ited facilities (see Recommendation 4.1). The searches would be based on HLA matching, and results would indicate whether the HLA-typing was high- or low-resolution and score each of these depending on the degree of match, cell dose, and availability. The algorithm should also be flexible enough so that transplant physicians could modify it depending on their own search criteria or ones the physician feels are important for a particular patient.

The availability of a unit depends on the overlapping demands of multiple clinicians with patients with similar needs. Although the requesting physician should be notified that a potentially matching unit has been identified, the bank and the cord blood center should assist with making the ultimate decision to use a particular unit for transplantation in a particular individual. Units “held” for a particular patient should not be reserved by or shipped to any other transplant centers. However, units should not be able to be reserved indefinitely, and thus it is important that the bank and cord blood center work with transplant centers to ensure that reserved units are shipped or cleared within a reasonable amount of time.

All parameters in the search should be traceable and should be maintained by the cord blood center. The units available from different banks should be comparable to one another, and thus standardization of the processes and the procedures used for the collection and storage of the units is essential. A set of protocols (e.g., infectious disease testing, steps in processing, storage guidance, and matching requirements) for all banks supplying information to the cord blood center is required to ease the processes used to search for and identify cord blood units. Lack of compliance with these protocols would result in punitive measures by the cord blood center (see Chapter 7).

Ideally, with any search algorithm, the available cord blood units and adult donors would appear in the same search results, although listed separately, ranked by availability and HLA match. This would enable transplant physicians to compare all possible options for their patients and select the best match for their patients’ needs.

Probability of Finding a Donor

At the request of the Institute of Medicine committee, the New York Blood Center (NYBC) completed a voluntary simulated search of cord blood unit matches for 9,970 patients within its inventory of 20,444 cord blood units for which high resolution HLA typing had been completed. A 4/6 HLA match or better could not be found for 94 patients (1 percent). Fifty-seven of these patients were non-Caucasian.

Cord blood banks have been able to recruit a diverse donor population, but it is not fully consistent with the census data on the racial and ethnic

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