For weeks before our first son was born, visitors to our house commented about the box that sat with my hospital bag next to the front door. Labeled "Caution: Human Whole Blood" in bright red lettering, it seemed destined to invite vampire jokes. When we patiently explained to our friends about cord blood banking—that we were having our son's umbilical cord blood frozen for potential future medical use—we got a variety of reactions: polite, confused, disinterested, skeptical. Most people thought we were nuts. That was in 2001.
Misconceptions Regarding Cord Blood Banking
At the time, even my OBGYN was against cord blood banking. He quoted the American Academy of Pediatrics (AAP), which said in 1999, "Given the difficulty of making an accurate estimate of the need for autologous transplantation (one's own blood) and the ready availability of allogeneic transplantation (someone else's blood), private storage of cord blood as 'biological insurance' is unwise." He agreed to perform the collection procedure, but he really thought I was being swindled.
I couldn't blame him. I, too, had been a skeptic. When my mother suggested cord blood banking as her gift to our unborn son, my first thought was, "There are so many other things we could get with that money!" My second thought was, "Besides, isn't that a scam?" I began to research cord blood storage with the goal of talking Mom into giving us something more practical.
Yet the more I learned about cord blood and its uses, the more storing it sounded like a great idea. Even in 2001, there was a long list of diseases and conditions that could be treated, maybe cured, with cord blood: leukemia, certain cancers, and anemia. According to the March of Dimes, more than 70 disorders can now be treated with stem cells from umbilical cord blood.
Even though the AAP had said storage of cord blood as "insurance" was unwise, the word "insurance" stuck in my mind. The decision to purchase insurance is really based on odds: when one buys flood insurance, for instance, one is assessing the odds that it will be needed. In 2001, the odds of a person developing a disease that could be treated with cord blood were generously estimated at 1 in about 200,000. In other words, not very likely.
Chances of Needing Cord Blood
I began to ask myself, "What if?" What if my son did develop cancer or leukemia, for example? Just how likely was that? I thought about our family's medical history. I'd lost my dad to lung cancer, my grandfather to leukemia. My mom was fighting breast cancer. As the list went on, I realized something that has just recently been proven true: the chances of someone developing a disease or condition that the medical community may be able to treat with cord blood is a lot more likely than 1 in 200,000.
According to recent data based on the Abt Associates Clinical Trials 2004 cord blood study, it could be as low as 1 in 27 for the average population (though not all patients with a disease treatable with cord blood stem cells qualify for transplant). Further studies show that given the current indications for hematopoietic stem cell transplantation (HCT), the lifetime likelihood that a child will someday need cord blood stem cells is estimated at 1 in 400, with odds that a child or family member may benefit from banked cord blood at 1 in 200.
What about the "ready availability of allogeneic transplantation" referred to by the AAP? According to a 2002 US Government Accounting Office report, "the theoretical probability of finding a match [in the National Marrow Donor Program] varies by race, ranging from under 60 percent for African Americans to over 80 percent for Caucasians." This means that there's no matched donor in the registry for at least twenty percent of the people searching. Although there are other registries out there, some people still die while waiting for a donor. That's hardly what I would call "ready availability." On the other hand, if we decided to bank, our son's cord blood would be just a call away.