If you are considering privately banking your cord blood, there are some important things you need to know. Here are some key questions we strongly recommend you ask the cord blood bank that you are considering contracting with to collect and store your cord blood.
1. How will you ensure my cord blood will be collected in an appropriate facility, by professionals with specific training in cord blood collection?
Your cord blood must be collected by a trained person. This role is usually covered by a trained phlebotomist, midwife or doctor. The person collecting the cord blood unit must either
- work for an establishment that is licensed by the HTA, or
- under the authority of an HTA licence via a formal third party agreement.
The premises where the procurement will take place must be risk assessed by a trained individual to ensure that it is suitable. This assessment must be documented. There are no exceptions to these requirements. You should also ask what arrangements will be made if the assigned phlebotomist is unable to reach the hospital in time or is ill.
2. What is the maximum time you allow between a cord blood unit being collected and stored? What happens if the unit is not stored within these maximum timeframes?
For optimal viability, it is recommended that cord blood is stored as soon as possible following collection, certainly within 72 hours. (NetCord-FACT 2013) Minimising time between collection and cryopreservation (frozen storage) is key. Increased time in transit can be detrimental to the quality of the cord blood unit. The private cord blood bank should assess the quality of cord blood units where the time between collection and storage has exceeded their set parameters. Clear information should be made available to you on the results of the quality assessment. This is to enable you to make an informed decision about whether to store your cord blood.
3. According to your acceptance criteria, what is the minimum number of cells that must be present for my unit to be banked?
Private cord blood banks set their own criteria of the minimum number of cells that they will bank. Doctors will select cord blood based on various factors, including the quantity of cells present. (This is explained in Table 1: How could privately banked cord blood be used?). If your cord blood unit contains a low number of cells, then it may not be suitable to use in a transplant.
4. Will you inform me if the cord blood unit is unlikely to be suitable for transplant?
The private cord blood banks should state clearly the information that will be provided to you throughout the process of collecting, processing and storing your cord blood. The bank may not assess the likelihood of the cord blood unit to be used in a transplant. They may instead leave this decision up to a physician should the need arise. You may wish to compare banks based on the information that they are able to provide you with about your cord blood. It is common for private cord blood banks to provide clients with TNC and CD34+ cell counts. You may wish to use the table presented here (How could my privately cord blood be used?) to inform your decisions about private cord blood banking.
5. What quality control tests are performed to assess the quality of my cord blood?
Common methods include: testing for microbiological (bacterial and fungal) contamination, viability testing, total nucleated cell count, CD34+ cell count and colony forming unit assays. These methods are explained in more detail in the ‘Key cord blood banking information’ section of this guidance.
6. What would happen to my cord blood unit if the bank were to close down for any reason?
HTA standards require private cord blood banks to have arrangements in place for continued storage of cord blood units should they close down. You may wish to ask the bank to explain their arrangements to you.
7. Some private cord blood banks say that they have ‘successfully released’ cord blood units. Does this relate to the successful treatment of a patient with cord blood?
‘Successful release’ does not necessarily mean that patients have been treated with the cord blood. It could simply involve the transfer of a cord blood unit from the private cord blood bank to a hospital. If you have questions about how a bank’s cord blood has been used, then you should ask the private cord blood bank how many units of cord blood banked by them have been used to treat patients. You may also wish to ask the banks for information that they have about clinical outcomes for the patients treated.
8. What about the fees and costs?
The fees set by private cord blood banks will vary. You should ask for a breakdown of the charges to find out what is included. For example
- Is the service of a trained phlebotomist is included?
- Would you be reimbursed if your cord blood unit was not collected or found not suitable to be banked?
- Are there cost implications for you if the private cord blood bank went out of business or if their premises suddenly became unfit for use?