WASHINGTON – Flyers in upscale doctors' offices portray it as the hot new baby-shower gift: a registry where friends and family chip in almost $2,000 to start privately banking a newborn's umbilical cord blood, just in case of future illness.
That idea of biological insurance is a long shot that most mothers-to-be can safely ignore, say new guidelines from the nation's pediatricians that urge more parents to donate their babies' cord blood — so that it might save someone's life today.
The guidelines come as the government begins setting up the first national cord-blood banking system, aiming to prevent some 12,000 deaths a year — if public banks can compete with marketing-savvy private companies that now house the bulk of the world's preserved cord blood.
Cord blood is rich in stem cells, the building blocks that produce blood — and the same stem cells that make up the bone-marrow transplants that help many people survive certain cancers and other diseases. But cord blood has some advantages: These younger stem cells are more easily transplanted into unrelated people than bone marrow is, and they can be thawed at a moment's notice, much easier than searching out a bone-marrow donor.
There should be plenty for both private and public banking, says an optimistic Dr. Elizabeth Shpall of the public M.D. Anderson Cord Blood Bank. After all, cord blood from most of the nation's 4 million annual births is thrown away.
Chief hurdles: Improving consumer awareness — and the small number of hospitals that allow donations.
Her own work illustrates the industry's stark socio-economic contrasts: At Houston's Ben Taub General Hospital, Shpall finds the mostly Hispanic mothers-to-be not only unable to afford private banking — few have even heard that cord blood has a medical use.
Armed with a $3 million federal grant to improve much-needed minority donations, she is working with Spanish-language TV and radio programs that in a few months will begin telling Houston moms about their cord blood choices, and which hospitals allow donations.
Her message: "Unless you have a family member with cancer, it's unlikely you would ever need it, and you would be doing a service to humanity to donate it."
Today, about 50,000 cord blood donations are stored in more than 20 public banks around the country. The new National Cord Blood Inventory aims to triple that number, enough that virtually anyone who needs stem cell treatment could find a match — especially minority patients who today seldom can as most bone marrow donors are white.
Private banks have an estimated 400,000 units stored.
What's the controversy? Deciding who really needs to store a child's own cord blood for later use. Private storage costs $1,500 to $1,900 up front, and about $125 a year thereafter, although some offer special programs for lower-income families.
Guidelines published last month by the American Academy of Pediatrics say:
_Parents should consider private storage only if an older sibling has cancer or certain genetic diseases that cord blood is proven to treat.
_Everyone else should consider donating their child's cord blood. The odds that a child would need an infusion of his or her own cord blood later in life are slim, between one in 1,000 and one in 200,000.
Private banks vehemently disagree, arguing that as scientists learn more about stem cells, the blood could create personalized treatments for heart disease or other more common killers.
"That's still considered very experimental," counters Dr. Mitchell Cairo of Columbia University Medical Center, who co-authored the new guidelines.
Also, doctors don't even know if cord blood remains usable after being stored for decades.
Still, last month Illinois doctors reported the first apparent success in treating a child's leukemia with her own cord blood — something usually impossible because that blood so often carries the cancer-triggering genetic defect.
The report has expectant parents calling Advocate Hope Children's Hospital to ask if they, too, should store their babies' cord blood, says Dr. Ammar Hayani, who performed the transplant only after genetic testing showed that patient's cord blood was defect-free.
"It's probably overadvertised by some of these companies as this biological insurance. That's probably overdramatization of its potential," says Hayani, who advises parents of the pediatric academy's guidelines. "But I think parents need to know" both sides' arguments, she says.
About 11 states have recently passed legislation to try to increase the information that expectant parents receive about their cord blood choices: store it, donate it, or discard it.
It's no different than how families choose between public or private schools, says Steve Grant of Cord Blood Registry, which began offering the baby-gift option last year after noticing grandparents putting up the money.
"The competitive nature seems misplaced to me," he says. "Family banking is not in any way detracting from the ability to build a public system."