Cord Blood Donation Can Save Someone’s Life

For generations, the umbilical cord and placenta of a new baby was considered nothing more than medical waste, something to be tossed out after the delivery. But advances in science have revealed that the blood left in both the cord and placenta contains cells that can be stored and used later by patients suffering from more than 70 life-threatening diseases and conditions.

In order to draw attention to the gift that keeps on giving, medical communities celebrate World Cord Blood Day on November 15 each year. It’s a way of highlighting the value of the gift as well as the more than 35,000 cord blood transplants performed in the past 30 years.

“Allogeneic transplants, or transplants performed using a donor other than the patient, are the best lifesaving treatment option for many patients with leukemias and other blood diseases. At Sylvester Comprehensive Cancer Center at the University of Miami Health System, we perform over 100 of these transplants per year, of the roughly 250 total transplants we perform each year.  Critically, umbilical cord blood can be used with a high degree of success even if it’s not as well matched as other alternatives,” explains Dr. Krishna Komanduri, a Sylvester hematologist and transplant expert. “It’s an excellent alternative source for patients who lack other donors.”

The value of cord blood

Cord blood is full of hematopoietic stem cells (HSCs), which are capable of developing into many different types of circulating blood cells and are therefore responsible for the constant renewal of blood in our bodies. But what makes cord blood cells so valuable is that they can help a patient when a match hasn’t been found via a sibling or an unrelated donor.

The umbilical cord is one of three sources of blood-forming cells; the other two are bone marrow and peripheral blood stem cells. But using bone marrow and peripheral blood stem cells usually requires a very close match between donor and recipient. In fact, transplant doctors look for nine out of 10 markers to match. (If there’s a mismatch, it is more likely either for the donor cells to attack healthy recipient tissues or that the donor cells could even be rejected.) It is estimated that 70 percent of patients won’t have a family donor and will have to seek either bone marrow or cord blood from an unrelated donor.

Fortunately, cord blood, unlike bone marrow, does not need to match as closely — and it can work just as well by replacing diseased blood-forming cells with healthy cells.

“It’s been shown that patients can tolerate the cord blood transplant with more mismatches,” Komanduri explains. “It’s not that it’s necessarily better than other sources, but it may be the only option for some patients.”

This is true when a patient needs a transplant very quickly. While finding a marrow match and collecting a donation can take weeks, even months, cord blood units kept in public cord banks are more readily accessible.

Cord blood transplants serve as treatment for blood cancers and other blood conditions, including leukemias and lymphomas, multiple myeloma and other plasma cell disorders.

Other treatable illnesses are inherited immune system disorders, inherited metabolic disorders, sickle cell disease, severe aplastic anemia and other marrow diseases.

Of course blood cord transplants aren’t perfect. “The immune system recovers more slowly, so a patient may be more susceptible to infections for a longer period of time,” Dr. Komanduri says. “Because babies have not been exposed to as many pathogens, they [and their blood cord cells] have what I call a relatively naïve immune system.”

What’s more, recent medical advances have improved the outcome of transplants that use a haploidentical donor — someone who might be a 50 percent match to the recipient — by decreasing potential rejection. These donors are usually a parent, child or sibling.

Nevertheless the need for cord blood donations persists, particularly from minority racial and ethnic communities, including, African-American, Asian, Native American, and Hispanic. (Recipient and donor are more likely to match if they have the same ethnic background.) According to the non-profit registry and advocacy organization Be The Match, which is operated by the National Marrow Donor Program, 28 percent of umbilical cord blood transplants in 2017 were performed on transplant patients of color.

How it’s collected

Collecting cord blood is painless and straightforward. The umbilical cord is clamped and cut after a baby is born. Then, a needle is inserted into the cord itself to collect the remaining blood. This is sent to a cord blood bank where it is tested to ensure it is free from infection or disease and to make sure there are enough blood-forming cells needed for a transplant. It is also tissue typed and listed on the registry. If the donated cord blood unit has too few blood-forming cells, it can be used for research.

New parents have two options if they want to collect blood cells from their baby’s umbilical cord. After they give their consent, these stem cells can be stored in a private or public bank. Parents who choose the private route pay an annual fee that can run into the thousands of dollars.

Komanduri, however, doesn’t encourage such an option, unless there’s a known genetic disease in the immediately family. “Almost no private cord blood has been clinically used,” he says. “There’s really little societal value.”

Both the American Academy of Pediatrics and the American Congress of Obstetricians and Gynecologists recommend the use of private cord blood banks only when there’s a sibling with a medical condition who could benefit from the stem cells.

Donating the cord blood to a public bank, on the other hand, makes it available to those in need. The Be The Match Registry, for example, allows doctors to search its list of potential bone marrow donors and donated umbilical cord blood units to find a match for their transplant patients who don’t have a match in their family. It also costs nothing to store.

“It’s truly an altruistic donation,” he says. “Parents are helping people who need the help.”

In Their Words
Ana Veciana-Suarez, Guest Contributor

Ana is a regular contributor to the University of Miami Health System. She is a renowned journalist and author, who has worked at The Miami Herald, The Miami News, and The Palm Beach Post. Visit her website at anavecianasuarez.com or follow @AnaVeciana on Twitter.

Tags: blood transplants, Dr. Krishna Komanduri, leukemia, Sylvester Comprehensive Cancer Center, World Cord Blood Day