Cord Blood Banking in the UK: Status and Directions of the RCOG

Its been a hectic week at StemLife and I apologise for not having updated the blog for a while. A few friends and family members kindly updated me with emails about the recent announcement by the Royal College of Obstetricians and Gynaecologists (RCOG) on cord blood banking.

Firstly, I'd like to clarify the role and function of the RCOG. Most relevant is that the RCOG sets the exams that all aspiring gynaecologists have to pass in order to practice. If you check out their website, its tagline is "Setting standards to improve women's health". Clearly, the focus of the College is on women and one of their roles is also to "reduce maternal and neonatal mortality and morbidity", i.e. to assess the risks involved in any gynaecological or obstetric procedures for both the mother and the doctor involved.

It was in this capacity that the College issued a recent statement reflecting the same sentiment that they had back in 2001- that they supported cord blood banking if for altruistic reasons- that is for donation and public use. From the statement made by the head of Department of Women's Health at King's College London and Chair of the RCOG expert group, Professor Peter Braude said that they "had a huge amount of commercial companies offering cord blood storage to parents and medical practitioners wanted guidance on the validity of some of the advertising claims".

I checked out the number of companies offering this service in the UK and found that there are now 7 (acknowledgements to Dr. Frances Verter's wonderful site) which is a significant number for 595,000 or so births per year. I can imagine that the clinics must get very crowded with brochures all claiming to be the better bank. There has also probably been some confusion amongst the doctors, nurses and hospital staff when parents come in requesting a collection from cord blood bank a,b or c.

However, the biggest problem that I forsee is not so much that parents might come in with different kits, but rather for the three following reasons:

1) Most deliveries requesting cord blood are at NHS (government) hospitals where doctors are on rotation duty (leading to point 2)

2) The doctors delivering the babies are not necessarily the same as those seeing the patient in the clinic (which doctor gives consent to collect?)

3) Most doctors are not trained to collect cord blood for this purpose and may not always be successful (whom does the client/patient hold responsible?)

Clearly, these pertinent issues warrant the intervention of the RCOG due to the potential risk taken by the doctor in collecting the cord blood when the doctor may not know what to do and that he/she has to do it. It is the slight confusion that happens which can result in really bad taste for both patient, hospital and doctor. Therefore, to protect the reputation of the doctors and lessen the paper procedures (which are already a big hassle for the hospital staff), the RCOG has taken the stand that cord blood should be donated to the NHS, and that if NHS hospitals choose to permit cord blood collection, they have to draw up their own guidelines on what charges there should be and who bears the liability. I think that a fair payment made to the hospital and doctor for successful procedures would be acceptable to the requesting client (full refund if unsuccessful for the avoidance of doubt on anyone's part).


A MIS-INTERPRETATION

Unlike what has been proclaimed on the headlines of news articles(BBC, Times), the RCOG is not against cord blood banking but rather prefers that in its NHS hospitals, cord blood is donated for the public's immediate use- instead of banking it for a possible future use.

One of the messages that the RCOG then helps to advertise is that the NHS provides banking of donated cord blood at the following hospitals, where staff are available to assist and ensure that its done right.

I found the list of hospitals from this site and here's an extract:

NHS cord blood banks centres currently collecting donor cord bloods in UK

Although antenatal patients may offer to donate for unrelated transplantation, the option of altruistic cord blood banking for the National Blood Service banks is, for logistic reasons, currently undertaken only at the following hospitals: Northwick Park Hospital in Harrow, Barnet General Hospital, The Luton and Dunstable Hospital, and the Mater Infirmorum Hospital in Belfast.


Is collecting cord blood as dangerous as the RCOG articles proclaim?

StemLife Malaysia has already successfully banked more than 6000 units of cord blood with the assistance of doctors and nurses with the mutual understanding that cord blood collection can only take place if it is safe and does not alter the process of birth by the mother nor affect the baby's aftercare. I'm not sure about the UK, but having worked with private hospitals in Malaysia, care of the mother and the baby is always the doctor's first priority. Cord blood is collected in utero to ensure that the blood is collected without clots and only as much as the umbilical cord is able to yield. Furthermore, doctors also respect the patient's wishes and knows that they may play a part in the welfare of the child subsequently in life (StemLife has a story about this, but I'll tell you about it at a later date).

Additionally, I checked out the College of Paediatrics website too to see what the role of its doctors are supposed to play. I found that one of the roles would involve the education of the public about the potential use of cord blood stem cells in the child's life.

Duties of a paediatrician:

Paediatricians, whatever their specialty interest, should understand their particular responsibilities for the holistic and life-long health of children who come under their care: each contact is an opportunity for health promotion and disease prevention.

Paediatricians should be aware of current medical and political affairs affecting the lives and health of children.

We have supportive paediatricians here and I'm delighted to say that they are increasingly aware that stem cells could play a role in helping siblings and the child itself should it take ill with a condition treatable with stem cells.


You can read the actual message from the RCOG here, but bear in mind that it takes into account the fact that the NHS is already an overburdened government healthcare institution. In the appeal for funding for the NHS cord blood bank, if the potential use of cord blood stem cells is as small and insignificant as they say, why bother putting anymore money into something which might never be used?


The NHS has had structural and economic issues* for a while and we should not find it surprising that if you try to overlay a private service (like cord blood banking) on top of a public-funded healthcare system, there will undoubtedly be tensions as to what services are on offer at public hospitals and, at what cost to the system.

*UK Health Secretary Patrcia Hewitt has announced earlier this month that the NHS's overall deficit is GBP 512 million (approx. RM 3.4 billion).