A cord blood bank is a facility which stores umbilical cord blood for future use. Both private and public cord blood banks have developed in response to the potential for cord blood in treating diseases of the blood and immune systems. Public cord blood banks accept donations to be used for anyone in need, and as such function like public blood banks. Traditionally, public cord blood banking has been more widely accepted by the medical community. Private cord blood banks store cord blood solely for potential use by the donor or donor's family. Private banks typically charge around $2,000 for the collection and around $200 a year for storage.
The policy of the American Academy of Pediatrics states that "private storage of cord blood as 'biological insurance' is unwise" unless there is a family member with a current or potential need to undergo a stem cell transplantation. The American Academy of Pediatrics also notes that the odds of using one's own cord blood is 1 in 200,000 while the National Academy of Medicine says that only 14 such procedures have ever been performed.
Cord blood contains hematopoietic stem cells (which can differentiate only into blood cells), and should not be confused with embryonic stem cells or pluripotent stem cells, which can differentiate into any cell in the body. On the possibility that cord blood stem cells could be used for other purposes, the World Marrow Donor Association and European Group on Ethics in Science and New Technologies states "The possibility of using one's own cord blood stem cells for regenerative medicine is currently purely hypothetical....It is therefore highly hypothetical that cord blood cells kept for autologous use will be of any value in the future" and "the legitimacy of commercial cord blood banks for autologous use should be questioned as they sell a service which has presently no real use regarding therapeutic options."
Regulation
In the United States, the Food and Drug Administration regulates cord blood under the category of "Human Cells, Tissues, and Cellular and Tissue Based-Products." The Code of Federal Regulations under which the FDA regulates public and private cord blood banks is Title 21 Section 1271. Several states also require accreditation, including New York, New Jersey, and California. Any company not accredited within those states are not legally permitted to collect cord blood from those states, even if the company is based out of state. Potential clients can check the New York accreditation status from the New York Umbilical Cord Blood Banks Licensed to Collect in New York. Both public and private cord blood banks are also eligible for voluntary accreditation with either the Association for the Advancement of Blood & Biotherapies (AABB) or the Foundation for the Accreditation of Cellular Therapy (FACT). Potential clients can check the current accreditation status of laboratories from the AABB list of accredited cord blood laboratories or the FACT search engine of accredited cord blood banks (on their home page). Other countries also have regulations pertaining to cord blood.
Collection and cryopreservation
Cord blood collection happens after the umbilical cord has been cut and is extracted from the fetal end of the cord, diverting up to 75 +/- 23 mL from the neonate. It is usually done within ten minutes of giving birth. Additional stem cells may be collected from the placenta. After the health care provider draws the cord blood from the placental end of the umbilical cord, the placenta is couriered to the stem cell laboratory, where it is processed for additional stem cells. An adequate cord blood collection requires at least 75mL in order to ensure that there will be enough cells to be used for a transplantation. Before the cord blood is stored for later use, it undergoes viral testing, including tests for HIV and Hepatitis B and C, and tissue typing to determine Human Leukocyte Antigen type. It will also be examined for nucleated cell count, cell viability, blood group antigen ABO & Rh blood group system, molecule cluster (CD34), and bacterial and fungal growth.
After the collection, the cord blood unit is shipped to the lab and processed, and then cryopreserved. There are many ways to process a cord blood unit, and there are differing opinions on what the best way is. Some processing methods separate out the red blood cells and remove them, while others keep the red blood cells. However the unit is processed, a cryopreservant is added to the cord blood to allow the cells to survive the cryogenic process. After the unit is slowly cooled to −90 °C, it can then be added to a liquid nitrogen tank which will keep the cord blood unit frozen at −196 °C. The slow freezing process is important to keep the cells alive during the freezing process. There is no consensus yet on optimal procedures for these cord blood cells, although many cryopreservation strategies suggest using dimethyl sulfoxide (DMSO), slow or controlled rate cooling, and rapid thawing.
Cord blood stem cells (though usually from donors) are currently used in the treatment of several life-threatening conditions, mainly blood and immune system related genetic diseases, cancers, and blood disorders. The first clinically documented use of cord blood stem cells was in the successful treatment of a six-year-old boy afflicted by Fanconi anemia in 1988. For two decades after that, cord blood became increasingly recognized as a source of stem cells that can be used in stem cell therapy.
Public banks
Public cord blood banks function like public blood banks, in that they accept donations from anyone, discard donations that fail to meet various quality control standards, and use national registries to find recipients for their samples. Since patients who need cord blood frequently need more cells than a single collection would have provided, public banks frequently combined multiple samples together when preparing the treatment for a single patient. Before the advent of haploidentical bone marrow transplantation, cord blood's lack of requirement for an exact genetic match made it easier to provide patients samples from unrelated donors.
A recent large study by the journal Pediatrics concluded that almost all cord blood transplants come from public banks:
<blockquote>In the Pediatrics study, transplant specialists who collectively have performed thousands of stem cell transplants for childhood leukemia and other illnesses report that only 50 involved privately banked blood. (Support for public cord-blood banking is widespread in the medical community.) Forty-one cases involved blood used to treat a family member, often a sibling; in 36 of those cases the need for a transplant was known before the cord blood was collected. Only nine cases involved giving cord blood back to the donor, a practice known as autologous transplantation and the chief selling point for private cord-blood banking.</blockquote>
Private banks
Private banking is typically costly to parents and not covered by insurance. The ability to use the cord blood may also depend on the long-term commercial viability of the enterprise. The odds that two siblings will have a 6/6 match, for a matched related bone marrow transplant, are 25%.
The policy of the Society of Obstetricians and Gynaecologists of Canada (SOGC) supports public cord blood banking (similar to the collection and banking of other blood products, i.e. altruistic, anyone can use it), as well as stating that it should only be considered under certain circumstances. The policy of the American Academy of Pediatrics states that "private storage of cord blood as 'biological insurance' is unwise" unless there is a family member with a current or potential need to undergo a stem cell transplantation. Private storage of one's own cord blood is unlawful in Italy and France, and it is also discouraged in some other European countries.
As of 2007, contracts of the largest cord blood banks do not explicitly state that the cord blood belongs to the donors and child with all the rights and privileges one would reasonably expect from ownership. The ambiguity leaves open future uses not approved by the donors and child. At the majority of private cord blood banking facilities, the mother owns all rights to the cord blood that was banked, until the minor in which the cord blood was taken turns eighteen. At that time the minor has all rights to his or her own banked cord blood.
Concerns have been raised that the current interest in cord blood could cause a perception that cord blood is "unused" by the birth process, thus decreasing the amount of blood which is infused into the child as part of the birth process.
In 2024, the New York Times described problems with microbial contamination as well as low-volume samples that did not have adequate stem cell counts.