies, there is immune deficiency, bone marrow failure syndromes... if something like that had happened in the family before and if that's a risk for them going forward, that might motivate them to consider this.
Q: What else can cord blood can help treat?
A: In the past decade or so, the scientific community is starting to look at cord blood stem cells to see if they can treat other things outside of transplants. There have been clinical trials looking at the use of blood and autism, etc.
But it's really exciting to see the scientific community making that shift. Like I said, outside of transplant to be able to say, can we take these cells that are readily available to every single person for everyone, get a cord, and see if we can use them to benefit people with other types of challenges in the neurologic space, not just in the blood and immune space?
Q: Is there anything else you would like to add about cord blood banking?
A: We consider everything outside of transplant regenerative medicine. And it’s very different. People who are using transplant are very ill. Whereas with this, they're using the cord blood cells to rebuild that person's blood and immune system. They're basically infusing the child's cord blood back into them. There's not this whole other complex system. So, it's not, if someone has leukemia where they need to have a transplant and they're very sick. And so regenerative medicine is when we use the stem cells for a simple infusion.
Q: When you're ill, as you said, it's a bigger kind of procedure whereas with this, based on what you just said, is it more of a dialysis treatment?
A: Well, dialysis is when you’re taking something out, right? You put somebody in the hospital, and they have an I.V. bag hung up with a tube and they put it in, and they drain the blood into the person. The regenerative medicine infusions can be a one day procedure.
When you think about a blood transfusion, it's not like you're taking out the person's blood and filling them up again. Or if there's a cancer, basically, you're trying to go after the cancer cells. And then you're bringing in somebody else's stem cells and those are going into the bone marrow and they're building out new red blood cells, new white blood cells, and new platelets. And they're filling that person up with a new blood and immune system. You’re walking around with somebody else's blood and immune system.
Q: Is there a limit to how many times you could use cord blood banking? Do you have to use your entire bag at one time or are they able to kind of section it out and use it?
A: The ability to use it one time or multiple times absolutely depends on what you're using it for. If you’re using the cord blood for a transplant, they will use the entire thing every single time.
To use seeds as an analogy, if you have devastated someone's blood and immune system and you’re putting in new cells to grow out a healthy, functional system, you want to give them as many seeds as possible. You want to give all of them. Now, when we bank cord blood, we do bank in a format that’s a five compartment bag. We're trying to provide flexibility for the future.
Q: Is there a limit of how many times you can use public cord blood banking?
A: If you needed a stem cell transplant or used a donor through the public registry, you could go back for some reason—if it didn't graft or you had another problem down the line. Again, the public system is there for everybody. It's really a public registry of stem cells. The cord blood inventory is part of that searchable system as well.
If I'm a doctor and I have someone who needs a transplant, I'm going to consider all the stem cell options. Do they have a family member who's a match? Do they have cord blood banks? You're taking all the different things into consideration and trying to decide what's the best for that patient.
But there's not a limit. If you use a public source and you need another source, then that's why they're there. That's one of the things about banking in general. When you talk about how you prepare and how do you know ... it's an educational lift. It's really hard to explain umbilical cord blood banking in five minutes. You know, it's only really the burden of it on the expecting family to do a little bit of research and say, what do I believe, what's my family history, what's available?
I believe families should be aware there's an option and they should find out: can I publicly bank, can I privately bank…but I just really get upset when I talk to people after having a baby and they’re saying, oh, I don't even know, I've never even looked into it. That's what we really want to do, is raise awareness so people can get information they need and make the right decision for their family. When I moved from labor and delivery into working in cord blood banking it was because I didn't want them to go in the trash. To realize that it could be a resource to help save someone's life…it just seemed like a calling to me.
Q: You said there's only certain hospitals that do public banking, so do you see that expanding in the future?
A: The public system is a supply and demand system because to survive financially as a public bank, you need to want to take in a certain number of units and process them.
It's like a library, right? You want to have a book for everybody. We are the great melting pot and we have amazing genetic combinations. To define each person, to be able to find a match for them, they need to have an incredibly wide, diverse library of units that are banked. It costs a fair amount of money. I don't see a lot of growth in the public system right now.
Not every hospital is necessarily going to be able to be aligned with the public bank. But that's not to say they can't do other things that provide value. I think that there's research initiatives there to educate the family and support that increase in understanding.
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