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The numbers suggest that a stranger is far more likely than anyone in the donor's family to need a particular child's cord blood. Even if a medical disaster struck a child whose blood was privately banked, it's not a guaranteed fix. With some diseases, such as leukemia, a child's own stem cells can't be used because they may well contain the genetic mutation that caused the illness in the first place.
Commercial banks would argue that stem cells from a healthy sibling are the next best thing. And while some studies indeed conclude that transplants from siblings are more successful than those from strangers, others are equivocal. What's more, there's only one chance in four that the blood of siblings will be compatible.
The companies have to admit as much. The small print on ViaCord's Web site warns: "Although the potential use of umbilical cord blood is expanding rapidly, the odds that family member [sic] without a defined risk will need to use their child's umbilical cord blood are low. There is no guarantee that the umbilical cord blood will be a match for a family member or will provide a cure."
Zitlow, however, notes that Cord Blood Registry's release rate is growing along with the medical applications for cord blood. "We are averaging about two transplants a month at this point," he points out. To be fair, most banks have been in business for only a decade, and their young clients still have lifetimes ahead during which medical needs might arise.
A key sales pitch for private banks is that if disaster does strike, you know exactly where your blood is. "If you've chosen to donate those cells, you relinquish ownership of those," Zitlow of the public repositories. "If you were ever in a situation where you needed those cells, there is no guarantee you'll get them back, and no guarantee that they were even processed."
About half of public donations are indeed rejected, usually because they don't contain enough blood-forming cells, or they are screened out for diseases. But as for the specter of people desperately trying to reclaim their publicly donated blood? It's simply never happened, says Darlene Haven, medical education manager for the public National Marrow Donor Program. "In the eight years of the NMDP Cord Blood Program, the NMDP is not aware of any case where a family who had donated cord blood then needed a transplant with the donated cord blood unit," she explains. If a family ever does request a donation back, provided it's still available, "it would likely be returned for the cost of storage and processing or billed to the insurance company."
Advocates of public banking like to say that if everyone donated, there'd be no need for private banks there'd be a supply so diverse that anyone could find a match, especially since cord blood is easier to match than bone marrow. The NMDP estimates that even now 95 percent of people are able to find at least one donor match within the public repositories. These banks still struggle, however, to find matches for some ethnic minorities, and people of mixed-race backgrounds.
Yet the public banking system's limitations have almost nothing to do with private competition the problem is that just finding a place to donate publicly can be a major hassle. "Everybody is telling women to donate to the public bank if they don't want to do it privately," muses Lawrence Petz, medical director of StemCyte International Cord Blood Center. "But when they try to do that they find they can't."
Petz should know StemCyte is one of the few cord-blood businesses with both a private and public side. The Arcadia-based company does collections on behalf of public banks and offers a private banking service of its own. It has released more than five hundred units for transfusion, mostly unrelated donor matches collected for public donation Petz declined to specify how many were from the private bank.
In general, women who bank privately can deliver at any hospital. The company provides instructions for her doctors, storage containers for the blood, and a courier to deliver it to a processing facility. Few hospitals collect public donations, however. Verter believes there are fewer than two hundred in the nation the only one in the East Bay is Berkeley's Alta Bates Medical Center, which works with StemCyte.
This, Petz says, is because collecting cord blood takes expertise, and many doctors aren't experienced enough to collect usable samples. It's collected via syringe from the umbilical cord shortly after birth, kept cool, and then couriered to a lab for processing and freezing. Additionally, he says, shipping individual donations from around the country to a processing center is inefficient and expensive. (Processing the blood and testing it for disease is another hefty expense.) StemCyte collects at a few large hospitals with well-trained staffs, and then ships all the units together. If you don't happen to live near such a facility, good luck.
Congress tried to address the gap with the Stem Cell Therapeutic and Research Act of 2005, which provided funds to collect 150,000 units for public use. But some advocates of cord-blood therapy think that's not enough the feds have funded only six banks to date, according to Verter.
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