New Postpartum Trend: Mailing in Your Cord Blood

New mail-in donations aim to keep valuable stem cells out of the trash

By Bonnie Rochman Monday, July 26, 2010
    • Max Aguilera-Hellweg

    As their due date creeps closer, many pregnant women pack a go bag for the hospital: toothbrush, iPod, cute bringing-baby-home outfit. But in recent months, savvy mothers-to-be have started tucking in one more important item: a kit to collect and donate the blood in their babies' umbilical cord.

    Cord blood is a noncontroversial source of stem cells, yet experts estimate that 99% of this potentially lifesaving resource gets thrown away postpartum. Unlike the stem cells in human embryos, which can morph into any kind of cell in the body, the stem cells in cord blood have their futures largely mapped out, as blood, brain, liver or heart-muscle cells, for example. But researchers have shown that cord-blood cells can be reprogrammed, and over the next decade, doctors hope to adapt these cells to treat heart attacks, strokes, diabetes and maybe neurodegenerative diseases too. Cord blood is already being used in therapy regimens for patients with cancer, sickle-cell anemia, immunodeficiency, marrow failure and genetic diseases that call for transplants.

    Private cord-blood banks aggressively advertise their services to pregnant women and charge a bundle — some $2,000 for initial processing and about $125 per year after that — to store cord blood that can be used only by the donor's family. These for-profit companies lean heavily on the fear factor, encouraging parents to bank their baby's blood just in case a relative needs it one day.

    Public banks, by contrast, make their contents available to anyone who is a close-enough match. (There are 10 different proteins, or markers, involved; the more markers that line up, the closer the match. Although cord-blood therapies don't require a perfect match, transplants relying on adult bone-marrow donors do.) But there are only 19 public banks in the U.S., and until recently the only way women could donate to them was to give birth in one of the 175 or so affiliated hospitals that have a system in place to collect and transfer cord blood.

    That's where the Public Kit Donation project comes in. Three hospitals — two in Texas, one in North Carolina — are piloting a federal program that allows women to mail in cord blood from anywhere in the continental U.S. for inclusion in Be the Match, the national cord-blood registry. The project, which quietly launched in May and is being reported about first in TIME, lets moms-to-be request a free collection kit and teaches doctors how to use it in a seven-minute online tutorial.

    The temperature-controlled kit, about the size of a microwave, is packed with consent forms, vials for the mother's blood so it can be screened for HIV and other infections, and a bag with blood thinner to keep the cord blood from clotting. Turnaround has to be quick: the blood must be frozen at a bank within 48 hours of the baby's delivery. Experienced technicians typically siphon 2 to 8 oz. (60 to 240 ml) of blood per umbilical cord, but even they retrieve the minimum amount to qualify as a unit for donation (about 900 million cells) only about half the time, since the placenta doesn't always cooperate.

    It costs moms nothing to donate. The tab for collection, processing and storage can run to $2,500 but is being split by the government and the participating banks. Whenever matches are made, the banks are paid by recipients or their insurance companies, the same as they would be for a donated pint of blood from your arm. (Cord blood is far more valuable, however; a unit can cost up to $35,000.)

    Dr. Joanne Kurtzberg, director of the Carolinas Cord Blood Bank at Duke University, came up with the idea of remote collection after sending out similar kits to expectant parents whose baby might be a suitable donor for a sick family member. "We thought, Maybe this could work for public donors too," she says.

    Doctors hope to increase the number of minority donors in particular, because multiracial patients have a more difficult time finding a match. This reality received some attention in recent months when the parents of Devan Tatlow, a 4-year-old boy with leukemia, were seeking cord-blood donations from multiracial babies in the hopes of finding a match for their son, who is half South Asian and half white.

    Moved by that quest, Baltimore attorney Urmila Taylor — whose son, born on June 30, is of the same ethnic composition as Devan — decided to bank publicly rather than privately. Since no Maryland hospital is set up to directly accept cord-blood donations, Taylor requested a kit from Duke and asked her doctor to complete the online training. "She said, 'O.K., great,' " says Taylor, 33. "She also said it's a shame that for most women, it gets thrown literally in the garbage can."

    Not every doctor is as supportive in this era of tightly managed care. Collecting cord blood involves extra paperwork and extra time in the delivery room, and a few busy docs have expressed unhappiness about working for free, says Michael Boo, chief strategy officer at the National Marrow Donor Program, which administers the country's network of public cord-blood banks. But, he adds, "most understand this is a donation from the family to the public."

    "Cord blood is a resource," says Sarah Lueck, 33, a health-policy analyst in Takoma Park, Md., who is due to give birth in mid-August and plans to have her midwife collect her baby's cord blood. Lueck, who is listed on her driver's license as an organ donor, says, "If something happened to me, I would want my organs to be used by someone who needed them. It's sort of the same idea." To make sure she won't forget the kit (as one of the first women to receive one did), she's stashing it — where else? — in her birth-center go bag.