There is universal interest in developing a permanent source of cells which would be capable of generating any cell type and which would avoid the problem of transplant rejection. These human stem cells have the unlimited capacity to divide and the potential ability to develop into most of the specialised cells or tissues of the human body.

Human stem cells can give rise to different types of cells such as muscle cells, nerve cells, heart cells and blood cells. They could be potentially useful in generating replacement cells and tissues to treat many conditions, including Parkinson’s disease, Alzheimer’s disease, leukaemia, stroke and heart attack.

There are two major sources of stem cells: adult stem cells and embryonic stem cells. Cord blood is a relatively rich source of haemopoietic stem cells (HSC). About 100ml can reconstitute the haemopoietic system in small patients, usually children. The first successful related cord blood transplant was undertaken 16 years ago. Since then, over 3,000 transplants have been done worldwide.

In the past, the media has been highlighting such successes. It brings hope to many affected families. The best known staunch supporter of embryonic stem cell research Christopher Reeves (a.k.a Superman) did not live long enough to witness any major breakthroughs in stem cell cures for his spinal paralysis.

It is important that we do not lose perspective of the limitations of this new technology and thus send wrong messages and create false hopes to the general public.  Private cord blood banks has hyped on anecdotes and isolated examples of success in stem cell therapy. The issue is clouded further by the sales pitching and often non-evidence based medicine claims of private cord banks. Undoubtedly, parents would be vulnerable to “emotional marketing” at the time of the birth of their child. Professor Nick Fisk, Chairman of the Royal College of Obstetrics & Gynaecology Scientific Advisory Committee said “We are concerned that commercial companies are targeting pregnant women with such emotive literature when the scientific evidence is not yet there to back up their claims”.

There are no accurate estimates on the likelihood of children requiring their own stored cord blood. The best guess of this ever happening range from 1 in 1,000 to 1 in 200,000. There is therefore only a tiny and remote chance of children ever requiring to utilize their own stored cells.

Scientific indications for collection and banking of cord blood are far and few in between.  In families where there is a known genetic disease that can be treated by HSC transplantation, cord blood collection and storage are recommended for siblings born into these families. Cord blood collection is also recommended in specific settings, for e.g. 

1. A sibling who is suffering from leukemia, just in case he relapses and may require cord blood transplantation
2. A sibling in whom cord blood transplant is indicated but has no match related donor available.

The storing of cord blood privately by private cord banks is based on the premise that the sample is stored specifically for use within the family concerned and more specifically the child's own future use (autologous transplant).

Autologous transplantation itself may be problematic because the use of one’s own stem cells may not cure the underlying pathology. In the case of leukaemia and other congenital disorders, e.g. Thalassaemia and Fanconi’s Anaemia, transplanting one’s own stem cells with the defective genetic and immune structure would only result in returning the disease to oneself.

The 80-100ml of umbilical cord blood collected at birth may not be adequate when the baby grows into an adolescent or adult. The volume of cells is insufficient if he should ever require it later in life. Thus, the concept of a 'biological insurance' which is much hyped by the private cord banks is therefore actuarially unsound given the very low estimates on the likelihood of use, or the need of using one's own cord blood for transplantation. The emotional marketing is however burgeoning the bank balances of private cord banks.

The government has now come out with some guidelines to address the issue of cord blood collection and cord blood banking for future transplantation. The National Blood Bank has been collecting and banking cord blood as part of its non-profitable National Cord Blood Bank. The National Cord Blood Bank would be available to doctors to search the public registry for possible unrelated but matched samples as an alternative source for stem cell transplantation.

In the final analysis, public cord blood banking should be expanded for the benefit of the wider population. Collection of altruistic donations of cord blood and directed donations for families at high risk should be encouraged. The National Cord Blood Bank was set up to achieve these objectives at no cost. Rather than just to keep the cord blood banked for one's own use, it should be made available to others who may need the cord blood in the allogenic (genetically different) setting.

Dato’ Dr Musa Mohd. Nordin, FRCP