PEDIATRICS Vol. 104 No. 1 July 1999, pp. 116-118

AMERICAN ACADEMY OF PEDIATRICS:
Cord Blood Banking for Potential Future Transplantation: Subject Review
Work Group on Cord Blood Banking

RECOMMENDATIONS
When consulted by prospective parents who are interested in donating cord blood to a philanthropic bank or paying to have cord blood stored in a for-profit bank, the physician can provide the following information:

1. Although preliminary data show encouraging results in cord blood stem cell transplantation for a variety of genetic, hematologic, and oncologic diseases, the procedure at this time is considered investigational.
2. The indications for autologous transplantation are limited, and the potential for future expansion is unlikely.
3. Given the difficulty of making an accurate estimate of the need for autologous transplantation and the ready availability of allogeneic transplantation, private storage of cord blood as "biological insurance" is unwise. However, banking should be considered if there is a family member with a current or potential need to undergo a stem cell transplantation.
4. Conditions such as leukemia or severe hemoglobinopathy may indicate the need for directed-donor cord blood banking for sibling cord blood transplantation.
5. Philanthropic donation of cord blood for banking at no cost for allogeneic transplantation is encouraged. In such instances, the parents should be informed of the appropriate operational principles recommended for the bank listed herein.

Institutions or organizations (private or public) involved in cord blood banking should consider the following recommendations:

1. Recruitment practices should be developed with an awareness of the possible emotional vulnerability of pregnant women and their families and friends. Efforts should be made to minimize the effect of this vulnerability on recruitment decisions.
2. Accurate information about the potential benefits and limitations of allogeneic and autologous cord blood banking and transplantation should be provided.
3. A policy should be developed regarding disclosing to the parents any abnormal findings in the harvested blood.
4. Specific permission for maintaining demographic medical information should be obtained, and the potential risks of breaches of confidentiality disclosed.
5. Written permission should be obtained during prenatal care, and before the onset of labor. The practice of collecting cord blood first and obtaining permission afterward is considered unethical and should be discouraged.
6. Consultation with the institutional review board or hospital ethics committee about recruitment strategies and the wording of consent forms is recommended.
7. Cord blood collection should not be done in complicated deliveries, and the cord blood stem cell collection program should not alter routine practice for the timing of umbilical cord clamping.
8. Because of the investigational status of cord blood banking and the high risk for its potential abuse, the regulatory agencies (eg, US Food and Drug Administration, Federal Trade Commission, state equivalent of these federal agencies) are encouraged to have an active role in providing oversight for the safety and welfare of the population.

FOOTNOTES
The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.