and professional standards as they are applied to cord blood banking. The committee also makes recommendations on how to improve the system of cord blood collection, processing, and storage.

DEFINITION OF A CORD BLOOD BANK

A cord blood bank is a center whose central mission is to maintain a supply of cord blood for therapeutic use in transplantation. Figure 4-1 depicts the various aspects of the collection, storage, search and transplantation processes.

In most cases, a mother will register with a bank prior to giving birth. Upon adequate completion of the informed consent (more on the informed consent process can be found in Chapter 5), the mother’s obstetrician is informed of her wish to be a donor, and arrangements are made to collect the cord blood. This is either by providing the mother with a kit or, if the delivery hospital is affiliated with a bank, by noting it in the mother’s chart. In most cases, the collected blood is then transported to the bank in order to obtain volume and cell count. If both are high enough, the unit is processed, and samples are taken for infectious disease testing. If the review of the maternal history and infectious disease testing are both within the bounds established by the bank, another sample is sent for HLA testing. Because obtaining HLA type is the most expensive part of the process, this is generally not done until the unit meets the bank’s requirements in all other ways and is the last step before listing in a database.

Cord blood banks have been established in response to the needs of different patient populations, and the motivation to store cord blood varies from person to person. For some, there might be an immediate need within the family to treat a disease amenable to transplantation, for example to a sibling or a closely matched family member. Alternatively, a woman or a couple might donate altruistically (as with blood donation) by offering the cord blood as a public resource to be available for others with the need for an immediate transplant. Finally, some donors choose to contribute to research. Table 4-1 summarizes the primary banking options available to new mothers.

For the purposes of this report, the committee has classified cord blood banks into three main categories. Public banks store unrelated cord blood units that are philanthropically donated for transplantation or research purposes. The relevant information (e.g. HLA types, cell counts, and in some cases, the donor’s medical history) is then stored in a database made available to transplant centers searching for a cord blood unit for patients. Some public banks also store a limited number of units for autologous or family use when a disease that is treatable by cord blood transplantation is known to exist within the donor’s family. In these circumstances, the blood



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