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Cord blood banking in Canada


Minutes after giving birth, blood from the umbilical cord is collected and sent off to a central cord blood bank to be cryogenically frozen.  Years later this cord blood could be used to cure some cancers and treat rare diseases.

While to some this sounds like the stuff of science fiction,  the use of cord blood stem cells to treat disease is real and growing. Stem cells from cord blood can benefit both unrelated individuals who are a genetic match, or the cord blood donors themselves and their family.

Historically the only option for someone who wanted to save cord blood was to pay a fee to one of Canada’s nine private ‘family cord blood banks’. These private organizations facilitate the collection and storage of cord blood units for the exclusive use of the donor and immediate family.

Since September 2013 some Canadians have a second option which is to donate cord blood to the National Public Cord Blood Bank – a bank run by the Canadian Blood Services – where their cord blood is stored, entered into a public database, and is available for any appropriately matched patient at home or abroad, in need of a stem cell transplant. Once someone donates their cord blood to the public bank, they have no ownership over its use. If it is a match for someone else, they will not have access to it should they need it in the future.

While Canada now has a public and private option for banking cord blood, many gaps remain.

This article focuses on the questions Canadians are faced with about the practical and ethical issues associated with the choice to bank cord blood. For a brief description of what cord blood is and how it is collected, click here.

Canada’s public cord blood bank

“Canada hasn’t been pulling its weight” when it comes to cord blood banking according to Dr. Robert Klaassen, a pediatric hematologist oncologist at the Children’s Hospital of Eastern Ontario in Ottawa.

Klaassen says that prior to the opening of the first National Public Cord Blood Bank collection site in Ottawa, Canadians have mostly relied on stem cells from American, European or Australian bone marrow and cord blood banks, but have not been contributing to this international pool of nearly 18 million donors.

When an international stem cell match is found, provincial and territorial health systems pay a bill of $42,000 to procure the unit. Dr. Heidi Elmoazzen, Director of the National Public Cord Blood Bank says “it will be a big cost savings to our health care systems to rely less heavily on international [stem cell] sources.”

In 2012, there were 429 unrelated stem cell donor transplants in Canada. Of these, only 55 were from Canadian donors – the rest were from international sources.

The plans for the National Public Cord Blood Bank were announced in March 2011 with a mandate to increase Canadian capacity for cord blood collection, storage and research. Cord blood from the Canadian bank will also be available to the international community through a registry system.

With a total price tag of $48 million, the National Public Cord Blood Bank has a staggered plan for expansion to hospitals in four cities (Vancouver, Edmonton, Ottawa and Brampton) where cord blood can be collected. The rationale for selecting these sites, according to Elmoazzen is that they are in diverse communities, and are also located within reasonable proximity to two facilities in Ottawa and Edmonton that have the capacity to test and store cord blood.

In September 2013, the first public collection site opened in Ottawa, with women delivering at two Ottawa hospitals having the option to donate their cord blood to the public bank.

Although there are approximately 370,000 babies born each year in Canada, the National Public Cord Blood Bank has set a target to collect only 18,000 units over 6 years from the four sites. Elmoazzen says this figure was based on information from international cord blood banks and calculations for the ideal size of a bank, given Canada’s population and ethnic diversity.

Ethnic diversity is critical for the National Public Cord Blood Bank since Canadians from non-European backgrounds have a much lower chance of finding a match. Currently, most donors to international stem cell registries are predominantly of European background.

Armand Keating, a hematologist and chair of Cell Therapy and Transplantation at the University of Toronto notes that “stem cell transplant antigens tend to segregate along ethnic lines.”

While all Canadians will be able to access the National Public Cord Blood Bank, few will be able to contribute.

For those delivering in hospitals outside the four cities affiliated with the National Public Cord Blood Bank, private banks remain the sole option for banking their cord blood.

Private or ‘family banks’

There are nine private, or ‘family’ banks across Canada that facilitate the collection and storage of cord blood for the exclusive use of patients and their families. This comes at a cost. Most private banks charge about $1000 for the initial cord blood extraction and assessment, and about $100 per year for storage.

Clifford Librach, director of CReATe Cord Blood Bank in Toronto describes private banks as a form of “biological insurance”.

Monica La Vella, a Hamilton mother of two agrees. She says “the decision to bank cord blood was like taking out insurance for us.” La Vella notes that “we pay so much for insurance for our car and our home – why not pay for something that has the potential to save our children’s lives, and maybe even our own in the future.”

While there is only a 30% chance of stem cell matches from a sibling or related donor, Librach suggests that there are a growing number of disorders in which patients may benefit from cord blood stem cells that are re-transplanted to the same person, known as autologous transplantation.

However, he does concede that “the research needs to catch up with the banking of cells” when it comes to autologous transplantation. He notes that many of the potential uses for autologous stem cell transplantation – ranging from type 1 diabetes to cerebral palsy –  are still being tested in clinical trials.

For these reasons, the Society of Obstetricians and Gynecologists issued a clinical practice guideline in 2005 that did not recommend collection and storage of cord blood in family banks. The guidelines referenced data that only about 1 in 20,000 samples of umbilical cord blood have been used for autologous transplantation.

Tony Armson, head of the department of Obstetrics & Gynecology at Dalhousie University is the lead author of the SOGC guideline. He says that “a lot has changed since the guidelines were written in 2005 and that there are increasing opportunities for the use of cord blood.”

Armson notes that because of this, the SOGC guidelines are in the midst of being updated with a new section on the benefits and limitations of private cord blood banking. These guidelines will likely be released in 2014.

For now, the official position of the SOGC remains that banking cord blood privately is not recommended.

Making the decision about cord blood banking

Elmoazzen says that “it’s about providing families with education to ensure that they are making informed choices” when it comes to banking their cord blood.

However, in the next few years public cord blood donation will only be available at a fraction of Canadian hospitals. Given this, private banks will remain the primary option for those Canadians who wish to bank cord blood, and are able to pay the price.

Klaassen says that more should be done to build up the National Public Cord Blood Bank.

He says “There are hundreds of thousands of babies born every year and all those cords are being thrown away.”  He believes that there should be more cord blood units being banked, given the need for improving the diversity and number of cord blood units available to Canadians.

While establishing a national infrastructure to collect cord blood is an important first step, he suggests that “more support be put into this – the more cords are available, the more they’ll be used.”

While Klaassen advocates for more cord blood units to be collected, Keating suggests that a targeted approach to collecting samples from diverse populations will have more of an impact. He says that “the number of donors is meaningless if you are going to recapitulate the make up of existing registries.”

Should the National Cord Blood Bank expand beyond collection in four Canadian cities?

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10 comments

  1. Rebecca

    I believe several analyses have found that private cord blood banking is not cost-effective for individuals, e.g. http://www.ncbi.nlm.nih.gov/pubmed/19888044

    But a public bank makes a lot of sense, particularly as more uses are developed.

    Evidence has been piling up lately that delaying cord clamping is beneficial for newborns: http://www.ncbi.nlm.nih.gov/pubmed/23843134

    Does delayed cord clamping affect the harvesting of cord blood?

  2. Dr. Anthony Armson

    The question about delayed cord clamping is very relevant because this practice is becoming increasingly common, advocated by midwives and other prenatal care providers and requested by growing numbers of mothers. ‎There is some controversy regarding benefit to term newborns but delayed cord clamping appears to be particularly beneficial for preterm babies.

    Delayed cord clamping significantly reduces the amount of cord blood that can be ‎harvested for cord blood banking and in most cases there will be insufficient cord blood to store for future use. Consequently, mother’s and their partner’s must make a choice between delayed cord clamping and cord blood banking. If they decide to do one, they won’t be able to do the other. The decision will therefore be based on the parent’s priorities and the counseling that they receive from their care provider.

    • Lani Wittmann

      Dr. Armson , I am interested in the ethical issue you raise surrounding consent and informed decision making.

      I understand that the benefits of delayed cord clamping to the term infant were identified by Hutton & Hassan (2007) “Late vs early clamping of the umbilical cord in full-term neonates”; and again in the July 2013 Cochrane review “Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes” http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004074.pub3/abstract

      Leading maternity care organizations (WHO, FIGO, ICM, RCOG) all recommend that routine clamping of the umbilical cord be delayed (2-3 minutes or until cord stops pulsating).

      Given the current state of our understanding of the optimal timing of cord clamping, vs the reality that in order to guarantee an adequate volume for stem cell collection the cord must be clamped immediately, I was interested to read the information pamphlet and consent form used by the Canadian National Public Cord Blood Bank to see how they present the information so that parents can make the informed decision that is required. On the website and in the information pamphlet it is stated that “Canadian Blood Services’ National Public Cord Blood Bank does not interfere with the natural process of the delivery of the baby”, and that there are “no significant risks”. The consent form only addresses risks to the mother (pain, bruising at venopuncture site, lightheadedness, possible fainting). No mention is made at all of the potential risks to the term newborn (lower ferritin levels and iron stores, and 50% increased risk of iron deficiency anemia in the first 6 months of life).

      I am wondering what the ethics are surrounding this failure to disclose? Are parents who are approached as donors and who are keen to give the gift of life being given the full picture? I imagine the revised SOGC Guideline will be providing some clarification on this issue.

  3. In Canada

    I have been waiting for a bone marrow transplant but no match so they are going with Cord Blood as there was a good match. I go into the hospital and in a month’s time I am going to have the procedure. Up until now doing chemo and making me sick and was stuck in limbo….now I have hope!!!

  4. Bonnie Morrice

    This is a little off topic, but we were told that the cord blood that was taken at birth of our baby is contaminated with e-coli. Is it still useful? Do we continue to pay the $2800.00 to store it for the next 18 years?

    • Kms

      I have the same question. I was told that the cord blood of my baby is contaminated with e-coli. Can this blood be used in the future when needed? What is the recommendation? Any research or guidelines on this subject?

  5. carolle

    Since cord blood can be a lifesaver and Canadians (either privately or thru tax dollars) have had to pay exorbitant fees to obtain cord blood from international sources, it is a no brainer for the National Cord Blood Bank to collect. All Canadians are blessed to have access to healthcare so we should also have the responsibility to contribute to help reduce its costs whenever possible. I have also read with great interest about delaying cord clamping at birth and that it may impede the collection of cord blood. I believe that if delaying clamping also helps to provide a better start for a newborn, then it should take precedence over the collection. Merci. Expecting grandmother.

  6. Meghan

    I understand the need for diversity among donations. What I don’t understand is how the Canadian Blood Services cord blood donation information pamphlet requires fluency in English or French as a qualification to donate when they are looking for diversity.

  7. Charlene Rae

    |Cord blood is a viable for research. Cord blood collection should be standardized to help with leukemia and cancer treatments. No one should have to go through all the chemo and radiation etc if there is a better viable option. The more we collect the better the odds. Storage has to be far less costly than the other options of off shore search for match. If all new babies had their cord blood banked then how easy would that make treatment in the future.

  8. Thekla

    We would trust a national cord blood bank more than a private one. We signed up 10 y ago when our son was born and in year 7 they stopped sending annual invoices. When reminded, the invoice was sent. I now stopped reminding them and wonder now if our sample is still stored or not. Any tip how to verify? If I announce my visit in order to see our sample, they could stick a label with our name an any vial. I have no trust. Someone else has gone through it?

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