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Umbilical Cord Blood Banking: Procedural ad Ethical Concerns for This New Birth Option.

The umbilical cord is the lifeline from mother to child. Now the umbilical cord can also be the lifeline for the child with a life threatening illness. A rich source of stem cells previously discarded, the umbilical cord has become a precious commodity because of its ease in procurement and collection and its superiority over bone marrow in quality of stem cells. Umbilical cord blood as a hematopoietic source of stem cells has generated a great deal of scientific, clinical, and public interest of late, emerging as an attractive source of stem cells for allogeneic transplantation. As its clinical utilization grows and its technology continues to be refined, ethical considerations and issues regarding use are also growing.

Unique Properties of Umbilical Cord Blood

What makes umbilical cord blood so special? Umbilical cord blood is richer in stem cells, also known as CD34 cells, than adult blood or bone marrow (see Teaching Sidebar). The CD34 cell is a primitive cell with both self-renewal capacity and capacity to repopulate and produce mature blood cells. The fetus normally generates larger quantities of CD34 cells in its liver and bone marrow during development, making larger quantities of stem cells present in circulation and, therefore, in the umbilical cord itself.

Umbilical cord blood also has reduced immuno-reactivity and thus, lessens the risk of rejection by the recipient's immune system as well as graft vs. host disease (GVHD) when it is used as a source of stem cells for allogeneic transplantation. It is believed that cord blood has a muted immune system and naive stem cells, not yet educated to attack specific antigens. Although the reason for their reduced immuno activity is unknown, T cells (the white cells responsible for this targeted immune response) present in cord blood may be more tolerant or may be influenced by a suppressive effect of circulating maternal cells within the cord (Gluckman & Wagner, 1994).

Although results are still preliminary, umbilical cord blood has also proved to be an exciting source of stem cells for gene therapy and tissue transplantation as well. It appears that umbilical cord stem cells have a greater capacity for retroviral transduction (the mechanism by which the gene is transplanted into the body), making their use more advantageous than bone marrow in this modality (Gluckman & Wagner, 1994).

Lastly, another critical difference between umbilical cord blood and bone marrow is that cord blood is rarely contaminated by viruses such as cytomegalovirus (CMV) or Epstein-Barr virus (EBV). For the stem cell patient population, these viruses are associated with significant morbidity and mortality.

Umbilical Cord Blood as a Source for Stem Cell Transplantation

Allogeneic bone marrow transplantation (BMT) is now recognized as an effective form of therapy for a variety of hematological malignancies -- bone marrow failure syndromes, immunodeficiency states, and metabolic disorders. However, allogeneic BMT is limited by the availability of suitable HLA-compatible donors, the risk of donor-host immunologic reactions (primarily graft rejection and graft -- versus -- host disease) and the risk of opportunistic infections (Wagner, Kernan, Steinbuch, Braxmeyer, & Gluckman, 1995). By reducing complications, increasing the pool of suitable donors, and lowering the time of potential donor searches, umbilical cord blood has become an attractive alternate source of stem hematoepoetic cells for transplantation.

In 1988, Dr. Elaine Gluckman performed the first successful umbilical cord blood transplant in a patient with Fanconi's Anemia (Thompson, 1995). Since that time, it has been demonstrated that umbilical cord blood contains sufficient numbers of hematopoietic stem and progenitor cells to engraft small patients (approximately [is less than] 50 kg/110 lbs). Engraftment is durable and collection is safe.

Umbilical cord blood, once collected, can be tested and available within several weeks. Historically, bone marrow (marrow derived from a live adult donor) had been the primary source of the stem cells for transplantation. These donors are volunteers registered through the National Marrow Donor Registry (National Marrow Donor Program, 3433 Broadway St. NE, Suite 500, Minneapolis, MN 55413; www.marrow.org), a sophisticated computerized national database. The selection process is quite involved. First, an extensive search is performed to select the best suitable person. The selected donor undergoes intensive physical and laboratory testing followed by intense educational sessions. Upon successful completion of this extensive donor work-up and consent process, the bone marrow can be procured. Procurement involves an operative procedure, the bone marrow harvest. This process, from selection of donor to procurement of marrow, can take approximately 4-6 months.

Furthermore, as a greater percentage of the volunteer donors currently in the NMDP registry are Caucasian, patients from other ethnic and racial groups are under-represented in the potential donor pool. Every year compatible donors cannot be found for approximately tens of thousands of Americans in need of bone marrow transplants. With large scale umbilical cord blood collections across state, ethnic, and racial lines, the potential donor pool becomes enormous.

The speed and efficiency of stem cell procurement is especially critical when one is dealing with diseases requiring immediate therapy. Because every step along the way is critical, bone marrow searching and procurement is timely, costly, and limits donor availability. Clearly, cord blood is a far more advantageous and attractive alternative.

Umbilical Cord Blood Procurement: Considerations

Intrigue, concern, and even fear have surfaced over umbilical cord blood collection as public awareness surrounding the issue heightens. Families must be educated regarding the types, purpose, fees, and current pediatric recommendations as they apply to cord blood banking. A woman interested in the utilization of her child's cord blood unit has several options (see Table 1).
Table 1: Umbilical Cord Blood Banking Options

Type                        Purpose                   Fee

Option # 1: Autologous      Maintain a stored unit    Variable.
Banking (banking for        in the event that a       Involves an
oneself)                    member of one's family    initial
                            might need a              banking cost
                            hematopoietic stem cell   ($1000 to
                            transplant                $2000) and
                                                      then yearly
                                                      maintenance
                                                      fee ($50 to
                                                      $150)(*).

Option # 2: Philanthropic   Unit will be saved for    No fee.
donation                    the potential use of
                            the general public.

Option #3: Research         Procurement directed      No fee.
donation                    to an institution
                            researching the
                            properties of umbilical
                            cord blood units.

Type                        American Academy of Pediatrics'
                            Recommendations

Option # 1: Autologous      Not recommended due to
Banking (banking for        its investigational
oneself)                    status as a stem cell
                            source, limited
                            indication for autologous
                            banking, and low
                            likelihood of future
                            expansion (AAP, 1999).(**)

Option # 2: Philanthropic   Recommended with
donation                    appropriate informed
                            consent, low risk delivery,
                            no alteration of cord
                            clamping timing, appropriate
                            disclosure re: ID results
                            (AAP, 1999).

Option #3: Research         No recommendation made.
donation


Notes: (*) If there is a genetic history or malignancy within the family, it is possible that insurance will cover these costs. Select banks waive frees with a genetic or malignant family history.

(**) Banking needs should be presented if a family member has a current or potential need to undergo stem cell transplant.

It is essential for the expectant mother to address procurement of placental blood as early as possible in her pregnancy. Each bank or institution develops requirements and procedures surrounding technique of cord blood collection, transport of the unit to the storage or research facility, and processing guidelines. Establishing intent to collect cord blood early in the pregnancy facilitates the informed consent process, assessment of the family medical history, examination of factors potentially affecting cord blood collection, and education of the delivering obstetrician or midwife (Dracker, 1996). The receiving party must also make arrangements for acceptance and processing of the unit.

The obstetrician or midwife collecting this unit may or may not be familiar with cord blood collection. It is imperative for the health care professional to receive instruction from the bank or institution receiving and banking the cord. Each bank has its own procedure and equipment for collection. Procedure and equipment will drive the collection process.

Undoubtedly, informed consent is the most crucial issue at hand. Consumers need to be educated as they attempt to make informed decisions surrounding cord blood collection and storage. Consent includes discussion of testing, collection, processing, storage, and ultimate potential uses of the umbilical cord unit. Expectant families need to understand that extensive infectious disease testing will be performed on the mother, as well as the cord blood unit obtained. They must be prepared to receive full disclosure of results. Consent requires an explanation of the process of the actual collection as it relates to the vaginal and cesarean delivery. A clear description of what will happen to the cord upon arrival in the lab should be provided to the family. All known potential uses and limitations of the collection must be presented as part of the informed consent process.

Familial and genetic history must be obtained. Genetic conditions affecting the hematopoietic system would preclude the placental blood donation (Rubinstein, Rosenfield, Adamson, & Stevens, 1993). These conditions include hemoglobinopathies (sickle cell anemia, thalassemias), deficiencies of erythrocytic enzymes (glucose-6-phosphate dehydrogenase), congenital anemias (Fanconi's anemia), and congenital immunologic defects (severe combined immuno-deficiency, bare lymphocyte syndrome) (Rubinstein et al., 1993). The world-renowned Placental Blood Program (New York Blood Center, 310 E. 67th Street, New York, NY 10021. Phone: [212] 570-3169; Fax:[212] 570-9061), directed by Dr. Pablo Rubinstein, uses an interview prior to cord blood donation, which is intended to elicit a thorough family and infectious disease history. A prenatal history focusing on potential high risk behaviors and/or infectious exposures of the mother and fetus is critical. Infectious organisms potentially passed from mother to child may also contaminate placental blood and be transmitted to the cord blood recipient. Individuals donating to cord blood banks philanthropically must also provide ethnic background, as this is important in donor selection criteria.

Process for Umbilical Cord Collection

After the infant has been delivered, the cord blood collection should be performed as soon as possible (Dracker, 1996). Time to clamping has an influence over the volume of placental blood collected (Bertolini, Battaglia, De Iulio, & Girolamo, 1995). Although there has been some controversy associated with "too early" clamping for the purpose of cord blood collection, the recommendation remains that clamping should be done within 30 seconds of delivery for optimal recovery (Bertolini, Battaglia, De Iulio, & Sirchia, 1994). For vaginal deliveries, studies have indicated that clamping within 30 seconds and keeping the baby below uterine level prior to clamping is linked with increased placental blood volume (Bertolini, Lazzari, et al., 1995). Having the placenta in-utero during the collection is believed to increase blood volume collected in a vaginal delivery as well as a Cesarean section (Bertolini, Lazzari et al., 1995). The theory is based upon the notion that the uterine contractions facilitate placental blood collection by squeezing the placenta (Dracker, 1996). However, some suggest the more likely factor is the shorter time to newborn detachment and the initiation of the collection (Dracker, 1996). Factors that may negatively affect cord blood collections include maternal medications, prenatal and perinatal infections, hypertension, poor fetal growth, and abruption and abnormal placentation (Dracker, 1996).

A closed collection system is utilized more frequently because of its association with decreased bacterial and maternal fluid contamination (Bertolini, Lazzari et al., 1995; Dracker, 1996). The system consists of a venipuncture device connected by tubing leading to a collection bag, essentially a blood donation set. An anticoagulant and tissue culture medium (typically refrigerated) are added to the collection bag using sterile technique; the type and dose of anti-coagulant and culture media is dictated by the processing and storage facility (see Table 2).

Table 2. What the Delivery/Cord Collection Team Must Consider: An Inventory
1.   Completion of the informed consent process

2.   Cord blood collection kit: venipuncture device,
     bag, culture medium, anticoagulant

3.   Designated collector

4.   Optimal collection based on type of delivery

5.   Delivery complications that preclude cord blood
     collection

6.   Type of storage after collection until
     shipment/transport

7.   Responsible party for shipment/transport to bank
     after collection


Umbilical cord blood collection is performed by phlebotomy, simply puncturing the umbilical vein with the venipuncture device after the area of insertion is disinfected. Whether or not the placenta has been delivered, the blood flows by gravity. It is worthwhile to note aggressive phlebotomy may be associated with collapse of the umbilical vein and, subsequently, poor blood flow (Cord Blood Registry, 1997). Some milking of the cord may be necessary (Bertolini, Lazzari et al., 1995). The process may require added assistance if the placenta has been delivered; the placenta may be placed in a sterile basin or be held above the person performing the collection. The cord collection is approximately 5 to 10 minutes in duration (Cord Blood Registry, 1997). The volume collected ranges from 50 to 200 cc (Rubinstein et al., 1993).

Processing the Collection

Losses during umbilical cord blood processing must be minimized, since total volume of cord blood directly affects ultimate total number of uncommitted stem cells available for transplantation. The unit is to be stored at room temperature until it reaches the bank or institution to which it is directed, for no longer than 48 to 72 hours. It should not be refrigerated (Rubinstein et al., 1993). Once in the lab, a minimal amount of sample is tested for viability, sterility, cell count, and maximum yield (Cord Blood Registry, 1997). An aliquot, a small sample stored separately from the unit, must also be available for HLA typing if the unit is to be used for potential hematopoietic transplantation. Umbilical cord blood may be stored in its original form or may be volume reduced prior to storage. In light of space issues and cost of liquid nitrogen, volume reduction prior to storage is very attractive to banks. The unit should be maintained in the liquid phase of the nitrogen tank rather than the gaseous phase; the gaseous phase is susceptible to temperature fluctuations when opening and closing the tank. Currently, the length of time a cord blood unit is viable is uncertain. Units in storage for as long as 7 years have been thawed and demonstrated a recovery within the range of the original mononuclear cell count (Rubinstein et al., 1993).

Umbilical Cord Blood Banking: Ethical Considerations

While the utilization of umbilical cord blood as a critical stem cell source for transplantation continues to grow, ethical considerations are also growing. The three areas which have aroused controversy since inception of the idea of using umbilical cord stem cells for hematopoietic reconstitution include ownership of the cord blood collected, quality of the product collected, and control and regulation of banking facilities. Of course, from each of these general areas arise a myriad of other questions and concerns critical to consider as the use of umbilical cord blood as a stem cell source expands.

Need for Informed Consent

Fernandez has done considerable writing regarding the ethical concerns for this issue. Fernandez (1998) reminds us that prior to the consideration of cord blood as a stem cell source for transplantation, cord blood, the umbilical cord, and the whole placenta were considered "human residuum" and discarded in their entirety with no one claiming property rights. Viewed as such and discarded, the issue of informed consent was never raised.

However, with the advent of cord blood transplantation and stem cell research, the status of collected cord blood has changed. Cord blood must now be considered quite viable human tissue with living cells. Furthermore, these living cells will be collected, processed, and stored to maintain their viability. Viewed in this way, "ownership" of the cord blood and considerations of how the cord blood will be used must be guaranteed in a way so as to protect the newborn and its family. In summary, cord blood donation should follow the same regulations as all other organ donations. And in fact, current practice dictates that consent for cord blood collection must be obtained from the newborn's mother, as legal guardian of the "minor" donor, prior to labor or immediately after birth.

The issue of informed consent and allowing medical personnel to collect cord blood following delivery, be it for the use of research, autologous collection, or anonymous donation, raises many questions. For example, regardless of the intended use of the cord blood, the quality of the "product" must be carefully examined and screened. A thorough family medical and social history must be obtained. The product itself must be screened for infections such as hepatitis and HIV, as well as for metabolic and malignant disease. Family medical and/or social histories will dictate whether the blood cells are at high risk for carrying disease.

Ethical issues exist regarding the screening test and the results of these tests. Who should receive these test results? What does this mean in the setting of anonymous donation? What mechanism must be in place to "back track" the newborn and family in the event of positive or even equivocal results necessitating further testing? Should it be the obstetrician, the pediatrician, or the family doctor who is the connecting link? And by receiving these results, would this violate the confidentiality of the mother? Fernandez (1998) states that the initial consent from the mother must discuss the option of the accepting any information regarding findings in the specimen screening and potential ramifications of those findings.

Anonymous versus Autologous Donation

Another ethical question raised is the concern with anonymously banking cord blood without the ability to recontact the donor. Genetic disorders such as sickle cell anemia are often not detectable at time of birth, but rather declare themselves later in childhood. Could such genetic disorders be missed in the initial screening of the cord blood, yet still be passed on by the donor to the recipient? Most genetic diseases cannot be transmitted by marrow or cord blood transplants, especially with the sophistication of current cytogenetic testing. Nevertheless, this possibility highlights the necessity of obtaining thorough health histories prior to collection and use of the cord blood for transplantation.

Another provocative issue regarding anonymous donation is a family's potential inability to directly access their own blood. If a family donates a child's cord blood into a registry, the family has the exact claims to that blood as the general public. In other words, should the child or a family member be in need of transplantation in the future, the child or the family member would not be guaranteed access to that cord blood, but rather go through the same search process as the general public.

This leads to the most serious ethical issue regarding cord blood collection -- the concept that this same blood could later save the newborn's life (as is publicized by for profit commercial banks). Such "biological insurance" is a debatable point. It is uncertain whether parents should be encouraged to collect and store their newborn's cord blood not for anonymous donation, but rather for potential autologous transplantation should the child develop a malignancy or metabolic disorder. The increasing expertise in unrelated transplantation, coupled with poor outcomes in autologous transplantation for a variety of malignancies, has led many stem cell transplant experts to believe that saving an umbilical cord for autologous use may be futile and misleading by companies who promote it. Exactly how can scientists answer the question, "What are the odds that a child will require an autologous transplant in his or her life time?" We know that if a child were to develop a malignancy later in life, an autologous stem cell transplant would not be the first choice of therapeutic modality, as there would be no way to ensure that the stem cells did not contain this same malignant and/or clonal abnormality. The stem cell choice for the child would be stem cells from a healthy donor. However, the issue of storing cord blood for "direct donation" in the event that a sibling or other family member may need a transplant has been publicized in the media and is often raised by parents.

From a medical point of view, there is one appropriate situation to encourage parents to store cord blood for their own families (Fernandez, 1998). This would be for inherited metabolic disorders that could be corrected by autologous transplant. In some cases, scientists are now able to manipulate a genetic defect and correct it through the transplantation process. Families with such medical issues must receive appropriate genetic counseling and education.

Issues of Banking

The actual number of stem cells available to families for transplantation poses another ethical concern. Stem cells from cord blood collection are currently adequate for a recipient of less than 50 kg (approximately 110 lbs.) This limits the potential number of hosts for which the stem cells could serve, specifically the adult population. Is it worth collecting and storing large numbers of cord blood specimens for a limited population of potential candidates? Hopefully, as time passes, this ethical concern will be eliminated, as advancing technology, specifically cord blood expansion techniques, make cord blood an adequate source of stem cells for adults as well as children.

Those involved in stem cell collection must also consider the ethics of asking families to make a large financial investment for a potentially unfeasible procedure. Many facts about umbilical cord blood collection are still unknown. For example, it is unknown exactly how long stored cord blood is viable. What are the odds of the child needing an autologous transplant, how would one determine these odds, and would there be guarantee of viable cells? How does one weigh the limitations of cord blood versus the benefits? How will future research impact the strength of this "biological insurance"? Is there a justification of storage in the absence of "disease?"

This raises yet the final ethical area to be considered -- the commercial aspect of the "product." Fernandez (1998) discusses the concerns over the marketing of banking to expectant, vulnerable parents. He also raises the issue of potential abuse by for-profit storage companies to exploit the fears of parents for monetary gain. It is recommended that governments and/or international organizations strictly enforce regulation or legislation of the fixed cost of banking cord blood.

Finally, of huge concern is the rise in the number of commercial banks in the world. Should cord blood storage be run by the private or the public sector? With the rise of commercial banks, there is a grave need for standardized policies and procedures addressing handling the cord blood, informed consent, and histocompatibility testing. Wagner (1997) predicts that the first source of hematopoietic stem cells to be regulated by the U.S. Food and Drug Administration will be umbilical cord blood. While such regulation will address many ethical issues, no doubt new ones will continue to be raised. Nonetheless, such ethical considerations should not become a barrier, but rather an integral part in the development of this growing and promising field.

Nursing Implications: Helping Parents to Weigh the Odds

No doubt exists over the limitless value of umbilical cord blood. Its role in the clinical and scientific advancement of stem cell transplantation is just beginning to be widely appreciated. Banking this resource has now become a new birth option for parents. With this option also comes ethical and financial burdens-for families, weighing whether or not to opt for something so touted as "the only option" by many for-profit commercial banks (see Table 3). As pediatric and obstetric nurses, it is imperative that we become aware of the issues and controversies surrounding the decision to harvest, bank, and store umbilical cords (see Table 4). We must advocate for parents, many who find it difficult to resist public pressure to optimize an opportunity that may not be for everyone. The best form of advocacy in this situation is to help parents become educated consumers.

Table 3. What Families must Know: Factors Affecting the Decision to Bank
1.   Childhood cancer is rare.

2.   Long-term viability is not known.

3.   Saving a cord blood for autologous use may be
     futile.

4.   Amount of stem cell collected in the cord blood
     will impact its utility in transplantation.

5.   Banking costs vary from bank to bank.

6.   Umbilical cord blood banking is not a covered
     expense under most insurance plans.


Table 4. What Families must Know: A Teaching Plan for Nurses
1.   Pros and cons of banking

2.   Understanding the banking process

3.   Importance of timing of the collection

4.   Selection/education of obstetrician/collection personnel

5.   Selection of banking facility

6.   Potential uses for collected cord blood units

7.   Associated costs

8.   Insurance coverage; indications for coverage


References and Readings

American Academy of Pediatrics Work Group on Cord Blood Banking. (1999). Cord blood banking for potential future transplantation: Subject review. Pediatrics, 104, 116-118.

Bertolini, F., Battaglia, M., De lulio, C., & Girolamo, S. (1995). Cord blood collections: Effects on newborns. Blood, 86, 4699-4700.

Bertolini, F., Battaglia, M., De lulio, C., & Sirchia, G. (1994). Placental blood collection: Effects on newborns, Blood, 84, 3361-3362.

Bertolini, F., Lazzari, L, Lauri, E., Corsini, C., Castelli, C., Gorini, F., & Sirchia, G. (1995). Comparative study of different procedures for the collection and banking of umbilical cord blood. Journal of Hematotherapy, 4, 29-35.

Cetrulo, C.L., Sbarra, A.J., & Cetrulo, C.L., Jr. (1996) Collection and cryopreservtion of cord blood for the treatment of hematopoeitic disorders: The obstetrician's overview. Journal of Hematotherapy, 5, 149-151.

Cord Blood Registry. (1997). Cord blood banking: Information for the caregiver (Video). San Bruno, CA: Cord Blood Registry.

Cord Blood Registry. (1997). Umbilical Cord Blood Banking: A new birth option for your family (Video). San Bruno, CA: Cord Blood Registry.

Cord Blood Transplants. (1996). Bone Marrow Transplant Newsletter, 7(1), 1-3.

Donaldson, C., Armitage, W.J., Denning-Kendall, P.J., Nicol, A.J, Bradley, B.A., & Hows, J.M. (1996). Optimal cryopreservation of human umbilical cord blood. Bone Marrow Transplantation, 18, 725-731 (response).

Dracker, R.A. (1996). Cord blood stem cells: How to get them and what to do with them. Journal of Hematotherapy, 5, 145-148.

Fernandez, M.N. (1998). Eurocord position on ethical and legal issues involved in cord blood transplantation. Bone Marrow Transplantation, 22(S1), S84-S85.

Gluckman, E. (1994). Current knowledge about the properties of umbilical cord blood hematopoetic stem cells. (Editorial). Bone Marrow Transplantation, 14, 185.

Gluckman, E., & Wagner, J. (1994). Workshop on umbilical cord blood cells in transplantation. Presented at the Keystone Symposium, Keystone, CO.

Nimgaonkar, M.T., Rosco, R.A., Persichetti, J., Rybka, W.B., Winkelstein, A., & Ball, E.D. (1995). A unique population of CD34+ cells in cord blood. Stem Cells, 13, 158-166.

Rubinstein, P., Rosenfield, R.E., Adamson, J.W., & Stevens, C.E. (1993). Stored placental blood for unrelated bone marrow reconstitution. Blood, 81, 1679-1690.

Sousa, T., de Sousa, M.E., Godinho, M.I., Mendes, C., Carvalhais, A., & Barbosa, I.L. (1997). Umbilical cord blood processing: Volume reduction and recovery of CD34+ cells. Bone Marrow Transplantation, 19, 311-313.

Stewart, S.K. (1995). Appendix C: Glossary. In M.S. Tallman & P.J. Stiff (Eds.), Bone marrow transplants: A book of basics for parents (pp. 151-158). Highland Park, IL: Blood & Marrow Transplant Newsletter.

Thompson, C. (1995) Umbilical Cords: Turning garbage into clinical gold. Science, 268, 805-806.

Wagner, J.E. (1997) Allogeneic umbilical cord blood transplantation. In J.N. Winter (Ed.), Blood stem cell transplantation (pp. 187-216). Boston: Kluwer Academic Publishers.

Wagner, J.E. (1993). Umbilical cord blood stem cell transplantation. The American Journal of Pediatric Hematology/Oncology, 15(2), 169-174.

Wagner, J.E., Kernan, N.A., Steinbuch, M., Braxmeyer, H.E., & Gluckman, E. (1995). Allogeneic sibling umbilical-cord-blood transplantation in children with malignant and non-malignant disease. Lancet, 346, 214-219.

RELATED ARTICLE: Glossary of Terms

Adapted from Bone marrow transplants: A book of basics for patients (Stewart, 1995)

Stem cell: "mother" blood cells from which several different types of blood cells evolve

Allogeneic stem cell transplant: transplant in which stem cells are taken from a donor, rather than the patient's own stem cells, for infusion

Graft versus host disease: a condition that can occur following an allogeneic stem cell transplant in which the donors' stem cells attack the patient's tissues and organs

HLA (Human Leukocyte Antigen): a genetic "fingerprint" on white blood cells and platelets, composed of proteins that play a critical role in activating the body's immune system to respond to foreign organisms

Autologous donor: a donor for oneself or one's family

Anonymous donor: a donor donating for the good of the general public

RELATED ARTICLE: Information Regarding Philanthropic Programs by For-Profit Organizations

To assist families who currently have a parent or child suffering from a serious cancer or immune system disorder for which cord blood treatment could be used, Cord Blood Registry has developed the Designated Transplant Program[TM]. This program provides cord blood banking for possible use in a sibling or parental transplant at no cost to qualified families. Examples of these diseases are leukemia, lymphoma, myeloma, various anemias (Fanconi, Cooley's, Sickle Cell), and genetic diseases such as Hurler's Syndrome and SCIDS.

If you are aware of an upcoming transplant related pregnancy, in which a family might be able to use stem cells from the umbilical blood, agencies such as Cord Blood Registry in California will arrange for collection, processing, and storage of a family's cord blood. No processing charges or annual fees are paid by the patient. Families may apply to this program with a letter from their hematologist or oncologist indicating their need. When the transplant material (cord blood) is then required and family consent received, the cord blood will be immediately available for release to the attending physician or transplant center. For further information on one such designated transplant program, please contact the Cord Blood Registry at 1-888 CORD BLOOD (1-888-267-3256).

For those interested in the report issued by the National Bioethics Advisory Commission to the President (NBAC) on human stem cell research, an executive summary may be found on the NBAC website (www.bioethics.gov).

Pediatric Ethics, Issues, & Commentary focuses on exploring the interface between ethics and issues in clinical practice. If you have suggested topics or cases for consideration in the column, please contact Anita J. Catlin, DNSc, FNP; 230 Hillside Avenue, Napa, CA 94558; (707) 226-9002.

Lydia Gonzalez-Ryan, MSN, PNP, is a Pediatric Nurse Practitioner with the Stem Cell Transplant Team at Children's Memorial Hospital, Chicago, IL.

Karen Van Syckle, MSN, CPNP, is a Pediatric Nurse Practitioner with the Stem Cell Transplant Team at Children's Memorial Hospital, Chicago, IL.

Kelly D. Coyne, MSN, CPNP, is a Pediatric Nurse Practitioner with the Stem Cell Transplant Team at Children's Memorial Hospital, Chicago, IL.

Nicolle Glover, BSN, RN, is the Clinical Research Nurse with the Stem Cell Transplant Team at Children's Memorial Hospital, Chicago, IL.

Note: The authors would like to express gratitude to Paul Haut, MD, and Morris Kletzel, MD for content review and editorial support, as well as Peggy, Bill, Brendan, and Colleen Hogan, for painting a "picture" of cord banking as the lifeline for children with life-threatening illnesses.
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