Untying the Gordian knot: policies, practices, and ethical issues related to banking of umbilical cord blood

Abstract

Since the first successful transplantation of umbilical cord blood in 1988, cord blood has become an important source of hematopoietic stem and progenitor cells for the treatment of blood and genetic disorders. Significant progress has been accompanied by challenges for scientists, ethicists, and health policy makers. With the recent recognition of the need for a national system for the collection, banking, distribution, and use of cord blood and the increasing focus on cord blood as an alternative to embryos as a source of tissue for regenerative medicine, cord blood has garnered significant attention. We review the development of cord blood banking and transplantation and then discuss the scientific and ethical issues influencing both established and investigational practices surrounding cord blood collection, banking, and use.

Figure 1

Cord blood harvest following delivery. The placenta is suspended, fetal side down, in a stand lined with a clean chuck pad. The cord is brought down and gently tethered onto a work surface below. The cord is prepped with betadine and alcohol. The umbilical vein is punctured with a 17-gauge needle attached to a sterile, pre-barcoded collection bag containing 25 ml citrate phosphate dextrose anticoagulant, which is placed on a rocking scale. The cord blood flows into the bag by gravity over approximately 9 minutes. Cessation of flow is indicated by stabilization of the bag weight on the scale. After completion of the collection, the tubing is stripped and heat sealed. The cord blood collection bag is transported to the processing laboratory.