Sydney Cord Blood Bank - How to Search Cord Blood
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How to Search for Cord Blood
A cord blood transplant is performed in Australia at Transplant Centres sited in major public hospitals.
The transplant doctor would submit a search request to the Australian Bone Marrow Donor Registry (ABMDR) to search for suitable bone marrow and /or cord blood units. The ABMDR searches international databases and obtains a list of suitable donors. As well as available bone marrow donors, such a list will include a selection of available cord blood units with their cell count and HLA type (HLA A,B and DR) and the level of HLA matching, e.g. 4,5 or 6 out of 6 HLA matching (4/6,5/6 or 6/6). A response is usually obtained within a day of the application.
The Transplant doctor selects one or more potentially suitable cord blood units for additional HLA typing.
Once all the information is available, the Transplant Doctor will reserve one or possibility two cord blood units. Arrangement is made for the transport of the cord blood unit in a special shipper kept at -180°C to the Transplant Centre.
The search for a suitable cord blood will usually be completed within weeks depending upon the availability of matched units.
The SCBB has received over 1000 inquiries and released over 155 CB units to patients in Australia and overseas (New Zealand, U.K, France, Israel, Canada, USA , Argentina, Hong Kong, Malaysia, and Singapore).
Designated Donation
This is a donation of cord blood for use where there is a family member with a disease such as leukemia and who is in need of a bone marrow transplant. Arrangement for such donation and banking of the cord blood are made with the doctor treating the family member needing a transplant.
For such a designated donation, the following aspects are important:
- The tissue typing of the baby needs to be compatible with the family member for whom the cord blood would be used.
- Cord blood transplant is considered appropriate therapy by the physician treating your relative.
- Delivery may need to be planned, for example, by induction so that appropriate personnel can be available to collect the cord blood.
- The collected cord blood unit may be inadequate and may have to be supplemented by a bone marrow harvest from the baby.
Arrangements for the collection, processing and storage of the cord blood have to be made by the physician treating the family member. Processing and storage will normally be arranged at the Laboratory of the Transplant Centre.
If the cord blood cannot be collected or is unsuitable for banking, all is not lost. If the donor and patient are tissue compatible, bone marrow can be collected instead from the donor when transplant is needed. If the donor is not compatible (70% chance), search can be made of the unrelated bone marrow donor registries and Cord Blood Banks. There are over 10 million unrelated bone marrow donors registered world wide and over 300,000 donations of cord blood stored (with over 19,000 in Australia). The likelihood of finding a suitable unrelated bone marrow donor is over 30% and of a suitable unrelated cord blood donation is over 90%.
Private Use Donation:
Some families consider collecting cord blood to keep for their own private use, either for the child who donated or for another family member in case there is ever a medical need.
There are commercial "for profit" banks offering private storage "as an insurance". The reasons given are to treat a future disease which may require a transplant, or as a source of stem cells to treat a range of diseases in the future for use later in life.
There is currently no proven role for such cord blood and it is unlikely to be used.
The facts relevant to considering the potential benefit / use of privately stored cord blood are as follows:
Diseases that require transplant include leukemia, solid cancers, genetic diseases and bone marrow failure (aplastic anemia).
The most common reason for transplant in childhood is for leukemia. However, 75% of children with leukemia are cured with conventional treatment and never need a transplant. Even if the donor developed leukemia and required a transplant, would their cord blood be used to treat themselves? The answer is no. The reason is that the least successful form of transplant is from the person's own cord blood or bone marrow. The most appropriate source of cells for transplant is from another person whether it be another family member or an unrelated anonymous marrow donor or cord blood donation.
As well, if the leukemia develops in early childhood, the cord blood may well contain the propensity to develop leukemia. Evidence already shows that children who develop leukemia have evidence of this in their blood at birth (KB Gale et al, "Back tracking leukemia to birth: Identification of clonotypic fusion sequences in neonatal blood spots". Proc Natl Acad Sci 1997;94:13950-13954).
If another family member develops leukemia, it does not matter whether the cord blood was stored since that donor is available to have bone marrow cells collected. The chance of a person finding a donor match in the family is 30%. The chance of finding a suitable unrelated cord blood or bone marrow donor is over 90%.
Can the cord blood (currently) be used to treat a genetic disease in the cord blood donor? The answer is no since the cord blood is affected. Cure of genetic diseases and aplastic anemia requires someone else's stem cells.
There is the potential to grow stem cells into other tissues such as heart muscle and nerve cells and that these might be able to be used for treatment in later life. This research is being performed in experimental models. It has a long way to go before it has a potential application in humans, but the potential may well develop into a reality in the future.
A number of august bodies and authorities have commented on this issue, indicating that the value of storing cord blood for private use is questionable (at present). They include the American Academy of Pediatrics (www.aap.org) in Cord Blood Banking for potential future transplantation. Subject Review (RE9860) Pediatrics 1999;104:116-118; Professor Leonard Johnson ( Oregon Health Sciences University) in "Blood and Bone Marrow Transplant Newsletter" Issue #43, July 1998 (www.bmtinfonet.org/newsletters) and the British Royal College of Obstetricians and Gynaecologists (www.rcog.org.uk) in Umbilical Cord Blood banking: Scientific Advisory Committee Opinion Paper 2 (October 2001). In these and other reviews, it is estimated that the likelihood of using cord blood collected for private use ranges from 1 in 2,500 to over 1 in 200,000.
If your cord blood is donated to a public bank it is estimated that in 10 years time, the chance that your cord blood will still be in the bank is around 85%. If it is there and there is a need for you to use it, it is available.
Can your child's cord be transferred to a public bank if you no longer wish to pay for it to be kept for your family? The answer is NO. The Sydney Cord Blood Bank does not offer this service. There are private cord blood banks that will store such cord blood. The Sydney Cord Blood Bank is not involved in designated donation or private use donation of cord blood banking.
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