Sel Stem Darah Tali Pusat - Bank Swasta atau Bank Umum?

Simpanan Sel Stem Darah Tali Pusat - Pilihan Bank Simpanan - Bank Swasta atau Bank Masyarakat Umum?

Jawapan dari AABB.......Ada Dua konsep perkhidmatan!

Assalamualaikum WBK,

Salam Sejahtera kepada rakan-rakan saya sekelian, ibu-bapa, bakal ibu-bapa, pengunjung dan pembaca blog ini. Kepada pembaca dari beberapa syarikat tertentu, janganlah cetak rompak atikel ini ya!

Kali ini Saya akan menterjemahkan beberapa lagi jawapan kepada soalan popular (FAQ) yang diterbitkan di laman web Persatuan Bank Darah Amerika (American Association of Blood Banks – AABB www.aabb.org). Ini adalah hanya sebahagian dari soalan-soalan yang dijawab. Saya akan cuba menterjemahkan soalan-soalan yang lain jika masa mengizinkan, Insyallah.


Adakah semua Bank Darah Tali Pusat Sama?

Tidak. Terdapat dua kategori perkhidmatan Bank Darah Tali Pusat (DTP) iaitu Bank Swasta dan Bank Masyarakat Umum (Bank Kerajaan atau Bank NGO). Ada Bank yang menawarkan kedua-dua perkhidmatan sekali gus, tetapi DTP yang disimpan didedikasikan kepada satu jenis kegunaan sahaja. Untuk menerima perkhidmatan dari Bank-Bank itu, Ibu perlu memberikan kebenaran. Perbezaan antara Bank-Bank adalah dari segi ujian, dimana ujian yang dilakukan kepada Ibu dan DTP mungkin berlainan dan terpulang kepada jenis Bank. Organisasi Pentadbiran Pemakanan dan Ubatan USA (The Food and Drug Administration - FDA), yang mengawal industri ini di USA memerlukan supaya kedua-dua jenis Bank, Swasta dan Umum, didaftarkan dengan FDA.


Apakah itu Bank Darah Tali Pusat Masyarakat Umum?

Bank DTP Masyarakat Umum memproses dan menyimpan DTP yang telah diderma oleh masyarakat untuk kegunaan masyarakat umum. Bank Umum menghadkan jumlah DTP minima (dan jumlah sel minima) yang diterima. Had minima ini ditetapkan berdasarkan kepada jumlah yang mungkin mencukupi untuk pesakit yang memerlukan transpantasi. DTP yang tidak memenuhi tahap minima akan dibuang atau akan digunakkan dalam penyelidikan (ini tertakluk dan memerlukan kebenaran dari Ibu). Beberapa Bank Umum mendapati bahawa lebih kurang satu pertiga hingga ke tiga suku dari DTP yang diterimanya tidak mencukupi untuk digunakan dalam transplantasi diatas sebab-sebab tertentu. Oleh kerana ia mungkin bertahun lamanya sebelum DTP itu digunakkan untuk transplantasi, sejarah perubatan keluarga penderma perlu diselidik dan ujian yang terperinci akan dilakukan keatas Ibu. Sejarah keluarga perlu diselidik untuk mengurangkan risiko pesakit terdedah dan dijangkiti penyakit genetik yang mungkin dibawa dalam DTP tersebut. Sampel darah diperlukan dari Ibu dan DTP untuk beberapa ujian, termasuk ujian penyakit berjangkit dan kontaminasi Bakteria. Kesemua maklumat mengenai keluarga yang menderma DTP ini akan disimpan rapi dan dirahsiakan.

Setiap orang mempunyai jenis tisu atau jenis Antijen Lukosit Manusia (Human Leucocyte Antigen - HLA) yang berbeza dan unik. Setiap DTP yang diderma juga adalah kombinasi unik dari ibu dan bapa penderma. Setiap DTP yang diderma akan diuji jenis HLA nya. kandungan selnya juga diselidik. Maklumat ini akan dimasukkan kedalam pengkalan data supaya pakar-pakar dapat mencari DTP yang sepadan apabila mana-mana pesakit memerlukan dermaan DTP. DTP yang disimpan Bank Masyarakat Umum sedia digunakkan oleh sesiapa yang memerlukanya dan bukanya disimpan khas untuk penderma atau pun keluarga penderma. Bank DTP Masyarakat Umum tidak mengenakan apa-apa bayaran/Fi kepada penderma. Tetapi Bank-Bank ini membiayai semula kos mereka dengan mengenakan bayaran/Fi kepada pesakit (atau insuran pesakit) apabila pesakit mengunakkan DTP yang disimpan. Malangnya, bukan semua Hospital dapat berganding bahu dengan Bank DTP Masyarakat Umum, jadi bukanya semua Ibu yang ingin menderma akan dapat mendermakan DTP mereka.

Kongres USA telah meluluskan rang undang-undang yang memulakan dana untuk membina program simpanan DTP Nasional bagi Masyarakat Umum. Salah satu tujuan rang undang-undang ini adalah untuk menambahkan jumlah dan jenis DTP yang sedia ada untuk Masyarakat Umum. Masyarakat minoriti pula kurang bilanganya dalam program ini. Jadi, pesakit dari masyarakat minoriti mungkin mengalami kesukaran untuk mendapatkan DTP yang sepadan denganya.


Apakah itu Bank DTP Swasta?

Bank DTP swasta memproses dan menyimpan DTP khusus untuk kegunaan pelanggan dan keluarga pelanggan. Oleh kerana Bank DTP swasta tidak bekerjasama khusus dengan mana-mana satu Hospital, ibu-ibu akan deberikan kotak koleksi DTP untuk diberikan kepada Doktor pakar pada hari kelahiran bayi. Kotak koleksi sudah sedia mengandungi beg koleksi, pelekat nama, dan bahan-bahan lain yang diperlukan untuk koleksi dan penghantaran DTP ke makmal pemprosesan. Ibu-Bapa akan membayar Fi permulaan untuk pemprosesan dan juga seringkali Fi simpanan tahunan. Maklumat terperinci mengenai perkhidmatan ini termasuk pengangkutan, tanggungjawab penghantaran, tanggungjawab keatas DTP dan isu kegagalan perkhidmatan perlu dijelaskan dalam kontrak antara pelanggan dan Bank. Oleh kerana DTP disimpan khusus untuk kegunaan keluarga sendiri, maka ujian pelanggan, ujian jenis tisu dan ujian-ujian lain mungkin ada atau mungkin tidak dilakukan. Polisi yang diamalkan mungkin berlainan antara Bank-Bank Swasta. Adalah penting untuk diketahui bahawa DTP yang disimpan dalam Bank Swasta tidak boleh didermakan dan digunakkan oleh Masyarakat Umum melainkan kesemua syarat-syarat dipatuhi seperti mendapatkan kebenaran pelanggan (Ibu), ujian umum, ujian penyakit berjangkit, dan ujian jenis tisu. Bank DTP perlu menyediakan lapuran yang mengandungi maklumat makmal untuk setiap ujian dan juga perlu memberi penjelasan dan intepretasi keputusan ujian.

Sekian buat masa ini......Wslm..WBK

Cord Blood Banking in the Middle East

If there's one building that I never get tired of looking at in KL, it has definitely got to be the Petronas Twin Towers. If the number of tourists in the park just beneath it is any indication, it confirms that I am certainly not the only one. Since the sunshine brings such perfect days and stormy nights, even the movie producers are out in full force, taking full advantage of the predictability of cloudless skies.

These towers were once the tallest in the world (est 1998), but it has now been beaten by the Taipei 101 (2004) and I read that the completion of Dubai's Burj Dubai which is a huge structural icon in the making, will rank number one as of next year if the project finishes on schedule (estimated completion Dec 2009).

I know you must be wondering where I'm going with this but please indulge me a little longer.

As someone who has yet to visit the middle east nations, I can only imagine what their cities and populations are like. Dubai has a population of just over a million people, so I'm wondering what all the space in the Burj will be used for, but I suppose that they are planning to attract migrants to the city and plan to expand the city's population to three times of what it is today in the next one or two decades.

The population in other Arab Emirates is also fairly small. Doha, the capital of Qatar which lies westerly of Dubai across the sparkling Persian Gulf competes with Dubai in terms of infrastructure and is likewise in the process of establishing itself for other activities apart from finance. Doha laid claim to a fantastic sports center built to groom and train athletes for modern Olympics and apparently also has some architecturally tasteful and stylish designer buildings which serve as office and varsities.

Qatar is wealthy due to their oil and gas deposits which provide the financial bedrock for the economy and with a small population of less than a million, the GDP is thus very high.

It is in Doha which Richard Branson and his partner Excalibur (PE fund) have decided to relocate and re-launch the Virgin Cord Blood Bank with the new name of Virgin Health Bank QSTP (where QSTP is an abbreviation for Qatar Science and Technology Park).


WHY DOHA?

According to the press article, the Virgin Team did consider other major cities in the UAE but decided on Doha due to the Qatari commitment from the government and its Queen:

BACKED BY THE GOVERNMENT
"Branson said today that the bank chose Qatar because “the government of Qatar and the queen in particular understood the importance of this and wanted it.” Evans said that the presence of facilities such as the Weill Cornell Medical College campus and the future Sidra Medical & Research Center (now under construction) in Qatar were also part of the country’s draw."

The Qatar Science Center (featured on the right)


HOW MUCH?

At the press conference held on Tuesday, the investment in starting a cord blood bank was announced to require 9 million British Pounds (46 million RM) while stating that 10 million USD had already been spent.

As for the charge for Virgin's services which encompass a private-public model, nothing is confirmed but it is supposed that the Qatari government will initiate the project by footing the bill. Given a birth rate of approx. 16 births per 1000 people, all of Qatar would have a birth rate of 16,000 per year. Not too much to handle if most deliveries are managed by a few hospitals.

The shareholders have declared that all profits from the service will be channeled back into health care charities, and to be fair to the corporates, probably less operational and running costs.


NEW GOALS

"The company’s goal is to create a comprehensive source of stem cells that could be of particular use for treating people of Middle Eastern descent, whose tissue types are often underrepresented in the public tissue banks such as those in the U.S. and elsewhere. “This cord blood bank could end up being bigger than the U.K.’s bank quite quickly,” Branson noted at a press conference today marking the company’s inaugural board meeting in Qatar."

I wrote about Virgin's plan previously and if you need a helpful reminder of what it was, click here.


Cultural Mind-Shift

One of the acknowledged challenges of the service would be to convince the Qataris to participate and engage the cord blood service. I was very impressed to know that the Qatari Islamic religious leaders are forward thinking and have already issued a fatwa (muslim sharia law) approving the collection of cord blood and encouraging its use. Dr. Yousuf Qaradawi a prominent Islamic scholar has endorsed its use.

Here in Malaysia, it would be great if the Islamic leaders would take up the issue and do the same in responding to the concept of cord blood banking.

Singapore Advertises Cord Blood Stem Cell Banking (Part 1)

Last week in the Singapore Straits Times, there were two snippets about cord blood stem cell banking. The first one was a news piece on the Singapore public cord blood bank (entitled Cord Blood Bank has saved 21 lives**) which was campaigning for an increase in units (arguably an ad in itself). The other snippet was an ad by a local private Singapore Cord Blood Bank Cordlife. The ad appeared 2 days after the news article and I don't think its a coincidence to keep the conversation and interest in Singaporean's minds.

The first article from the Singapore Cord Blood Bank at a press conference reveals quite a lot about what its like to be an operator of a public bank:

How many cord blood stem cell units have been released and where have they gone?

"In the 3 years it has been open, the Singapore Cord Blood Bank has saved 21 lives - here and overseas... a 22nd donation was winging its way over to France"

"Of the 21 recipients, 12 were patients here while the other nine were ethnic Asians in Europe and Malaysia."

Comment: 21 cord blood units utilized in transplantation is very respectable for a small bank. Financially, at a purchase price of SGD 26,000 per unit in Singapore, the SCBB would have generated SGD 312,000 in revenue for the 12 Singaporean patients and another approximately SGD 320,000 from the 9 overseas patients (assumption is that these patients came through the NMDP network and paid the standard price). That would bring the SCBB's total revenue to SGD 632,000 or slightly more than this.


How many Singaporeans have donated cord blood and how many of those have been successfully banked?

"The repository has been able to bank about half of the 9,000 donations so far. Donations sometimes do not yield enough stem cells to be viable*."

Comment: The yield of 50% is very much in line with what I've heard from other public cord blood banks. However the article doesn't explain that units are discarded due to bacterial / viral contamination (let's not forget that vaginal flora and fauna can be quite substantial) and that the cord blood bank sets its own guidelines as to the volume and/ or cell count required at the beginning before they proceed to process the unit.

As a guide, at the time of receipt of the cord blood unit, most public cord blood banks insist on a minimum volume of 100 mls or total cell counts exceeding 1 billion. The rationale for this is that the cord blood unit needs to be at a level high enough to treat an adult (including caucasian weight & bigger sized asians), otherwise its not worth keeping (bearing in mind that this inventory can and most certainly will take years to clear). *Thus the term "viable" in the article refers to the unit's chances of being used.

Targets for the Singapore Cord Blood Bank?

"An earlier target of banking 10,000 samples by next year has been extended to 2013 said Mr. Sobak (SCBB's CEO and COO of SingHealth), since its been harder to get good-quality donations."

Comment: 10,000 units in the tank is an ambitious target but let's consider the following points:

1) The SCBB is based in the KK Women's and Children's Hospital, which alone delivers the vast majority of Singaporean babies has handled almost 40,000 babies at its peak, but more likely in the range of fifteen to twenty thousand now.

If the SCBB were able to collect all of the cord blood units from all the babies delivered there per year, without approaching any other hospitals (and discounting the 50%) the SCBB would have had about twenty thousand or so units by now. But, that would mean that they would have been working at a pace of 20 units per day seven days a week, all year round for 3 years. Hence the limitation of time, processing space and cost all plays a part in the operational capacity. [4 years more for 5000 units]

2) Cordlife, the first local Singaporean private cord blood bank started in 2001 only recently achieved 13,000 units in 2008 (announced in an ad) and claim only a 1% contamination rate, which means that they store almost every unit they receive. So repositories take a long time to build. [7 years for 13,000 units]

3) StemLife achieved 10,000 units in 2006, about 4 years after operational commencement (I assure you, not without toil).


Another target mentioned by the CEO was 30 transplants for the financial year 2009. I find this to be an interesting target, as I suspect it greatly depend on whether the requests just happen to match the units in the tank? Or perhaps it is now possible to analyze the recipient population and to try to identify the relevant donors to collect the cord blood from.

Anyway, getting back to the financial year for SCBB, I suppose the financial target would be in excess of SGD 1 million in revenue - if they manage to sell the inventory overseas. It is a business after all.


What are the likelihoods of use?

"At least six people are diagnosed daily in Singapore with different types of blood-related diseases said the bank's medical director William Hwang."

"Many of these patients will require a blood stem cell transplant to survive"

"With these samples and those fom banks worldwide, the odds of local patients finding a match is about 10-20%"


OK, quick back of the envelope calculation here. 6 people diagnosed daily in Singapore with a blood related disorder, ie 2000+ people. Let's say 50% will require a transplant at some stage, so let's bring the figure to about 1000 people needing a transplant.

And since only 10-20% will be able to find a match from all available units locally and internationally, ie 100-200 people will get their stem cell treatment... and the rest will have to wait.