By Chris Motola
Doctor in charge of Upstate Cord Blood Bank explains what the bank does and how donated umbilical cord blood (usually discarded) can save lives
Q: What is the Upstate Cord Blood Bank?
A: So the Upstate Cord Blood Bank is a public cord blood bank where we are collecting, processing and storing umbilical cord blood that’s donated from donors at Crouse Hospital, St. Joe’s and Community campus. And those cord blood stem cells are then available for use for patients who need bone marrow transplants. So that’s the short, short version.
Q: I’m old enough to remember the initial excitement over stem cells many years ago, but it fell off pretty quickly. What are we now able to use stem cells to do?
A: I just want to clarify that we’re not using embryonic stem cells, which have gotten a lot of bad press. That’s not what we’re talking about. These are stem cells in umbilical cord blood that would otherwise be thrown away. We’re not damaging an embryo or taking a life. The promise of stem cells actually is looking greater and greater. As with anything, we hope that it will be instantaneous that we’ll get everything we ever wanted, but the primary use of stem cells from cord blood is for bone marrow transplants. Bone marrow transplants using cord-derived or adult-derived bone marrow stem cells have been done for decades and they are life-changing and life-saving for patients who have leukemia, lymphoma or have other cancers that are so destructive or require so much chemotherapy that their own marrow fails. Or for people who have genetic defects and their own cells don’t work that well. Those are all proven and mainstream, standard- of-care treatments. In addition to that, there are some 80 diseases that have potential treatments using cord stem cells. That includes things like recovery after heart attack, neural degeneration after stroke, cerebral palsy. A lot of this is in the research phase, in clinical trials. They’re looking great and patients are gaining benefits off those clinical trials, but they’re not mainstream yet.
Q: What does a new parent have to do to get their kid’s cord blood to you?
A: We do have our website, upstatecordblood.com, and we describe everything there. But we’ve also connected with all of the clinicians who deliver at each of the three hospitals: obstetricians, midwives. The doula program we’re trying to connect with. So they all have the information if expectant mothers and families are interested in donating. Donation is relatively simple. There is a booklet we provide on cord banking that answers most of the frequently asked questions, but also included in that book is a consent. Because this is a medical procedure with medical and legal responsibilities, we want to make sure that no one has mistakenly said yes or no when they didn’t. So we have a formal document for consent. There’s also a questionnaire in there that’s about seven pages long, but you’d recognize a lot of the same questions if you’ve ever donated blood. Those are required, mainly to avoid risks from infectious diseases. We don’t want to tell a patient at the other end that they have brand new bone marrow and HIV. That’s frowned on for some reason. So we try to keep the questions brief, but we ask all the ones the FDA requires.
Q: Are there any medical risks involved in donating?
A: No. Less even than donating blood to the Red Cross. There’s no real risk to Mom or baby. After the baby’s out, the cord is clamped and cut. The blood we’re collecting is actually in the placenta. It’s not mom’s, it’s not the baby’s. It’s just the blood that’s left. So the main difference is just that, rather than throwing it away, we’re keeping it.
Q: Why isn’t collection standard operating procedure?
A: There are countries and states where the default is to collect it with patients allowed to opt out. Here it’s opt-in. Which is unfortunate, because the general rule is about 20% of people will opt-in if the default is not to donate, and about 20% will opt-out if the default is to collect it. Nobody likes doing paperwork. So New York state is an opt-in state, but even if it wasn’t we’d still want people to be informed and comfortable with their decision. But it would be easier if we were an opt-out state.
Q: Do donors get a say as to what it can be used for?
A: Yes and no. If someone donates, there isn’t a way to restrict who it’s used for; it’s put into a pool. Parents are giving up legal ownership. And we’re talking about our primary use, which is clinical use. Now, for units that do not actually meet criteria for clinical use, we actually have a question on the consent form that asks if the cord turns out to not be able to be used for clinical purposes, can we divert it to some of our researchers who are doing research into uses for medical cord blood. There are other groups that buy it to test cosmetics or as a manufacturing starting point. There’s nothing wrong with those uses, but they aren’t our mission, so we only partner with researchers who are looking into other medical uses for cord blood. So there’s a checkbox on the form if Mom’s not comfortable with the cord blood possibly being used for research. If the blood meets the criteria for clinical use, there’s no problem. If it doesn’t, and Mom has checked no, then it will be discarded.
Q: How much of a yield do you get out of each donation?
A: So if you’re looking at stem cells for a bone marrow transplant, the other source is adult donors, which you collect by literally sucking it out in the OR, or a process where you give donor medication to produce a lot more stem cells. Those both have downsides, but you can get a larger amount of stem cells from them than you can from a single cord blood donation. So even though cord blood is rich in stem cells, adults are much bigger. So from a single cord blood donation, we’re getting about enough for one bone marrow transplant if they’re a child. Adults will typically get two cord blood units. There’s not enough for multiple patients from one donation, although there is research that suggests it may be possible in the future, but we don’t know that yet.
Name: Matthew Brian Elkins, M.D.
Position: Laboratory director and medical director of the Upstate Cord Blood Bank
Hometown: Livonia, Michigan
Education: University of Illinois; University of Michigan
Affiliations: SUNY Upstate Medical University Hospital
Organizations: Association for the Advancement of Blood & Biotherapies; American Society for Apheresis; Blood Bank Association of New York State; College of American Pathologists
Family: Wife (a family physician), two children
Hobbies: Helping with his church’s sound and electronics