Should cord blood be collected for the future benefit of the child? The current debate about stem cell research has focused attention on cord blood and commercial firms are cashing in by offering to collect and store cord blood for future purposes.
Companies are advertising collection as a biological insurance whereby the blood is kept for possible transfusion if the child develops leukaemia or some metabolic disease. Claims, which are presently speculative, suggest that future medical advances will use the blood to cure diseases such as diabetes, breast cancer, ovarian and testicular cancer, melanoma, rheumatoid arthritis or for the regeneration of damaged heart valves. More accurate predictions would be that better treatments for childhood leukaemias will be found that do not require autologous cells. In any event, donor cord blood can be used.
The scientific arguments are in fact pseudoscience in that they talk about future “yet to be discovered” developments. Maybe there will be inventions that will need the patient's own cord blood, but research will be extremely difficult as trials testing “own versus other” blood will be a recruiting nightmare. At present, the likelihood of stored blood being used is very low - quoted at between 1 in 1 400 and 1 in 20 000 (Edozien BMJ 2006;333:801-4).
The Royal College of O&G says storage cannot be recommended because of insufficient scientific evidence and logistic problems. The American and Canadian Colleges are also critical of the process, as are midwifery, paediatric and ethical bodies. There are also medico-legal issues, like whose responsibility is it to take the blood, ensure it is free of contamination, correctly consent its collection, labelling, storage and testing for viral and other dangers? To whom does the blood belong - mother or child? Does the collection process take priority over other labour ward procedures?
It is clear that it cannot be a routine practice, but should those with sufficient resources be advised to pay for it? Parents-to-be want the best for their unborn child and can be considered vulnerable to promotion of this “just in case” philosophy. Yes, personal cord blood may be useful in future situations but at present it is more likely that other measures will overtake autologous transfusions. Medical science says “no” right now but there are other sciences and other beliefs, so it is up to individuals to decide whether recommending cord collection is medical paternalism or sound advice.
