Banking on cord blood
Issue 151 - 17 Aug 2023 (6-min read)
If you’ve never had a baby before, let me tell you that pregnancy is a time of intense learning — not only about what your body is capable of doing but generally about the vast field of medicine. Did you know the uterus takes up so much space that all other organs are squished aside for nine months? Or that hormonal changes can cause carpal tunnel syndrome? Or that a baby can express quite clearly whether it likes jazz music or ska?
This week, The Global Tiller delves into one such discovery: cord blood banking. We look into what it is and how it can save lives. We also look at how an industry has emerged around this seemingly noble gesture and why do we, as a society, resist public goods?
The seemingly magical properties of umbilical cord blood were not discovered until 1988 when a five-year-old boy with a rare blood disorder received the world’s first transplant of umbilical-cord blood from a newborn sibling and was cured. What makes cord blood so precious is that it contains blood stem cells – cells that can grow into any kind of blood cell in the human body, including the red blood cells that carry oxygen or white blood cells that form part of the immune system. These stem cells can then be used to treat leukaemia, sickle cell anaemia, and other blood diseases.
Naturally when its benefits were discovered, it sprang up a whole industry of cord blood transplantation, which works in much the same way as an ordinary infusion of blood. The frozen cord blood is thawed, the stem cells are tested for viability and then infused intravenously.
If you go to any prenatal visits at the hospital, rest assured you will be asked at some point whether or not you would like to donate your cord blood and, for many parents, the choice isn’t difficult to make. The doctors wait until after the delivery and allow most of the blood in the umbilical cord to go into the baby, then they cut the cord and save whatever remains. It has seemingly no harmful effects on the baby or the mother, and could end up helping someone in need.
Nevertheless, the practice has yet to become mainstream. According to Cell Trials Data, a provider of data on clinical trials of advanced cell therapy, cord blood banking rates are highest in the US, at 3% of births each year. In India, that number hovers around 0.4% of births, while in the UK just 0.3% of births bank cord blood each year and in France that number is as low as 0.08%. The global cord blood banking market was valued at $1.3 billion in 2020, and is expected to grow to $4.5 billion in the next decade.
But capitalism does its own thing and it comes as no surprise that corporations are advocating for private storage of cord blood as a 'biological insurance policy' for several hundred dollars upfront, plus a storage fee of $100 to $200 every year. Nevermind the fact that the longest cord blood stem cells have been stored with the cells still found to be viable is 20 years, or the fact that companies tend to overstate the odds of a child even needing to use their cord blood. According to the Canadian Blood Services, the chance of cord blood being needed by a child are between one in 20,000 (0.005%) to one in 250,000 (0.0004%). In India, the probability of needing the stored cord blood in the first 20 years of life is estimated to be 0.04% to 0.005%.
While parents are the easiest market segment to sell to (who wouldn’t spare money if it means their child has access to perfectly matched blood in the future), what makes cord blood banking a powerful health resource is when it is used as a public, and not a private, good.
There is no guarantee that a child’s own cord blood is what will absolutely save them — the stems cells from cord blood could carry the same disease that the child suffers from, for instance. But studies show that cord blood, not necessarily your own, can save lives. This is why public banks have released 30 times more units of cord blood than private banks, even though the latter have six times as many units in their storage worldwide.
What matters is how good of a match you can find and the chances of finding a matching bone marrow donor or cord blood unit ranges from 29% to 79% depending on your ethnic background. Currently, the majority of donors identify as white so white patients have the highest likelihood of finding a good match. The power here comes from the community, and it works when more and more people do it.
Cord blood banking illustrates the question facing humanity at large. If the solution to our problems lies in making sure everyone is taken care of, then why do we continue to let our selfish instincts steer us into corners where there is no guarantee anyone will survive?
Until next time, take care and stay safe!
Hira - Editor - The Global Tiller
…and now what?
The power of community is what makes us such an impactful species: by being highly collaborative we managed to create the world we live in today. Not a perfect world, but not the worst either.
And that seems to be even so ingrained in our nature that our bodies are made to help each other. This vital link that maintains the life of the fetus for so many months and connects it so strongly to the mother, hosts some kind of wonder: the ability to grow new cells, of any type, through stem cells. This concrete materialisation of how connected we are with each other is where you find life.
We seem meant to be collaborative, to be connected to each other. It sometimes seems though that this goes against our own judgment. Because if you listen to a lot of people, they will tell you how humans are selfish, competitive, greedy and other bad adjectives.
We don’t trust ourselves. This goes to a point that for the longest time (and still today), we held onto the idea of the “tragedy of the commons”. In this world straight out of the Lord of the Flies, the “selfish gene” was meant to be the norm: we thrive against one another, not with one another.
But nature keeps coming to prove us wrong. And it defeats our core economic beliefs that could let us think that private initiative will solve many of our issues through competition, hoarding and self-interest.
For too long, we cut the cord from our very own nature, and by doing so we deprived ourselves of the ability to heal our societies by using some of those stem cells that could help “reprogram” our systems. It is probably time for now to reconnect this cord between ourselves and finally realise that our survival lies in our ability to share, to connect and to work with and for one another.
Whether it’s blood, cord blood, organs, money, time, knowledge, there are many ways for us to share, to donate. And even if it comes at a cost for us at some point, it’s not a payment we’re making, it’s an investment: in our trust for humankind, in our trust in the future and in our ability to build systems that resemble our nature, not structures that nurture our dissensions.
Philippe - Founder & CEO - Pacific Ventury