[img_assist|nid=194|title=|desc=|link=none|align=right|width=100|height=43]Increasingly stem cells from umbilical cord blood (UCB) enter the biomedical and biopolitical discussions about stem cells: as «donation» and baby's «First gift», as biological «life insurance» or as life saving «therapeutic» for a sibling.
Is umbilical cord blood banking a live insurance for a newborn baby, or a commercial enterprise that promises much too much? What problems are bound to follow it?

To take blood stem cells from cord blood instead of from bone marrow is a simple and non-invasive technique. The blood is taken from the umbilical cord after it is clamped and cut, and therefore without risk for mother and child. In contrast to the blood of children and adults, the cordial blood still contains blood stem cells, identical to those in the bone marrow. The chance that the cells carry a virus infection is very small, and they can be transplanted like other blood stem cells.

As with other issues of medical technology, the techniques also bring medical, legal and social questions about, questions about the commodification of body parts.

Currently stem cells from cordial blood are used in three different ways:

• Donation: Parents can donate the cells to a public blood bank. After some test about the immunological type of the cells, and about possible virus infection of the blood of mother and child, the cells are stored anonymously for whoever might need them. Such blood banks are often connected to medical universities.
• Storage: Parents can also store the cells in a commercial blood bank. Especially in the USA numerous banks exist, with a wide variety in services offered and prices charged. In Germany two banks offer their services: Cryo-Care and VITA34, which worked closely together with the Women's Medical University Bochum. Under the idea of a «life insurance», parents as the legal guardians of a child can have the blood stem cells stored for 20 or 99 years for between 1800 and 3300 Euro.
• Specific usage: A third option is to use the cells for a «targeted donation». In this case the cells are directly used for the treatment of somebody else, mainly siblings or parents of the newborn. The most spectacular case is that of Adam Nash, born in the USA in 2001. Using In Vitro-Fertilisation (IVF), pre-implantation genetic diagnostics (PGD), and pre-natal diagnostics his parents were making sure that a baby was born that would not have the genetic disease Faconi anaemia, and that its immune type would match those of its sister who is ill with this disease. Directly after the birth cordial blood cells were transplanted to her, and the press covered it as a gift of the newborn to his sister.

Alarming is that the technological possibilities gave the parents and doctors at least two times the opportunity to check on the quality of the child (whether it would be ill and whether it would have a suitable immuno type) and to end the pregnancy if the foetus did not fulfil those quality traits. It is beyond doubt that the technical options can turn a child into a by-product in producing blood stem cells.

For the treatment of...

According to the websites of commercial blood banks, cordial blood stem cells can be used a number of purposes that look to good to be true: life-long, custom made help for a long list of life threatening diseases.

One practical problem, however, is often overlooked. The amount of blood that can be taken from the umbilical cord is only about 100 ml. With the current state of the art, the number of blood stem cells is only sufficient to treat a person with up to a weight of 35 or 40 kg. That makes is sufficient to treat a child, but not an adult. Research is done on the multiplication of blood stem cells, but has so far not been successful. In addition to that, there is no experience with long-term storage of such cells. At the moment one expects a maximum storage time of 15 years. The life insurance could therefore become already useless before the child comes of age.

The expectations for a possible future use of the cells are high. The US company Cord Blood Register lists more than 40 diseases that can be treated with stem cells: leukaemia and other cancers, stem cell disorders, metabolic diseases, (inherited) immune system disorders and other inherited disorders. Until the middle of May the page held a disclaimer, stating that the list consisted of disorders that are currently treated with stem cells from bone marrow, and that the stored blood stem cells might not be suitable for the treatment. This disclaimer however has been removed now. What new results brought this change about remains unmentioned by the company.

Not to be used in case of leukaemia

Transplantators actually stress that someone's own (autologen) stem cells could be unsuitable in a lot of cases, especially with (at least partly) inherited disorders. Even for a child with leukaemia, the transplantation with his/her own stem cells would only be second best, compared with a suitable donor. (Allologen) donor cells usually trigger a slight immune reaction necessary for the treatment. "The success rate are about 10 to 15 per cent lower, if one's own cells are used instead of donor cells", says Prof. A. Ho from the University of Heidelberg. In addition to that, one has to expect that with the most common form of leukaemia in children, Acute Lymphoblastic Leukemia, tumour cells will already present in the blood during birth (Lancet 1999, 354:1499). Using the child's own cordial blood would be a too high danger of relapse.

For a lot of the disorders listed, the stored cells will therefore be of no use to the child from which they are taken.

Currently the use of stem cells is tested for a wide variety of diseases, including Parkinson's disease, Diabetes Type 1 and heart attacks. Due to the age of the patients, there is of course no cordial blood available, so for the coming decennia scientists will have to fall back on stem cells from bone marrow or other cells. Therefore it becomes even less probable that the storage of the cordial blood stem cells is worth it. If one believes that in the foreseeable future stem cell therapies will work out, also has to believe that these therapies will be without one's own cordial blood.

Property rights

If cordial blood stem cells are made available, the issue of property rights have to be addressed. Question lik: How do the cells belong to? The simple answer would be: To that person from whose umbilical cord they come, whose body they resemble. However, due to the small amount, there will be only enough for one treatment, and there is only one moment, directly after birth, that the cells can be harvested. Can a child sue its parents for not using that chance? Do parents have the right to donate the cells? Do they have the right to use them for a sibling instead of keeping them for the child itself? Or do individuals have the moral obligation to donate the cells, instead of wasting them by storing them for the unlikely case that the owner needs them? Chances are much higher that they will be used if they are donated to a public blood bank. But then again how life threatening does the situation have to be before they can be given out? The company VITA34 in Germany froze about 10,000 bags of blood since 1997, and nobody used his/her sample yet. Might they have been put to better use in a public blood bank? And again, who is to decide that?

I do not want to answer this questions, but I want to show which legal issues, which moral obligation can and will come up in this context. Problems already exist, if somebody gets under the moral obligation to give up his/her bodily integrity because s/he wants and/or is supposed to help somebody when it comes to bone marrow and live organ transplantations.

Another scenario can be developed if autologen cordial blood cells could in future in fact be used for a wider variety of disorders. In that case, it will only be a matter of time before the owner of the cells or his/her legal guardian will consider selling them, no matter how high the chances are of using them herself. When it comes to selling and buying organs, the internet already shows how to work your way around restricting national laws. Selling of bodily integrity exists in (commercial) organ donation, surrogate pregnancies and drug trials, and the price for the one set of matching cells for a dying child will be high.