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Cord blood in public banks

Nearly eight years after issuing guidelines for banking cord blood, the American Academy of Pediatrics has come out with a new set of recommendations for the physicians to provide parents with correct information on cord blood banking and the different kinds of banking systems — private and public. The recommendations, much like the ones made in 1999, make a strong case for public cord blood banking. The Academy clearly states that storing cord blood for self-use or for use by a family member at a later date should be "discouraged." According to it, the chances of self-use when stored in private banks are slim — 1 in 1000 to 1 in 2,00,000 or less. Banking newborns' cord blood in private banks may be appropriate only when any of the older siblings is already suffering from a disease that can be cured by using cord blood stem cells. Also, from a purely medical point of view, it states, "Most conditions that might be helped by [using] cord blood stem cells already exist in the infant's cord blood." It is not possible to treat certain kinds of disorders using cord blood stem cells that are already pre-conditioned. For the same reason, the recommendations put the onus on the parents to prevent the use of their child's cord blood donated to public banks in the event of the child developing certain disorders later.

Contrary to what the private banks seek to project through their promotional campaigns, the Academy discourages storing cord blood for self-use as a form of "biological insurance." What makes cord blood banking attractive is that stem cells are available readily and in plenty in cord blood compared to embryos, and harvesting them is not vulnerable to objections on ethical grounds. Above all, the risk of graft-versus-host disease is much less. Public cord blood banks require to be actively promoted as much as the general blood banks since both work on the same principle — easy and free availability to whoever needs the life-saver. Apart from having therapeutic value, cord blood stem cells are a good source material for research. Unfortunately, dedicated public cord blood banks are yet to come up in India. With the huge investments required and the need to run them on a not-for-profit basis, financial support from the government is essential to make public cord blood banking a reality. With millions of births taking place every year in the country, the benefits that will accrue to science and the society are limited only by the lack of facilities to store cord blood. There is clearly a strong case for the government taking on a more proactive role.

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