Once again, umbilical cord blood (UCB) stem cell collection and storage has been in the headlines of the popular press. UCB can be collected at birth and stored for the future use of the donor, its siblings or donated for public use. There are two main types of banking - public and private. Both forms of banking rely heavily on the assistance of qualified medical staff to facilitate the collection procedure. However, UK obstetrician Leroy Edozien has reported in the British Medical Journal (BMJ) this week that NHS maternity units should not promote the commercial banking of UCB.
Instead, he argues, women should be encouraged to donate altruistically to public banks in the interests of equitable access for all to these potentially valuable cells. Some of the objections to private collection include the low probability of future use, high costs, and misleading advertising. In addition, Edozien argues that NHS Staff who do collect on behalf of private companies may be compromised by potential liability claims from unsatisfied mothers, and that the collection process itself places a logistical burden upon those within the labour suite, further exposing them to litigation.
What is interesting is that despite being encouraged to donate UCB for the public good, very few women are actually afforded the opportunity to do so. There are currently only two active public banks in the UK, located in London and Belfast, which are run independently. The London Cord Blood Bank (also known as the NHS Cord Blood Bank) was set up by the National Blood Service in 1996 with the aim of supplying donated cord blood units for use anywhere in the world. The ability to donate to the NHS bank, however, is severely restricted as it only accepts collections from maternity departments at the Barnet General, The Northwick Park and The Luton and Dunstable hospitals. These hospitals were specifically selected on the basis of their high rates of normal delivery and high ethnic diversity of potential donors. In Belfast, the Northern Ireland Blood Transfusion Service set up the Belfast Cord Blood Bank in 1993. It currently collects donated units from two hospitals, the Mater Inforium Hospital and the Royal Jubilee Maternity Hospital.
In addition to these banks, a scheme is being set up in Newcastle where donations can be made for research purposes to a new research initiative based at The Newcastle University UK Centre for Cord Blood. The Centre will collaborate with experts at the Minnesota-based biomedical company, BioE, and aims to improve storage methods and develop cord blood therapies. Restrictions, however, are also imposed on the ability to donate to this scheme. The Centre currently only accepts donations from the Royal Victoria Infirmary Hospital.
It would therefore appear that women who live outside these prescribed geographical locations are deprived of the opportunity to donate the cord blood that they are purportedly being 'encouraged' to contribute for public use. It would seem the question that needs to be addressed is 'if women had the chance to donate UCB, would they be willing to do so?'
Little is known about parental views towards UCB banking, in particular why parents choose to donate or bank privately. However, a study involving expectant mothers was carried out in Canada in 2003, the aim of which was to investigate the knowledge and attitudes of pregnant women with regard to collection, testing and banking of UCB cells. The results showed that 70 per cent of the women involved reported very poor knowledge of cord blood banking and a slightly higher proportion indicated that health care professionals should make more information about both service options available. Furthermore, a staggering 86 per cent said that they would have chosen to donate to a public bank had they been aware of the facility, many citing altruism as the reason for this choice. Similarly, a study involving a sample of Swiss women that examined parental attitudes to UCB banking, published in 1998, found strong support for public donation.
Whilst there is a dearth of information regarding the attitudes of women within the UK, the results of these two studies suggests that women in general demonstrate a willingness to donate UCB if offered the choice. If it is possible to conclude that women within the UK would also emulate this stance, then women don't need to be 'encouraged to donate', as has been suggested, they simply require the means by which to do so. In the interests of choice and autonomous decision-making, public banks should now be afforded greater funding to allow such acts of altruism. And if private companies continue to plug the gap in the meantime, then so be it.