Why Cord Blood Remains Controversial (2024)

Why Cord Blood Remains Controversial

The first successful transfusion of infant umbilical cord blood was in 1988, and since then more than 35,000 such procedures have been performed. The practice has remained controversial, not so much over the medical ethics of stem cell use as whether parents should pay to bank their baby’s cord blood on the small chance it would someday be useful, or donate it to a public bank in the hopes of it saving someone else.

Expectant parents may not even be aware of the practice until well into the pregnancy when they encounter requests to donate their baby’s cord blood, or marketing from private banks who will offer to store the blood — at a hefty price. Worldwide it’s $6.2 billion industry, and by some estimates could hit $9.3 billion by 2023, according to one recent report.

Public banks store more than 646,000 cord blood samples, while private banks have more than 3 million, according to the Parent’s Guide to Cord Blood Foundation. Samples stored in private banks have quadrupled since 2004. More than half of states have mandates requiring or encouraging physicians to educate expectant mothers about all forms of cord banking.

Here is an overview of the issue, including how to decide if you should donate or preserve your baby’s cord blood.

The Value of Cord Blood

Cord blood is known to contain potentially life-saving hematopoietic (blood) stem cells that offer advantages over bone marrow or peripheral stem cells, says Dr. Garrick Slate, a board-certified OB/GYN who is the lead physician at Women’s Healthcare of Maine. “The cord blood cells are more biologically tolerable and have less risk of rejection from the recipient and less risk of ‘graft-versus-host’ disease.”

Cord blood banks will tell parents that stem cell therapy has benefits for up to 80 known diseases, but the actual applications are hardly as common as they would lead you to believe.

“This is true, but most of them are rare, which is why cord blood is not a household word because the established medical uses that the insurance companies are willing to pay for are basically cancers, metabolic disorders, inherited blood disorders. In children, all of these things are rare,” says Fran Verter, Ph.D., founder of the Parent’s Guide to Cord Blood Foundation, which maintains databases of both public and private cord blood banks.

Cord blood stem cells are also used for medical research. But the pace of achieving applicable uses has been slow, Verter says. “Where cord blood has enormous potential is things that are in clinical trials such as cerebral palsy, autism, potentially at some point multiple sclerosis, neurologic diseases. And that's really where the big potential market is,” she says. “Enthusiasm among parents has kind of fallen off, and the reason is the frustration that the clinical trials pipeline moves more slowly than the public had anticipated.”

Public vs. Private Cord Blood Banks

The Parent’s Guide to Cord Blood Foundation works with both public and private cord banks, and Verter says it’s important to remember that they have completely different business models.

Donating a baby’s cord blood to a public bank incurs no cost to the parent, but it’s unlikely that specific blood would be available should their child require stem cell therapy down the road. There’s a limited number of donations sites across the U.S., making it especially challenging in rural areas. Even if a donation site is close by, most cord harvests are not viable for use in either therapy or research.

“If you do send it to the hospital, you don't know if it made it into the banks. The hospitals only bank the biggest and best units that they receive. The rejection rate is like 80 percent, so there's really no guarantee you'll ever see it again. It's free, but it's kind of a gamble that anything will actually be saved,” Verter says.

Private banks, also known as family banks, market cord blood as “biological insurance” in case their child or a family member requires stem cell therapy. It isn’t cheap: Private banks initially charge between $1,000 and $2,000 to collect and process units, with shipping and doctors’ fees adding a few hundred more, plus $100 or more per year to store the blood. Health insurance rarely covers any of this.

How Should Parents Decide?

Slate, who has spoken about the utility and ethics of cord blood, says its harvesting and storage is not routinely recommended by most physicians or their governing bodies.

“The American Academy of Pediatrics does not recommend the routine storage of umbilical cord blood as ‘biological insurance’ against future disease given the lack of scientific data supporting its use and the current availability of public banks providing allogenic samples for transplant,” Slate says.

“If a patient is offered private cord banking at time of their labor and delivery experience, the physician should disclose any financial interests or any other potential conflicts of interest,” he says.

Since there’s no financial toll in donating their baby’s cord blood to a public bank, parents should discuss the option with their physician to see if their hospital works with a nearby donation site. For private banking, parents should weigh the costs against whether there’s a family history of specific genetic, hematologic and malignant disorders known to respond to stem cell therapy.

Verter says parents thinking about the issue should do research — her foundation is a good place to start — talk to their doctor and ask questions. If you’re considering private banking, comparison shop around.

“Does the bank actually have accreditation? How long have they been using the same lab? Are they well-established? Everybody says in their brochure that they're a leading bank. They can't all be leaders,” Verter says.