New parents have a lot on their minds and many important decisions to make during the exciting months before birth. Increasingly, one topic expectant parents are discussing is cord blood banking. As a childbirth educator, I am counseling more and more parents about it every day. Cord blood banking is the process of freezing the blood that remains in a baby's umbilical cord after delivery because it is rich in lifesaving stem cells.
For many of my students, saving cord blood is an easy decision. The difficult question is deciding which bank to choose. Collecting, processing, and banking stem cells is a highly specialized industry, and it is important to choose wisely. Keep in mind that you are making a decision to entrust your newborn's unique stem cells to a banking service. The most important thing is that the company (and your baby's cells) are there if you need them and that they are viable (usable) if you ever need them. Cord blood stem cells are a miracle of nature that can only be collected once in a lifetime. If you are planning on saving your baby's cord blood, here is a guide to help you decide which bank to choose.
The five "must have" features you should look for in a cord blood bank:
1. Make certain that the bank you choose is accredited by the American Association of Blood Banks for the specialized processing of cord blood stem cells. "Membership" (simply paying dues) or general accreditation is not sufficient-the bank should be accredited for the specialized processing of cord blood stem cells. That means the bank and its laboratory and administrative procedures are reviewed, inspected, and validated regularly and are compliant with the guidelines established by AABB for cord blood processing. Don't assume that a lab that handles sperm, ovum, or whole blood is qualified to process your baby's stem cells. Also, don't assume that a bank going through the accreditation process is acceptable. Until the accreditation is complete, don't bank on it.
2. Make sure the bank is financially stable. Cord blood processing and storage is a very costly industry. In the past decade a number of public and family banks have gone out of business. When that happens, the fate of the sample is uncertain. Cord blood storage is usually a long-term commitment, and you want to be certain that the company you choose will exist in ten, twenty, or more years when your family might need to make a withdrawal.
3. Make sure the red blood cells are removed from your baby's cord blood before it's cryopreserved. Nearly all cord blood banks process samples to remove the red blood cells. This helps preserve the viability of the stem cells. Red cell separation, however, is a very specialized process. Make sure you ask the bank about their experience and track record in terms of cell separation. How long have they been doing it? Do they publish their results? Using their current processing methods, have any of their samples been used in transplant? (Some banks switch processing methods from time to time.)
4. Choose a bank that will store your cord blood in more than one cryovial-not blood bags. This is very important. Cryovials have been used by many laboratories and institutions for years and were designed specifically for long-term storage at low temperatures. It is well documented that blood bags have a risk of breakage during long-term storage. Cryovials also allow your sample to be sealed inside a second layer of material protecting it. This second layer is specially designed for long-term cryogenic storage and provides additional protection for your stem cells from potential contamination by any viruses that are currently unknown but may be identified at some point in the future. Storing in cryovials also allows you the option of putting your stem cell sample into multiple units. This creates more flexibility for use. Because medical science is already clinically testing the ability to expand or grow more stem cells from just a small sample, this kind of flexibility may be useful in extending the utility of the stem cells you have stored. It is important to look ahead to the clinical usefulness of your sample as medical science develops in the future.
5. You'll want a bank that has processed a significant number of cord blood samples and has provided samples that
have been successfully used in transplant. Research both of these issues. The number of cord blood samples processed and stored speaks to experience, which is obviously an important factor when choosing a health care service provider. Would you prefer a surgeon who has performed fifty by-pass operations or 1,500? It is also very important for the stem cell samples that are processed and cryopreserved to be acceptable to a transplant physician. Each sample should be handled as if it were going to be used in this fashion. If your stem cell sample is ever required for transplant, it will be rigorously tested for bacterial contamination, viruses, cell viability, and cell count before it will be accepted for use. Good viability and high cell count are the results of proper processing. Verify that samples have been provided for transplant. Most importantly, ask if they have ever had a sample rejected for use because of loss of cell viability, contamination, or low cell count. It is a red flag if a company has a high number of samples stored but a very low number of samples used in transplant.
Important considerations about cord blood banks:
- Find out what will happen to your sample if the company goes out of business. If a company goes out of business your baby's sample could be in jeopardy. Find out if the company has any affiliations that might help protect your sample if they go out of business. If the company doesn't own their own laboratory and storage facility, what will happen to your sample when the contract between the lab and the bank expires? This is good to investigate to make sure you are comfortable with the company you choose.
- Look for a bank that processes and stores only stem cells in dedicated facilities. Some banks may store other human and nonhuman tissue. Sperm banks, blood banks, and hospitals perform a variety of processes for numerous applications, but most don't have dedicated facilities, equipment, or staff. That increases potential for cross-contamination or material error and may mean that the processing applied to your stem cells is based on the cost- effectiveness of materials, rather than procedures that will provide the highest yield of stem cells.
- Make certain the bank performs "controlled-rate" freezing. Controlled-rate freezing is performed with computerized equipment that lowers the temperature of the sample as safely as possible. This means that the temperature of your stem cell sample is slowly lowered over a period of hours, past the point of freezing, until it is ready for long-term cryogenic storage. Rapid freezing or simply putting a sample directly into cryogenic storage may damage the cells.
- Choose a bank that has published data on their collection and processing methods. This can help validate the integrity
of the bank. Published data validates the process because the data must be carefully reviewed by impartial scientific
and medical peers and verified for accuracy prior to being published.
- Should I choose a bank that is close to my house? Geographical proximity should not influence your decision of where to bank your baby's cord blood. Most important are whether the company (and your baby's cells) is there if you need them and that the cells are viable (usable) for use in therapy if they are ever needed. Your sample can be express-shipped to your hospital in time for therapy, no matter where you store it.
Checklist of Questions to Ask:
_____ How many samples do they have stored in their family bank?
_____ How many of their samples have been used in transplants (using their current processing method)?
_____ Does the bank have affiliations with insurance companies and hospitals?
_____ Does the bank offer hospital or obstetrical caregiver education programs?
_____ Are programs available for families with a medical need (if applicable)?
_____ Is the bank in a risky location in terms of hurricanes, earthquakes, or airport closures?
_____ Is the bank financially stable?
_____ Is the collection kit sterile? (If you need a C-section this will be very important.)
_____ How will the shipping process work?
_____ What kind of education program do you have in place for training doctors to do collections?
_____ Will they send you a rebate if your doctor charges you a collection fee for the blood draw?
_____ Are they accredited by the AABB for the specialized processing of cord blood stem cells? (Some companies have their certifications posted on their Web sites.)
_____ Do they remove the red blood cells from the sample before freezing it? If so, how much experience do they have with red cell removal (That is, how many client samples have they processed that way?)
_____ Is the blood stored in cryovials?
_____ In how many units will the sample be stored?
_____ What will happen to your sample if the company goes out of business?
_____ Is the cord blood processed in a designated facility (separate from sperm or other tissue processing)?
_____ Does the bank perform controlled-rate freezing?