Donated umbilical cord blood can be used to treat people with life-threatening diseases including leukemia, other types of cancer, and immune and genetic disorders. Cord blood transplantation is often an effective alternative for people in need of bone marrow transplantation who cannot find a suitable tissue-matched donor, either within their own family or from unrelated donors on bone marrow registries.

The importance of umbilical cord blood

The growth of a fetus while in the mother's womb requires nourishment and oxygen. These essential factors pass from the mother's blood to the fetus' blood through the placenta (the afterbirth) and are then carried to the developing infant through the umbilical cord. The blood found within the umbilical cord is the baby's?not the mother's. Typically after a baby is born, the umbilical cord is cut and is thrown away, along with the placenta and several cupfuls of blood that may still be in the cord. However, researchers have discovered umbilical cord blood is rich in hematopoietic stem cells, the immature blood-forming cells also found in blood and bone marrow. These stem cells have the ability to differentiate (change) into red blood cells (cells that carry oxygen to all parts of the body), white blood cells (cells that help the body fight infections and diseases), or platelets (cells that help blood clot and prevent bleeding).

Bone marrow transplantation is a medical (not a surgical) procedure in which diseased marrow (a spongy, fatty tissue found on the inside of larger bones) or immune system is replaced by a healthy one. Cord blood transplants may have several advantages over other types of bone marrow transplants. Cord blood is stored and readily available for patients who need a life-saving transplant as soon as possible; bone marrow donation can take some time and patients need to wait for the donor to have their bone marrow harvested or blood stem cells collected. Clinical studies also suggest that patients receiving a cord blood transplant are less likely to have significant side effects.

The urgent need for minority donations

Since most tissue traits are inherited, there is a better chance of finding a matched donor within the same racial and ethnic group. Minorities continue to be increasingly under-represented in donor registries and therefore, have less chance of finding a matched donor compared with white people. While the likelihood of finding a match for people with Hispanic, American Indian, Alaska Native, Asian, Native Hawaiian, black/African American, and multi-race backgrounds has increased dramatically over the last several years, there are still many people who are unable to find a match because of these less common tissue traits. In 2006, 26% of cord blood units provided for transplant went to racially and ethically diverse patients.

Public versus private use

Donating cord blood to a public cord blood bank is very different from storing cord blood for private use. Private storage of umbilical cord blood reserves your baby's cord blood for use within your own family, whereas public storage makes cord blood available for any person in need. Many parents ask whether they should store their baby's umbilical cord blood for private use. The American Academy of Pediatrics (AAP) has issued specific recommendations about public and private storage of umbilical cord blood to address these issues. The AAP discourages the private storage of umbilical cord blood unless an older child in the same family has a health condition that could benefit from transplantation because the likelihood that a child will need his or her own cord blood for future use is estimated to be one in 1,000 to one in 200,000. Also, the child's own cord blood cannot be used to treat genetic disorders present at birth since the cord blood itself could be affected by the same genetic trait. It is best to discuss with your doctor your personal circumstances for wanting to store or donate your baby's umbilical cord blood.

Donating cord blood to a public cord blood bank is free of charge, while private storage of a cord blood unit is associated with significant fees. Initial fees for private cord banks may range from $500 to $2,000 in addition to annual storage fees of approximately $100 per year. For additional information on the AAP recommendations regarding public and private storage, visit http://www.aap.org/advocacy/releases/jan07cordbloodfaq.htm.

Whether you choose to donate your baby’s umbilical cord blood to a public bank or store it for private use in the future, cord blood banks should be licensed and accredited by AABB (formerly known as American Academy of Blood Banks). Accreditation is a process in which certification, competency, and credibility has been evaluated and approved. For a list of cord blood banks accredited by AABB, visit www.aabb.org.

How to become an umbilical cord blood donor

Donating cord blood requires some advance preparation. Prior to their 34th week of pregnancy, expectant mothers should look for the nearest cord blood bank. These facilities are typically affiliated with a hospital. The National Marrow Donor Program (NMDP) is a nonprofit organization that has a nationwide bone marrow and cord blood registry. The NMDP's Center for Cord Blood has registered more than 50,000 cord blood units from about 20 member blood banks across the United States and has two international registries. There are more than 190,000 cord blood units registered worldwide. In 2006, there were nearly 6,000 cord blood units listed in the registry and more than 450 cord blood transplants that were facilitated by the NMDP. The NDMP also has a list of other public cord blood banks, which have their own registry and list their donations separately. A cord blood bank will require consent from the mother before cord blood can be donated and stored. A health history questionnaire will need to be filled out by the mother, and she will be asked to give a small sample of blood that will be tested for the presence of infectious disease.

Who can donate umbilical cord blood

The following are some general guidelines for cord blood donation recommended by the NMDP. These guidelines are put into place to determine donor eligibility and are intended to protect the health and welfare of the person receiving the cord blood. Contact the cord blood bank you’re working with for specific eligibility requirements.

• Women must be at least 18 years old (16 in some states) and must be healthy. Healthy means a person feels well and can perform normal activities.

Those who cannot donate include women who are at higher risk for or have human immunodeficiency virus/ acquired immune deficiency syndrome (HIV/AIDS); women who have a history of cancer (except cured local skin cancer or cervical cancer in-situ [early-stage cervical cancer]); women who've had malaria within the last three years, or if it has been less than six months since a full course of antimalaria treatment has been given; women who have a positive test for Hepatitis C antibody or Hepatitis B surface antigen (any other history of hepatitis must be evaluated by the cord blood bank); women who've had an organ or tissue transplant; and women who've had tattoos or body piercing within the last year.

All other medical conditions and questions about any medication you are presently taking must be evaluated by the cord blood bank. Mothers who are expecting twins may not be able to donate, since typically there is insufficient amounts of stem cells recovered from the umbilical cord that are useful in transplantation.

Collection of umbilical cord blood

Donating umbilical cord blood poses no health risk to either the mother or the baby, and it is a painless procedure that does not change the birth process. Public cord blood banks take care of the costs of processing and storing your baby's cord blood, so donation is free of charge.

After the baby's birth, the umbilical cord is clamped and cut. Approximately three to five fluid ounces of blood is drained from the umbilical cord and placenta and placed into a collection bag or vial, called a unit. If there is not enough blood collected to yield a sufficient amount of blood-forming cells that can be used in transplant, the cord blood unit will not be stored. Instead, the cord blood unit will be used in medical research (provided you have consented for this use). Research using cord blood stem cells evaluates the therapeutic advantages stem cells may have on other diseases. The entire process of umbilical cord blood collection takes approximately five minutes. However, cord blood will not be collected if a delivery becomes complicated since the focus should remain on the health and welfare of the mother and baby.

Umbilical cord blood storage

Shortly after the cord blood has been collected, the cord blood unit is taken to a laboratory for processing, testing, and storing. It is tested for the presence of infectious diseases. In addition, the "tissue-type" of the cells is determined. This information is used to match patients with the cord unit. The specific name of the test being done is called Human Leukocyte Antigen (HLA) typing. HLAs are proteins that are found on the surfaces of all cells in the body, and especially on white blood cells of the immune system. It is the special combination of HLA proteins that make each person's tissue trait unique. The HLA type of the cord blood unit is listed on the donor registry, and doctors can access this information when they are looking for an HLA match for a patient in need of transplantation. All personal information is kept strictly confidential. Cord blood banks will contact a mother and inform her of test results that are important for the health and welfare of both her and her baby. After all screening tests have been completed, the cord blood unit is stored in either a vinyl or plastic bag, labeled with HLA type and placed in a liquid nitrogen freezer. Cord blood can be stored for a long period of time in this environment, and clinical studies have shown that, even after 10 years, sufficient amounts of cells necessary for transplant are still present in the cord blood unit. Research to learn more about cord blood stored beyond 10 years is ongoing.

Additional Resources

Blood and Marrow Transplant Information Network (BMT InfoNet)

Bone Marrow and Cord Blood Donation and Transplantation from the U.S. Department of Health and Human Services

National Marrow Donor Program (NMDP)

National Cord Blood Program, New York Blood Center

The Leukemia and Lymphoma Society: Fact Sheet on Cord Blood Stem Cell Transplantation (PDF)

More Information

Guest Author Series: Part I: Understanding Bone Marrow and Stem Cell Transplantation

Guest Author Series: Part II: Bone Marrow and Stem Cell Transplantation: Special types of transplantation

Guest Author Series: Part III: Side Effects of Bone Marrow and Stem Cell Transplantation

Guest Author Series: Part IV: Questions and Answers About Bone Marrow and Stem Cell Transplantation

Donating Bone Marrow

Last Updated: June 25, 2007