ASK DR. BAUGHAN                                             July 11, 1997

CORD BLOOD - POSSESSION OR RESOURCE?

One of the fascinating aspects of medicine is how many new technological advances create new ethical and social dilemmas. One such example is the discovery that blood from a baby’s umbilical cord after birth makes an excellent source of cells that can restore the bone marrow of someone undergoing a bone marrow transplant.  This blood is much less likely to be rejected (thus causing the bone marrow transplant to fail) than adult blood.  It is perhaps the ideal source of cells for someone if it happens to be their own blood preserved since birth.  Bone marrow transplants have been effective in leukemia, lymphomas and sometimes in other cancers, too.  This is a dramatic, wondrous opportunity to cure lethal cancers.

First twist, should medicine be a service profession, or should it be driven by the same profit motives of the rest of our free enterprise society?  There have been tissue banks developing along the lines of the Red Cross Blood Banks, certainly one of the noblest organizations devoted to the common good.  A national network of these banks has the potential to identify tissue types (not just cord blood, but kidneys, livers, hearts, etc.) suitable for transplant for anyone anywhere who may suddenly be in need.   Now a new type of business has arisen - a private tissue bank.  This bank, for an initial deposit fee and then a monthly or yearly fee, will store your baby’s umbilical cord blood for his or her exclusive use should your baby ever need it.  Of course, these banks are for-profit enterprises.  This means their fees will need to first and foremost generate a profit for their owners or stockholders. If your child develops leukemia, but you were not able to afford this service, too bad.

Second challenge,  should we as a society view the umbilical cord blood of infants as possessions of the parents and child, or as a community resource?  Legally, in this country, the answer is simple, “It’s your blood, you can do with it what you want.”  I’m not even interested in whether this is right or wrong.  The challenge medicine poses is,  “What would be the healthiest thing for the individual, and for society?  And are there different answers for each?”

Consider that for any given child, the chances of developing leukemia are very small.  If everyone stored their own blood,  many people would never need it.  It is yet uncertain just how long a given individual’s blood could be  preserved for their own use.  Long enough for some leukemias likely to occur before age 10, but uncertain after that.  So even with careful planning and investment in the service, a person’s own blood may not be usable when they needed it.  Inevitably, there will be some occasional technical errors and some blood will be lost or spoiled.  Here is a ripe new area for tort liability cases, something society needs like a hole in its collective head.

If private banks predominate, then only those who could afford the service will be able to receive treatment should they become ill.  However, even those who could afford it may lose out if their blood becomes outdated and there is no communal resource.  In a country with a widening gap between the wealthy and the poor, we will be increasingly confronted with decisions on limiting care for people without lots of money.  Can we ever really hope, though, that enough people would donate their child’s cord blood or register themselves with tissue banks to generate the national resource that could respond to the health needs of the country?  I don’t know, and right now that question may be premature.  More importantly, what could move us more in that direction?  I guess my bias is clear.  I do not think private umbilical cord banks will help with that movement, unless it is in reaction to them.