Umbilical cord blood banking Richard Branson's way

Abstract

Last week, Richard Branson expanded his ubiquitous Virgin Brand by branching out into an unusual and controversial area. For GB£1500, parents can buy processing and 20-year storage of umbilical cord blood. The UK National Public Cord Blood Bank currently stores over 7000 units of cord blood samples, altruistically donated for non-directed use, under the auspices of the National Blood Service. Private cord blood banking for personal use has also been in existence for some years and there are currently seven other private banks in the UK. These private banks have been widely criticised by health-care staff and medical colleges, such as the Royal College of Obstetrics and Gynaecology (RCOG), for approaching parents at a vulnerable time, making far-fetched references to future regenerative use in diseases such as Parkinson's disease, diabetes, and heart disease, while concealing the true likelihood for personal use for current indications, which is somewhere between one in 1000 and one in 200 000.What makes the Virgin Health Bank different is a dual public-private approach. A fifth of the cord blood sample will be stored for private use, for the child or a family member, and the rest will be donated to the public part of the bank, which is accessible to anyone in the world who needs it, at no cost. Additionally, Branson has pledged to donate his 50% of proceeds from Virgin Health Bank to initiatives involved in realising the potential of cord blood stem cells.Cord blood transplants are increasingly being used in preference to bone marrow transplants for several conditions, such as leukaemias, haemoglobinopathies, and some inherited metabolic diseases, because of fewer complications, easier availability, and higher matching success, especially for people from ethnic minorities. Since 1988, more than 7000 cord blood transplantations have been done around the world. The three main limiting factors are: first, the number of cells from one cord blood unit is usually not sufficient for an adult weighing more than 50 kg, but early results with double umbilical cord blood transplantations are encouraging; second, for many conditions, transplanting the child's own cord blood is not recommended because the defect is present in those cells already; and third, the available samples in public cord blood banks will not be sufficient as demand increases.At the end of last year, the US Health Resources and Services Administration, part of the Department of Health and Human Services, awarded US$12 million to a group of umbilical cord blood banks to begin collections for the National Cord Blood Inventory. Following advice from the Institute of Medicine set out in a 2005 report, the aim is to create an inventory of 150 000 high-quality cord blood units, to establish a centre for cord blood donations, which will allow doctors to find the best match with one phone call regardless of where the sample is held, and to systematically analyse the outcomes of cord blood stem cell transplantations.Undoubtedly, umbilical cord blood stem cells already show great promise for clinical use in several conditions in children and adolescents, and with better techniques and more samples available they may also be useful in adults. But they are also of great interest to researchers as a less controversial source of stem cells than those from fetuses or embryos. In-vitro experiments have shown that cord blood contains pluripotent stem cells that have the potential to differentiate into cardiac, neuronal, pancreatic, and skin tissue. These are very early findings, but progress in this field may lead to exciting possibilities for future generations. Any attempt to increase the available pool of umbilical cord blood cells, which are otherwise just discarded, should be enthusiastically praised.Branson has struck an interesting chord by combining altruism with self interest. Parents can be reassured that their family will benefit if needed, however remote the possibility, and at the same time they serve the public good. The cries by staff in the UK's National Health Service (NHS) and by the RCOG that the collection must not interfere with the care of mother and baby at a critical time and that already understaffed units and hospitals cannot provide the service of cord blood collection on demand, just show how unresponsive the NHS has become. Despite all its apparent emphasis on so-called patient choice, the UK Government has changed a once great service into a monolithic outdated business without the capability to fully embrace such exciting new initiatives as cord blood banking. Last week, Richard Branson expanded his ubiquitous Virgin Brand by branching out into an unusual and controversial area. For GB£1500, parents can buy processing and 20-year storage of umbilical cord blood. The UK National Public Cord Blood Bank currently stores over 7000 units of cord blood samples, altruistically donated for non-directed use, under the auspices of the National Blood Service. Private cord blood banking for personal use has also been in existence for some years and there are currently seven other private banks in the UK. These private banks have been widely criticised by health-care staff and medical colleges, such as the Royal College of Obstetrics and Gynaecology (RCOG), for approaching parents at a vulnerable time, making far-fetched references to future regenerative use in diseases such as Parkinson's disease, diabetes, and heart disease, while concealing the true likelihood for personal use for current indications, which is somewhere between one in 1000 and one in 200 000. What makes the Virgin Health Bank different is a dual public-private approach. A fifth of the cord blood sample will be stored for private use, for the child or a family member, and the rest will be donated to the public part of the bank, which is accessible to anyone in the world who needs it, at no cost. Additionally, Branson has pledged to donate his 50% of proceeds from Virgin Health Bank to initiatives involved in realising the potential of cord blood stem cells. Cord blood transplants are increasingly being used in preference to bone marrow transplants for several conditions, such as leukaemias, haemoglobinopathies, and some inherited metabolic diseases, because of fewer complications, easier availability, and higher matching success, especially for people from ethnic minorities. Since 1988, more than 7000 cord blood transplantations have been done around the world. The three main limiting factors are: first, the number of cells from one cord blood unit is usually not sufficient for an adult weighing more than 50 kg, but early results with double umbilical cord blood transplantations are encouraging; second, for many conditions, transplanting the child's own cord blood is not recommended because the defect is present in those cells already; and third, the available samples in public cord blood banks will not be sufficient as demand increases. At the end of last year, the US Health Resources and Services Administration, part of the Department of Health and Human Services, awarded US$12 million to a group of umbilical cord blood banks to begin collections for the National Cord Blood Inventory. Following advice from the Institute of Medicine set out in a 2005 report, the aim is to create an inventory of 150 000 high-quality cord blood units, to establish a centre for cord blood donations, which will allow doctors to find the best match with one phone call regardless of where the sample is held, and to systematically analyse the outcomes of cord blood stem cell transplantations. Undoubtedly, umbilical cord blood stem cells already show great promise for clinical use in several conditions in children and adolescents, and with better techniques and more samples available they may also be useful in adults. But they are also of great interest to researchers as a less controversial source of stem cells than those from fetuses or embryos. In-vitro experiments have shown that cord blood contains pluripotent stem cells that have the potential to differentiate into cardiac, neuronal, pancreatic, and skin tissue. These are very early findings, but progress in this field may lead to exciting possibilities for future generations. Any attempt to increase the available pool of umbilical cord blood cells, which are otherwise just discarded, should be enthusiastically praised. Branson has struck an interesting chord by combining altruism with self interest. Parents can be reassured that their family will benefit if needed, however remote the possibility, and at the same time they serve the public good. The cries by staff in the UK's National Health Service (NHS) and by the RCOG that the collection must not interfere with the care of mother and baby at a critical time and that already understaffed units and hospitals cannot provide the service of cord blood collection on demand, just show how unresponsive the NHS has become. Despite all its apparent emphasis on so-called patient choice, the UK Government has changed a once great service into a monolithic outdated business without the capability to fully embrace such exciting new initiatives as cord blood banking.