When Suma Gireesh, a software professional in Bangalore, was pregnant, one of the many decisions she took was opting for private cord blood banking. “I had seen the brochures for it at my gynaecologist’s office and it sounded like a lot of medical cures in future would be based on stem cells,” says Gireesh, whose child is now five years old. For Suranya Aiyar, a lawyer in Delhi, the reasons were more personal. “My mother-in-law had breast cancer, and my husband had read that research in stem cell therapy was on the verge of a breakthrough, so he was very keen that we do it,” says Aiyar who got several calls from cord blood bank executives as soon as she registered at a private hospital for delivery.
To the list of things Heidi Murkoff or the good Dr Spock tells you to expect when you’re expecting, today’s upwardly mobile and affluent parents-to-be can add another: being approached to consider private cord blood banking. Cord blood banking is the process of collecting the blood from the umbilical cord and placenta at the time of delivery and preserving it in a stem cell bank, usually for 18 to 21 years. Ever since the first cord blood transplant was performed in 1988, the buzz around cord blood banking has been growing, aided by progress in stem cell research. The reason? “The umbilical cord, which is usually discarded at the time of the baby’s birth, is a rich source of these life-saving stem cells,” says Mayur Abhaya, CEO and managing director of LifeCell, the first private cord blood bank to set up operations in the country. Stem cells are prized for the ability to develop into different types of cells, and research is underway for its application in various treatments.
Cord blood is also thought to have advantages over other sources of stem cells, such as bone marrow. “Cord blood is a better source for stem cells because it can be easily collected, without any risk to the mother or the child. Other benefits include less chance of graft cells attacking the host and emerging data on its utility in regenerative medicine,” says Mrinalini Chaturvedi, medical director at Cryobanks, another private cord blood bank.
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Much of the growth in cord blood banking in India is led by the private sector, which markets the procedure heavily. LifeCell, the largest private cord blood bank in India, says its samples have grown from 100 when it began operations in 2004 to over 60,000. Cryobanks has collected 35,000 private units from India, Africa and Dubai, and is in the process of setting up new banks in Africa and other countries in Asia. “Growth has snowballed,” says Chaturvedi who adds that the sector itself is seeing compound annual growth rate of 30 per cent. In contrast, Jeevan, one of the three public cord banks in the country, has just 850 units banked with it and is currently limiting the number of samples it accepts due to a paucity of funds. Public cord blood banks do not levy a fee for collecting and storing cord blood but parents relinquish their rights over the sample, as opposed to private blood banking, which costs between Rs 75,000 and over a lakh and where the depositor has sole rights over the sample. (In countries like the US, the emphasis is on public cord blood banking, which is supported by government funds, as it increases the donor pool available to the general population and, consequently, gives you a greater chance of finding a matching donor).
But while there might be consensus that the use of cord blood in stem cell therapy has tremendous potential, you might keep a few factors in mind if you are considering private cord blood banking.
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Ask a parent why he or she decided to harvest and store cord blood, and a likely response is “It’s a form of biological insurance for my child”. This is not surprising, considering this is also the line peddled by private cord blood bankers. But is it, really? “I would not say so — there is no evidence to support such a statement,” says Revathi Raj, consultant paediatric haematologist at Apollo Specialty Hospital, Chennai.
“I have as much chance of using my own cord blood as I have of being struck by lightning,” says Raj, succintly.
While the companies trot out a list of 70 to 80 diseases that have proven to be treatable with cord blood, remember that all these ailments come under the same umbrella of haematological (blood-related) illnesses. And in blood-related and genetic ailments, autologous transplants, where the donor uses his or her own cells, is not recommended because they are likely to carry the same genetic defect, says Dr Saranya Narayan, medical director at Jeevan Blood Bank, the public cord blood bank. The use of cord blood stem cells in other ailments looks promising but currently, much of it is only in the early stages of research, she adds. But private cord blood banking can be considered if an immediate family member (parents or sibling) has an illness that can be cured or has the potential to be cured with stem cell therapy and, fortunately , also has the identical human leukocyte antigen (HLA) pattern as the child from whom the cells will be collected.
Additionally, remember that the stem cells that are present in collected cord blood is usually adequate only for a patient weighing around 30 kg, and not a fully grown adult. This shortcoming, says Chaturvedi, is being overcome by dual cord blood transplant, where the cord blood of two infants is used. But this would necessitate using matching cord blood from another donor, and not just what you have banked.
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Ponnu Liz Malieckal, an assistant professor at a college in Kerala and now a mother of a seven-month-old, recalls being in a dilemma over whether to bank umbilical cord blood cells while she was pregnant. The 28-year-old had first heard of the process from an executive who called her soon after her visit to the gynaecologist but with collecting and storing the cord blood in private banks costing close to a lakh, the decision was not easy, especially with the executive using statements like “It’s not too much money to spend on the child you will have.” The couple finally decided against it after a paediatrician friend they consulted told them it was not necessary but Malieckal admits that there was a time when they were torn.
Parents are in a vulnerable position where their children’s well-being is concerned, and make an easy target for marketing. The decision, ultimately, is that of the parents alone but when presented with the argument that they might be denying their child “biological insurance”, few will think twice. And while one can argue that marketing executives are only doing their job, there are instances of doctors, too, nudging parents.
Gireesh, the software professional in Bangalore, says her doctor recommended private cord blood banking, which played a crucial role in her decision. This is in spite of the fact that even the banks will admit that the utility of autologous storage of umbilical cord blood for approved medical use is currently limited.
Companies will also tell you that harvesting cord blood is a once-in-a-lifetime opportunity, which is true enough. But should the need arise, stem cells can also be harvested from other sources such as peripheral blood and bone marrow (each with its own advantages and drawbacks) and research is going on to extract it from other sources such as menstrual blood.
The fact remains that the use of cord blood in the treatment of various illnesses does hold a lot of potential. But if you are considering private cord blood banking, make sure you take your decision after understanding all the details, especially the limitations.