Controversies in hybrid banking: attitudes of Swiss public umbilical cord blood donors toward private and public banking

Hybrid umbilical cord blood banking: literature review

PURPOSE

Interest gaps between public and private umbilical cord blood banks have led to the introduction of hybrid banking options. Hybrid models combine features of private and public banks as well as interests of parents, children and of patients, in order to find an optimized solution. While several different models of hybrid banks exist, there is a lack of literature about this novel model of cord blood stem cell banking. Therefore, the aim of this literature review is to assess different options of umbilical cord blood banking and whether hybrid banking could be a valuable alternative to the existing public and private cord blood banking models.

METHODS

We performed a systematic literature search, using five main databases. Five hybrid models regarding their advantages as well as their challenges are discussed in this review.

RESULTS

We found that a wealth of literature exists about public cord blood banking, while private and hybrid banking are understudied. Different modalities of hybrid cord blood banking are being described in several publications, providing the basis to assess different advantages and disadvantages as well as practicability.

CONCLUSION

Hybrid banks, especially the sequential model, seem to have potential as an alternative to the existing banking models worldwide. A previously conducted survey among pregnant women showed a preference for hybrid banking, if such an option was available. Nevertheless, opinions among stakeholders differ and more research is needed to evaluate, if hybrid banking provides the expected benefits.

Knowledge, Awareness, and Attitudes toward Umbilical Cord Blood Biobanking

BACKGROUND: Umbilical Cord Blood (UCB) stem cells are a non-invasive, effective alternative source of hematopoietic stem cells for the treatment of a variety of diseases. AIM: The aim of the study was to research knowledge, awareness, and attitudes of the general public and health professionals regarding the UCB storage. MATERIALS AND METHODS: A cross-sectional study was conducted with an online survey (n = 408) using the snowball method. RESULTS: A majority of respondents declared that they were not aware of UCB banking; however, people with an academic background in healthcare have a greater awareness of UCB banking. A subjective assessment found that their knowledge of UCB banking is better than that of non-professionals, however, they exhibited better knowledge and understanding of UCB use and banking in only a few aspects. People with an academic background in healthcare have a more polarized attitude toward cord blood banking and a higher percentage are unwilling to pay for UCB banking services. However, their preferences regarding public/private UCB banking do not differ significantly from those of non-professionals. CONCLUSION: Here, we show that there is not much difference between the laic and professional categories in terms of knowledge about the specific purpose and characteristics of UCB storage.

Changes in Knowledge about Umbilical Cord Blood Banking and Genetic Tests among Pregnant Women from Polish Urban and Rural Areas between 2010-2012 and 2017

The aim of this study was to evaluate knowledge of umbilical cord blood (UBC) banking and prenatal genetic diagnosis among pregnant women from rural and urban areas, and how this knowledge changed within a five-year period. A survey by questionnaire was conducted between 2010 and 2012, and in 2017 in public hospitals; the study population comprised 6128 women, with 2797 patients from the years 2010-2012 and 3331 from the year 2017. 41% of the studied population declared that they were living in rural areas. In the 2010-2012 period, fewer women from rural areas knew about UBC banking. In 2017 that same relative difference in knowledge persisted, but the percentage of women who now knew about this procedure rose significantly in both studied groups. Prenatal diagnosis was more familiar for urban inhabitants both in 2010 and 2017 but as with the UBC data, a trend of growing awareness was also seen in pregnant women from rural areas. Knowledge of new techniques such as UBC banking and genetic tests has grown among pregnant women during the time frame of our study, but there is still a need to emphasize the benefits of these two possibilities to pregnant women, especially among rural inhabitants.

Parents' knowledge, awareness and attitudes of cord blood donation and banking options: an integrative review

Background

For over 25 years cord blood has been used as an alternative to bone marrow for therapeutic use in conditions of the blood, immune system and metabolic disorders. Parents can decide if they would like to privately store their infant’s cord blood for later use if needed or to publicly donate it. Parents need to be aware of the options that exist for their infant’s cord blood and have access to the relevant information to inform their choice. The aim of this paper is to identify parent’s knowledge and awareness of cord blood donation, private banking options and stem cell use, and parent sources and preferred sources of this information.

Methods

An integrative review was conducted using several electronic databases to identify papers on parents’ knowledge, attitudes and attitudes towards umbilical cord blood donation and banking. The CASP tool was used to determine validity and quality of the studies included in the review.

Results

The search of the international literature identified 25 papers which met review inclusion criteria. This integrative review identified parents’ knowledge of cord banking and/or donation as low, with awareness of cord blood banking options greater than knowledge. Parents were found to have positive attitudes towards cord blood donation including awareness of the value of cord blood and its uses, with the option considered to be an ethical and altruistic choice. Knowledge on cord blood use were mixed; many studies’ participants did not correctly identify uses. Information sources for parents on cord blood was found to be varied, fragmented and inconsistent. Health professionals were identified as the preferred source of information on cord blood banking for parents.

Conclusions

This integrative review has identified that further research should focus on identifying information that expectant parents require to assist them to make informed choices around cord blood banking; and identifying barriers present for health professionals providing evidence based information on cord blood use and banking options.

Electronic supplementary material

The online version of this article (10.1186/s12884-018-2024-6) contains supplementary material, which is available to authorized users.

Current Knowledge and Practice of Pediatric Providers in Umbilical Cord Blood Banking

More than 35 000 umbilical cord blood (UCB) transplants have been performed worldwide, prompting the development of private and public banks to collect and store UCB cells. We hypothesized that pediatricians, who are uniquely poised to discuss UCB banking (UCBB) during prenatal or sibling visits, rarely do so. Through distribution of a 26-question electronic survey to general and subspecialty pediatric providers, we assessed baseline knowledge and conversations about UCBB. A total of 473 providers completed the survey; only 22% of physicians ever discussed UCBB with expectant parents. The majority responded that autologous UCB transplants were indicated in malignant (73%) and nonmalignant (61%) conditions; however, these are rare indications. Providers practicing >10 years were more likely to address UCBB ( P ≤ .001), whereas younger and female general pediatric providers were significantly less likely ( P < .001). Overall, pediatric providers rarely speak to families about UCBB, and we believe that they can be better informed to its current clinical utility.

Institutional Knots: A Comparative Analysis of Cord Blood Policy in Canada and the United States

Umbilical cord blood is a rich source of blood stem cells, which are of critical clinical importance in the treatment of a variety of malignant and genetic conditions requiring stem cell transplantation. Many countries have established national public cord blood banks; such banks often coexist with a panoply of private options for cord blood banking. Until recently, Canada was the only G8 country without a national cord blood bank. This differs markedly from the United States, which years ago established a national cord blood bank policy and inventory. This article investigates potential reasons for this discrepancy through a comparative analysis of the evolution of programs and policies on national cord blood banking in Canada and the United States. My analysis suggests that cross-national discrepancies in policy on public cord blood banking were determined primarily by institutional factors, principal among them formal governmental structure and the legacy of past policies. Institutional entrepreneurialism in the health sector played a constitutive role in the earlier evolution of national cord blood policy in the United States as compared to Canada.

Are hybrid umbilical cord blood banks really the best of both worlds?

Since the first use of umbilical cord blood (UCB) as a medical therapy, the number of UCB banks worldwide has grown. Public UCB banks offer the option of altruistic donation, whereas private banks allow a product to be stored for the exclusive use of the paying client. With many more UCB products banked privately than publicly in countries such as the USA, hybrid models blending aspects of public and private banking have been proposed. One such bank is in operation in the UK. In this paper we review the hybrid UCB model and conclude that it offers limited benefit to the general public. Furthermore, compared with private banking, this model provides few advantages and potential disadvantages to private clients.

Knowledge, beliefs, and decisions of pregnant Australian women concerning donation and storage of umbilical cord blood: a population-based survey

BACKGROUND

Many women giving birth in Australian hospitals can choose to donate their child's umbilical cord blood to a public cord blood bank or pay to store it privately. We conducted a survey to determine the proportion and characteristics of pregnant women who are aware of umbilical cord blood (UCB) banking and who have considered and decided about this option. The survey also sought to ascertain information sources, knowledge, and beliefs about UCB banking, and the effect of basic information about UCB on decisions.

METHODS

Researchers and hospital maternity staff distributed a survey with basic information about UCB banking to 1,873 women of at least 24 weeks' gestation who were attending antenatal classes and hospital clinics in 14 public and private maternity hospitals in New South Wales.

RESULTS

Most respondents (70.7%) were aware of UCB banking. Their main information sources were leaflets from hospital clinics, print media, antenatal classes, TV, radio, friends, and relatives. Knowledge about UCB banking was patchy, and respondents overestimated the likelihood their child would need or benefit from UCB. Women who were undecided about UCB banking were younger, less educated, or from ethnic or rural backgrounds. After providing basic information about UCB banking, the proportion of respondents who indicated they had decided whether or not to donate or store UCB more than doubled from 30.0 to 67.7 percent.

CONCLUSIONS

Basic information for parents about UCB banking can affect planned decisions about UCB banking. Information should be accurate and balanced, should counter misconceptions, and should target specific groups.

Public banking of umbilical cord blood or storage in a private bank: testing social and ethical policy in northeastern Italy

Background

In northeastern Italy, according to Italian legislation, authorized public facilities can accept the donation and preservation of cord blood stem cells (CB-SC). Attitudes and knowledge in pregnant women differs between the local and immigrant (non-European Union [EU]) population. In this study we assessed the choices that pregnant women have with respect to the public and private harvesting system and the main reasons driving their decisions. We examined the ethnic origin of the families and compared tests for syphilis screening and leukocyte (WBC) counts in the CB-SC bags that are required for validation of the collection.

Methods

Out of a population of 3450 pregnant patients at the Institute for Maternal and Child Health of Trieste, northeast Italy, 772 women agreed to cord blood harvesting and the associated lab tests. Of these, 221 women (28.6%) were from immigrant families of non-EU countries. Their ethnic affiliation was recorded, and tests were performed for syphilis screening and for nucleated red blood cell (NRBC) interference with the WBC count in CB-SC bags to assess cellularity and to determine if storage was appropriate.

Results

Of the 772 pregnant women, 648 (84.0%) accessed the public collection system, which is free of charge, and 124 (15.0%) accessed the private fee-based system. One woman from the non-EU group opted for the private fee-based system. Of the 3450 pregnant women screened for syphilis at the Institute for Maternal and Child Health, the Treponema pallidum hemagglutination (TPHA) and Venereal Disease Research Laboratory (VDRL) tests were the main tests performed (66.0% of total cases) because many gynecologists in the public harvesting system apply the Italian regulations of the 1988 Decree, while the private system requires tests on syphilis and leaves the option to the lab physicians to select the best determination method. We found that the chemiluminescence method was more specific (97.0%) than the TPHA (83.0%) and nontreponemal rapid plasma reagin VDRL (75.0%) tests (P < 0.05, χ² test). The specificity link between the two automatic methods versus microscopes for WBC dosing and NRBC interference was r² = 0.08 (ADVIA 120) and r² = 0.94 (XE-2100). The public system does not include human T-cell lymphotropic virus testing; this is reserved for the population from endemic zones.

Conclusion

In northeastern Italy current legislation prevents the establishment of private fee-based banks for storage of CB-SC. The cryopreservation, for future autologous personal or family use, is possible only by sending to foreign private banks, with a further fee of €300. These regulations confirm that Italian legislation tries to increase the anonymous allogenic donations and the number of CB-CS bags stored in the free-cost public system, that are available to anyone with therapeutic needs. Private banking is used almost exclusively by the wealthier local population. In the public system, many physicians continue to use older Italian laws regarding syphilis diagnosis, and NRBC interference on WBC count may have an impact on cord blood harvesting. Our findings suggest that in the EU there is no consensus policy on donor management. The value of storage for potential use within the family is useful only with collaboration between the public and the private systems.

High acceptance rate of hybrid allogeneic-autologous umbilical cord blood banking among actual and potential Swiss donors

BACKGROUND

Two competitive concepts of umbilical cord blood (UCB) banking are currently available: either allogeneic UCB is donated to a public bank or autologous cells are stored in a private bank. Allogeneic-autologous hybrid banking is a new concept that combines these two approaches. However, acceptance of hybrid UCB banking among potential donors is unknown to date.

STUDY DESIGN AND METHODS

In a prospective survey, we aimed to establish the acceptance of the hybrid banking model among actual and potential UCB donors in Switzerland. The study groups consisted of parents and pregnant women with or without children. As control group, women at reproductive ages were investigated.

RESULTS

The majority of participants agreed fundamentally with UCB donation, and overall acceptance of private banking was 47%. If a possibility for hybrid banking were to be made available, 49% would opt for such a public-private model and only 13% would choose private banking alone. Among the proponents of hybrid banking, a majority of participants chose donor cell splitting over the sequential banking mode. Fifty-six percent of responders wished prior notification before the release of their donated UCB to a foreign recipient.

CONCLUSIONS

This is the first study which compared the acceptance of allogeneic, autologous, and hybrid allogeneic-autologous UCB banking in different target groups. We demonstrated that hybrid cord blood banking is the preferred model of banking among actual and potential UCB donors. With increasing demand for UCB in the future, health care providers should therefore consider offering hybrid banking as a viable storage option.

Autologous cord blood harvesting in North Eastern Italy: ethical questions and emerging hopes for curing diabetes and celiac disease

Background

The Friuli Venezia Giulia (FVG), a region of North Eastern Italy, has passed legislation (Decree No 2324/2010) to regulate the banking of umbilical cord blood samples for personal, autologous, or family-directed use, and to implement the Agreement of the State-Regions Permanent Conference (Decree No 62/CSR/2010). This paper aims to identify the formalities and the reasons why families collect and bank their cord blood in foreign banks for both personal and private use.

Methods

To this end, at the Institute for Maternal and Child Health of Trieste (the regional capital city of the FVG), Italy, which assists about 1800 pregnant women a year, 129 questionnaires, drafted from January 2010 to December 2011 and concerning the granting of authorization to export samples, were examined.

Results

The collected data showed that 75% of involved families had resorted to anonymous public collection, which is available to anyone with therapeutic needs, and provided compatibility and hematologic protocols recognized by the scientific and international community (main indications: leukemia, hemoglobinopaties, and inherited hematologic and immunologic disorders). Conversely, 25.0% requested private storage at a foreign bank for personal or family-dedicated use. The principal motivation by disease was for treatment for diabetes (22.4%) and celiac disease (19.7%) (a multiorgan disease for which the FVG region has provided safeguards by approving a specific law granting support to families; Decree No 561/2007). For these two types of disease we found that information was received from the internet and not from general medical physicians, with a significant difference found using the χ² test (P < 0.01).

Conclusion

The indication of treating these diseases with cord blood stem cell transplantation appears to be well grounded and encouraging, and has recently been corroborated by the international literature; however, the economic and social motivations promoting cord blood storage, for a fee, in the event of diseases that are still under study, require accurate information through general medical physicians on the actual possibilities of treatment.

Family-directed umbilical cord blood banking

Umbilical cord blood transplantation from HLA-identical siblings provides good results in children. These results support targeted efforts to bank family cord blood units that can be used for a sibling diagnosed with a disease which can be cured by allogeneic hematopoietic stem cell transplantation or for research that investigates the use of allogeneic or autologous cord blood cells. Over 500 patients transplanted with related cord blood units have been reported to the Eurocord registry with a 4-year overall survival of 91% for patients with non-malignant diseases and 56% for patients with malignant diseases. Main hematologic indications in children are leukemia, hemoglobinopathies or inherited hematologic, immunological or metabolic disorders. However, family-directed cord blood banking is not widely promoted; many cord blood units used in sibling transplantation have been obtained from private banks that do not meet the necessary criteria required to store these units. Marketing by private banks who predominantly store autologous cord blood units has created public confusion. There are very few current validated indications for autologous storage but some new indications might appear in the future. Little effort is devoted to provide unbiased information and to educate the public as to the distinction between the different types of banking, economic models and standards involved in such programs. In order to provide a better service for families in need, directed-family cord blood banking activities should be encouraged and closely monitored with common standards, and better information on current and future indications should be made available.