The Future of Cord Blood Banking in Canada
Sheremeta, Lorraine, Plant, Margo, Knoppers, Bartha Maria, Health Law Review
The potential clinical utility of umbilical cord blood (UCB) as a source of stem cells has led to the emergence of several public and private cord blood banks across Canada (see Table 1). Although UCB banking in Canada remains in its early stages there are many regulatory and policy issues that need to be addressed. The purpose of the Stem Cell Network Catalyst project entitled "The Future of Cord Blood Banking in Canada" is to examine the socio-ethical and legal issues surrounding UCB banking and to develop an ethical framework to guide policy makers in mapping out the future of cord blood banking in Canada. As a first step in this process, a discussion paper was drafted in preparation for a workshop on point. The discussion paper provides a selective overview of key socio-ethical and legal issues implicated in UCB banking. The issues addressed include: 1) public awareness and perceptions relating to UCB banking; 2) the process of informed consent for the collection, donation, processing, storage and future use of UCB; 3) issues related to ethnic diversity; and 4) the potential of developing a national UCB banking and transplant program. Relevant literature is synthesized and points for discussion are raised. This poster presentation provides a concise summary of the main issues identified in the discussion paper and will serve to raise awareness and provoke reflection on these important socio-ethical and legal issues amongst Stem Cell Network researchers and participants at the Annual General Meeting.
The Current State of Cord Blood Banking in Canada: Public v. Private
At present Canadians can potentially access both public and private cord blood banks. Public UCB banks in Alberta, Quebec and Ontario accept donations of UCB samples that are processed and stored for future use--either autologous, related or unrelated. No fee is associated with UCB donation to a public bank. The samples are processed, stored and are accessible through an international registry to any appropriately matched individual who might need them. Alternatively, for a fee, private UCB banks process and store UCB samples for autologous or related transplantations.
Public Awareness and Perceptions of UCB Banking
There are few published reports of public opinion on the topic of UCB banking and transplantation. The following table provides a summary of the main findings from identified published works.
To date, the discussion about informed consent for UCB donation has closely paralleled the discussion about informed consent in the context of gene banks. UCB samples, like DNA samples, are collected and stored for future use. Unlike gene banking, the collection of UCB samples has a predominantly clinical purpose though samples not suitable for transplantation may have research value. The timing of eliciting informed consent is complicated by labour and delivery and by the fact that the biologic sample is directly referable to two individuals--the mother and the child--and potentially to other genetically related individuals.
An important goal of UCB banking is to increase ethnic and racial diversity of banked cord blood to ensure equitable access to transplantation. It is expected that UCB banking programs have the potential to be more successful than marrow donor programs at recruiting donations from ethnic minorities though in practice this potential has not materialized. In order to attain this goal, the potential barriers to donation must be explored and strategies to increase minority recruitment must be considered.
Should Canada Invest in a National UCB Banking and Transplant Program?
Arguments in Favour of Developing a National UCB Banking Program in Canada
** Canada has a large minority population that is not adequately served by existing Canadian or internationally accessible bone marrow or UCB banks. …