THE CHALLENGES OF A FRAGMENTED SYSTEM

Although independence often leads to innovation, it can also lead to inconsistency in quality from bank to bank and a need for transplant centers to access multiple banks. Thawing and processing the units received from different banks can also vary depending on the bank accessed. The proliferation of cord blood banks has raised the challenges of accessibility, the adequacy of the inventories, the standardization of techniques and documentation, and quality control. In addition, most cord blood banks have developed practices and procedures independent of any consistent quality assurance or regulatory oversight, although many banks are accredited by independent organizations such as the American Association of Blood Banks (AABB) and the Foundation for the Accreditation of Cellular Therapy (FACT).

The complexity of the search and matching process for cord blood units remains an issue for many transplant physicians. No standardized search algorithm is available, and the level of HLA typing differs from registry to registry and between cord blood units and bone marrow donors. At present, transplant coordinators must often search multiple registries and banks to find potential adult donors or cord blood units for a given patient before deciding on the best graft source. Within the United States, searches of the vast majority of adult donors in national and international registries (and the 14 participating cord blood banks) can be accomplished with a single search process through NMDP, although this process may sometimes take weeks, time that ill patients may not have. However, no single point exists for access to the entire cord blood inventory. In 2001, NetCord, an international organization, was established to facilitate searches of multiple cord blood banks to seek a match. This organization is an affiliation of 15 international banks with a combined inventory of 86,914 units10 (NetCord, 2005). Because not all banks belong to this network, one-request searches are still not possible.

Recent reports suggest that cord blood searches are becoming more uniform, but no uniform search algorithm exists. However, lack of a single portal and the absence of an evidence-based HPC search algorithm have hampered the increased use of cord blood. Therefore, until this uniform outcomes reporting is established, such an algorithm cannot be developed, and there will be no mechanism by which to establish a single search system.

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They are: AusCord (Australia), Barcelona (Spain), Düsseldorf (Germany), France Cord (France); Helsinki (Finland), Jerusalem (Israel), Leiden (The Netherlands), Leuven (Belgium), Liege (Belgium), London (Great Britain), Milan (Italy), New York (United States), Prague (Czech Republic), Tel Hashomer (Israel), and Tokyo (Japan).



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