I was recently introduced to an interesting topic in medicine when I was asked by my brother-in-law about a trend among new parents called "cord banking". He and my sister are having a baby in a few weeks and he told me they were trying to decide whether or not to do "cord banking". I did some research and it turns out he was referring to umbilical cord blood banking, which is the process of freezing and storing umbilical cord blood for its potential use in transplantation of hematopoietic stem-cells for treatment of immune, hematological, and other genetic disorders.
Interestingly, while the idea of storing one's baby's umbilical cord blood (UCB) seems like a great idea in event that the child might require that type of treatment one day, realistically, the likelihood of an individual needing an autologous transplant (i.e. of the cells from their own umbilical blood) of UCB has been estimated to be 1 in 2700. The reason that the likelihood is so low is because many diseases that utilize this type of treatment are genetic in origin; therefore, an autologous transplant is of no use to a person with a genetic disease because those hematopoietic stem cells will also carry the genetic defect.
Parents who do chose to utilize UCB for potential autologous use will do so through a private blood banking company; the cost of storing cord blood and tissue for 18 years at one bank costs $4,590. Considering the low likelihood of autologous use for the UCB, and the fact that there are public banks that store UCB for allogenic transplants, it seems as though the potential benefit of cord banking might not be worth the cost to parents. I think this decision poses an interesting ethical conversation from the perspective of a physician providing advice to an expecting couple. Of course you wouldn't want to discourage taking steps that might be advantageous for the child's health in the future, but recommending storage might place a difficult financial burden on the family. Personally I believe that a patient's obstetrician should have a clear understanding of cord banking and be able to provide an extensive explanation of the uses, costs, benefits etc. so that parent's can make an educated decision on their out without the influence of private banks that seem to inflate the necessity for such storage.
http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Umbilical-Cord-Blood-Banking
Interestingly, while the idea of storing one's baby's umbilical cord blood (UCB) seems like a great idea in event that the child might require that type of treatment one day, realistically, the likelihood of an individual needing an autologous transplant (i.e. of the cells from their own umbilical blood) of UCB has been estimated to be 1 in 2700. The reason that the likelihood is so low is because many diseases that utilize this type of treatment are genetic in origin; therefore, an autologous transplant is of no use to a person with a genetic disease because those hematopoietic stem cells will also carry the genetic defect.
Parents who do chose to utilize UCB for potential autologous use will do so through a private blood banking company; the cost of storing cord blood and tissue for 18 years at one bank costs $4,590. Considering the low likelihood of autologous use for the UCB, and the fact that there are public banks that store UCB for allogenic transplants, it seems as though the potential benefit of cord banking might not be worth the cost to parents. I think this decision poses an interesting ethical conversation from the perspective of a physician providing advice to an expecting couple. Of course you wouldn't want to discourage taking steps that might be advantageous for the child's health in the future, but recommending storage might place a difficult financial burden on the family. Personally I believe that a patient's obstetrician should have a clear understanding of cord banking and be able to provide an extensive explanation of the uses, costs, benefits etc. so that parent's can make an educated decision on their out without the influence of private banks that seem to inflate the necessity for such storage.
http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Umbilical-Cord-Blood-Banking
While 1:2700 is not a low number, it certainly isn't high enough to throw out. The storage cost certainly isn't cheap, but maybe in the future insurance companies will cover this or even require it. From the parent's perspective, if they had the money, it would be reassuring to have those stem cells in reserve. I can see where the genetic factor negates the usefulness, but if you have a late developing lymphoma, maybe science will have gotten to the point where they could epigenetically solve the problem? It's a stretch, but I would bet on science catching up to the problem.
ReplyDeleteI think the idea of saving the umbilical cord blood is intriguing especially if the blood could later be used in the event of a sibling developing a disease. I looked up some general information about umbilical cord blood banking and experts seem to suggest that the likelihood of needing your own umbilical cord blood is much smaller than the chance that it may be sought out for donation. This adds another layer to the cost analysis of saving and therefore paying for storage of this type of blood. If a family is planning on having multiple children, would it be a good "investment" to save the eldest child's umbilical cord blood?
ReplyDeletehttp://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Umbilical-Cord-Blood-Banking
http://www.asbmt.org/?page=63
ReplyDeleteThis is the link I meant to post!
Cord blood banking is such a hot topic nowadays! I had no idea the lifetime cost of storing the cord blood! $4590, that's insane! It becomes such a controversial question- could your child be that 1 in 2,700 that could even benefit from the cord blood. I kind of agree with Isabel's comment about maybe just saving one child's cord blood if you were to have multiple children. I also agree with John- who knows where medicine will be in the next 30-40 years so maybe saving your child's cord blood now when perhaps it would do no good will end up being able to save their life in the next couple of years. I absolutely agree with saving it if you know your child has a predisposition to contracting a certain condition or other factors but who could afford this? Since I'm sure the insurance companies will not cover it, how do you justify that much money if you only have a 1 in 2700 chance of using it and it actually doing something?
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