Frequently Asked Questions
The following questions are commonly asked by parents.
If you would like additional information about cord blood donation, please contact us at: firstname.lastname@example.org or 905.471.1113
CORD BLOOD USE
CORD BLOOD USE
Q: Are umbilical cord blood cells the same as embryonic stem cells?
A: No these cells are not the same. Embryonic stem cells are extracted from human embryos. Umbilical cord blood is just the blood left in the umbilical cord and placenta after a baby is born. It is usually discarded in the medical waste. There are no ethical, religious** or moral objections to the use of cord blood stem cells. **Jehovah Witnesses will not use blood in medical treatment including cord blood.
Q: How is cord blood used in medical treatments?
A: Cord blood is most often used in transplant to replace defective bone marrow that has been damaged by disease, environmental factors or cancer treatment (chemotherapy or radiation). Here is an overview of the process: Cord blood is collected at birth and sent to a specialized laboratory where the stem cells are separated from the other parts of the blood. The stem cells are carefully frozen to -190 degrees Celsius and stored at those temperatures until needed. When the sample is required for treatment, it is shipped to the transplant centre in the frozen state. It is thawed then transfused into the recipient’s bloodstream intravenously similar to a standard IV. The transfusion takes approximately 15 – 30 minutes. The body must then assimilate these new cells into the bone marrow so that the body can generate its own blood cells using the new bone marrow. It can take anywhere from 17 – 35 days for this engraftment to occur. During this time, the patient must be protected from all outside bacteria and viruses because the immune system is unable to fight disease.
Q: Who will use donated cord blood?
A: Researchers and medical transplant physicians to treat sick patients.
Q: How do transplant physicians use a donated sample?
A: Samples are reviewed when they arrive at the stem cell processing lab. Those that meet Victoria Angel’s criteria for medical treatment are processed and stored. Transplant physicians can access those samples for their sick patients. The following will occur:
- Transplant physicians will determine that their patient requires a cord blood transplant.
- The doctor will distribute information about the patient’s tissue type to various registries in search of a sample that matches or partially matches the patient’s tissue type.
- If a public bank has a suitable sample, confirmatory testing is done on the sample to ensure that the tissue typing is consistent with the information listed on the registry before it is infused into the sick patient.
- The cord blood sample is shipped to the transplant centre and transplant is completed.
Q: Do sick patients pay for the cord blood when they need it from a public bank?
A: Most public banks charge ~ $40,000 US per sample as a means of recovering expenses associated with the costly program. Shipping charges are also required. In Canada, most provincial health plans pay these costs. In some cases there are limitations should a larger person require two cord blood units for a ‘double cord transplant.’
Q: If someone in my family needs cord blood, when would they use a sample stored privately in a family bank and when would they use a sample from a public bank?
A: If a bone marrow or cord blood donor cannot be found within the family, physicians must search in public registries for a suitable treatment option. Transplant physicians will consult with patients when making their decision about treatment options.
In all cases, transplant doctors will consider:
- Type of disease – Some diseases can be treated using one’s own cells. This is called autologous transplant. Some diseases must be treated using cells from another person such as a family member or an unrelated donor (allogeneic transplant). The type of the disease will dictate whether they physician can use the patient’s own cells or if a donor must be located either in the family or in donor registries.
- Availability of treatment cells – The first place transplant doctors will look is at the family to see if there is a matching bone marrow donor or a suitable cord blood sample from a family member. These options are easily accessible and treatment can be given quickly before the patient becomes sicker. If there are no suitable options within the family, the physician must search donor registries to find an appropriate bone marrow donor or cord blood sample.
- Number of stem cells in the available sample – Treatments have better outcomes and fewer complications if higher cell doses are used. The required dose is calculated by using the patient’s weight.
- How quickly the patient needs treatment – Cord blood is frozen and ready to use. For bone marrow and peripheral blood donation it takes more time to find the donor and to prepare the donor for extracting the cells.
- The reliability of the cord blood bank – A Cord blood sample is more likely to be acceptable to a transplant physician if the bank where it has been processed and stored is experienced and accredited by FACT and/or AABB and has successfully released cord blood samples for treatment in the past. Victoria Angel has passed regulatory inspections by Health Canada and is accredited by an internationally recognized accreditation body, FACT. In addition, Victoria Angel’s recent release treated a patient in the European Union; engraftment was successful.
DONATING CORD BLOOD
CORD BLOOD DONATION
Q: If I donate umbilical cord blood is it always stored?
A: Public banks world-wide store only samples that are safe and have the highest odds of being used. The following criteria must be reviewed when determining if the sample is delegated to the research or whether it can be used for medical treatments:
- Donor acceptance criteria are met
- Time between collection and processing is < 48 hours
- Medical testing results reflect no cause for medical concern
- The overall cell count must be high –
- No labelling errors at collection
- Shipping temperatures have met requirements
- No other non-conformance issues are identified that preclude storage
At most public banks, less than 20 – 25% of donated samples are stored for medical use. All others are either delegated to research projects or are discarded.
Q: What happens to my cord blood if it is acceptable for storage?
A: If the cord blood unit is deemed suitable for transplant, it will be processed in the lab to extract the stem cells from the other blood components. The unit is assigned a unique bar-coded identifier. The donor’s name is not listed anywhere on the sample. The stem cells are then frozen and stored in a liquid nitrogen freezer. The maternal blood and a small aliquot of cord blood are tested for viruses and bacteria. If all is fine, tissue typing is completed and the unit is listed in the Registry’s central data base for transplant physicians to access for patients in need.
Q: What happens to my cord blood if it is NOT accepted for storage?
A: In most cases, samples that are not stored will be dedicated to authorized research projects or discarded. Research projects must complete an ethics review process to be able to obtain samples from Victoria Angel.
Q: Why do ethnic minorities or families with mixed ethnic backgrounds have special needs?
A: Tissue types (also called HLA types) are inherited. Patients are more likely to match someone who shares their racial or ethnic heritage. People of Aboriginal, African American, Asian, Southern European, or ethnically mixed families have a low probability of finding a suitable bone marrow match because these groups have such a large number of unique and diverse HLA tissue types. Unfortunately, bone marrow stem cell transplants require that the tissue type of the donor must be an exact match to the recipient (6/6 HLA match). Otherwise, complications will arise that will be fatal.
However, cord blood stem cells are more ‘malleable’. Cord blood can be used successfully with only a 4/6 HLA match. Many times, cord blood is the only hope for people who would otherwise never find a perfect match. In 2008, 36% of cord blood units used in transplants facilitated by the NMDP in the USA went to patients from racially or ethnically diverse communities.
Q: I am delivering at an Ontario hospital outside the GTA. How do I donate my baby’s cord blood to a public bank?
A: Check with your birthing professional to see if your hospital has a program that provides cord blood to research projects; you may be able to participate. Otherwise, you will not be able to donate your cord blood. Your only other options are to store it at a family bank (fees apply) or discard the cord blood in the medical waste.
Q: When should I contact the cord blood bank about donating umbilical cord blood?
A: Contact us during your 2nd trimester. You should preferably register before your 34th week of gestation. This allows time for Victoria Angel’s Medical Review Panel to screen your application. In addition, we must ensure that you receive the cord blood collection kit before labour begins.
Q: What if I decide that I want to donate later in my pregnancy?
A: If we are not able to go through the screening process and get the kit to you, you will not be eligible for our program.
Q: Does it cost me anything to donate cord blood?
A: There is no cost to parents who are accepted into the Victoria Angel program. Parents must speak to their physician to ensure that the doctor and hospital will waive any collection fees.
Q: Will donating my baby’s umbilical cord blood change my delivery experience?
A: Doctors and midwives do not change their current birthing practices when cord blood is collected. The cord blood is collected after your baby has been safely delivered. No blood is taken from your baby, only from the cord and placenta after the cord is cut.
Q: Can I donate cord blood if I wish to delay clamping the cord?
A: If you delay clamp 60 seconds or less, you may still donate your cord blood to a public cord blood bank. Your collector may need to be encouraged to work a little harder to ensure that there is adequate cord blood. This is achieved by performing multiple punctures in the cord and placenta with proper sterile technique.
Q: Can I donate if I’m having twins?
A: No. Most public banks, including Victoria Angel, cannot accept donations if you are having twins.
Q: How is our privacy protected after donating cord blood to a public cord blood bank?
A: Victoria Angel Registry of Hope protects the privacy of your family by keeping your names and contact information confidential. Names are not shared with any patient or transplant center. The baby’s cord blood is identified by a number, never by name.
Q: Are cord blood transplant patients ever given information about their donor?
A: No. The transplant centre requires medical information to ensure that the sample is safe for transplant. However, all identifying information is removed. It will not be available to the transplant centre or the cord blood recipient. They will not know your identity or the identity of your child.
Q: Will I be told if my sample is used?
A: No. You relinquish all rights to your sample and will not be notified of its use.
Q: Is it possible to store part of my sample privately and part of it at the public bank?
A: No. It is best to keep as many cells as possible in one sample.
Q: Can I change my mind once I have registered for the public banking program?
A: Yes. You can change your mind at any time until the cord blood sample reaches the cord blood processing laboratory. If you change your mind, you can elect not to collect the cord blood at birth. Once it is collected, you can decide not to ship it to the lab. However, you relinquish all rights to the sample the moment it reaches the laboratory.