Pregnant couples are often the target of advertisements recommending umbilical cord blood (UCB) collection at the time of their child’s birth: Support your child’s future—the best decision you’ll ever make.

What does UCB involve, and is it ethical for Christians?

Umbilical cord blood

During pregnancy, the umbilical cord connects the baby to the mother’s placenta in the uterus. It contains blood vessels. UCB refers to the human blood that remains in the placenta and the umbilical cord following the birth. Umbilical cords have traditionally been discarded following the birth. However, they have been found to be a rich source of multipotent hematopoietic stem cells (HSCs), which can be used in transplants to treat more than 70 different diseases, including diseases of the blood, the heart and the immune system. This branch of therapy is called regenerative medicine.

Stem cells are special cells that are capable of developing into many of the different types of tissue in the human body (so blood stem cells can be turned into nerve cells, for instance). The stem cells in UCB are classified as adult stem cells, even though they come from a baby. These are different from embryonic stem cells (which are taken from a 5-day-old embryo), and their use is ethically acceptable for those who wish to respect embryonic human life.[1]

How is UCB collected?

After the delivery (vaginal or caesarean), the cord is clamped and cut in the normal manner (often by the proud father). This separates the baby from the mother and the placenta, and it doesn’t hurt because there are no nerves in the cord. The part of the cord still attached to the placenta is cleaned, and a needle is used to drain the blood into a storage bag. This can be done before or after the placenta is delivered. The blood is then taken away for processing, which includes screening for infectious and genetic diseases. After processing it is placed in (frozen) storage in a blood bank, where it will stay until its possible future use as a source of stem cells for transplants or other therapies (current evidence suggests that freezing does not damage UCB).[2] The whole process is safe and painless, and takes just a couple of minutes.

Collection can only take place at the time of the delivery, so you need to decide beforehand if you want it done and let your doctor or midwife know.

UCB treatments

When the stored UCB is needed, it is thawed and delivered to the patient for treatment. When the stem cells are collected from a donor other than the patient, it is called an allogeneic treatment. When the cells are collected from the same patient for whom they will be used, it is called an autologous treatment. At the moment, UCB is being investigated for transplantation, gene therapy and stem-cell therapy. It is possible that more uses for UCB will be found in the future.

UCB transplants

There are several benefits in using UCB rather than the usual bone marrow for transplants. The cells proliferate more rapidly than bone marrow cells. UCB cells are immunologically immature compared to cells from adult bone marrow or peripheral blood stem cells, so they can tolerate an element of mismatch. As a result, there is less graft-versus-host disease (GVHD) following allogeneic transplantation. For patients with uncommon tissue types, UCB may be an option if an adult donor cannot be found. It is already in storage, so there is no delay in collecting it from a donor. It can usually be ready to give within two weeks, whereas finding a bone marrow donor can take much longer. Disadvantages in using UCB include the fact that there is a small risk (1:10,000) that a genetic disease may be transmitted to the patient.

UCB has been used successfully in transplants for people related to the donor for both malignant and non-malignant diseases.[3]

UCB stem-cell therapy

UCB is also being investigated for use in stem-cell therapy. HSCs are being trialled to modify the body’s immune system in diseases such as diabetes and arthritis. Researchers are currently using HSCs in gene therapy, as a way to deliver new genes to repair damaged cells. The benefits of using HSCs include the ease with which they are collected compared to all other stem cells. They are also believed to be more flexible, or plastic (able to turn into a larger number of different tissue types), than adult bone marrow stem cells.[4]

HSCs are being investigated for use in a wide variety of diseases, including heart, liver, eye, bone, nerve and hormonal diseases.[5]

UCB banks

UCB is stored by both public and private cord blood banks. Public cord blood banks store UCB for the benefit of the wider population. They are strongly supported by the medical community. Computerized registries allow the matching of patients needing a transplant to UCB supplies. Private cord blood banks are commercial organizations that store UCB for the exclusive use of the donor or the donor’s relatives. Fathers and siblings have a 25% chance of matching their child’s UCB stem cells. Of course, the match is perfect for the baby from whom the blood was collected. There is usually a collection fee, and then an ongoing storage fee. Private UCB banking is illegal in some parts of Europe.

There are arguments for both public and private banking. It should be remembered that if the blood is stored in the public domain, the individual is still eligible to access it (before it is used by someone else). The probability of actually utilizing one’s own UCB is very small. Estimates are difficult, but some put it as low as 0.0005% (1:200,000) within the first 20 years of life. This is partly because it is sometimes better to use stem cells from another donor. Your own UCB may contain the very same defect that means you need treatment. This is an argument for storing UCB in a public facility where more people will benefit from your donation.

However, private banking (where you are basically collecting and storing UCB for a family member) is recommended when there is a sibling with a disease that may be treated successfully with an allogeneic transplant.[6] In the end there is no absolutely wrong choice in ethical terms. You should discuss your own situation with your doctor. Several authorities warn parents to beware of misleading marketing by some private UCB banks.[7]

Ethics

It is ethical for Christians to use medical therapies to bring the body back to normal health so long as no other biblical principles are violated.[8] With UCB therapies in particular, as mentioned above, there are no ethical problems with the stem-cell treatments due to the ethical source of the stem cells. Regenerative therapy is a field of great promise to which no sensible person objects.

What about the ethics of collecting UCB? There are concerns that the rise of private UCB banks undermines the traditional idea that the donation of blood is a ‘gift’ to unknown others. Will private UCB banking allow those with sufficient money to keep blood for themselves, even though the chances of using your own blood may be very small? Some have also questioned whether it is right to take UCB without informed consent—since parents are often inadequately educated, and the child has no autonomy in giving permission for UCB to be taken.[9]

It is true that a market system discourages a sense of social solidarity, and undermines the altruism that is required for a society to exist successfully.[10] (This is why there have always been concerns about such practices as the selling of human organs for transplant.) Where private blood banking has been allowed, it has often led to unevenness in the quality of the product. This has prompted some to argue for a public system where all deliveries have cord blood collected, and where the government then regulates standards of quality.[11]

These discussions should not deter those who do have a high chance of using the UCB from taking advantage of the private system while it continues to exist, especially since there is a limit to how many cords public banks can store, and some are getting close to the limit.[12]

What of the infant autonomy argument? This seems disingenuous to me, given how quickly we have abandoned any autonomy for the fetus up to the moment of its birth. Besides, we allow parents to consent to treatment for minors, including the donation of renewable tissue (tissue that can replace itself). There is further ethical justification in collecting UCB in that it is beneficent (it does good) by making potential medical cures available for more people.

The issue, then, is making sure that parents are fully informed of what is involved. To achieve informed consent, we need agreement from mentally competent people who have not been pressured in any way, and who are aware of all the benefits, risks and burdens of the procedure. I would suggest this could be achieved by following these guidelines:

1. Doctors should be honest about their financial or other interests in private banks, and not accept rewards for providing private banks with UCB samples.
2. Collectors should be aware that both parents have the right to participate in the decision, and therefore both need to be informed. To avoid pressure to make a decision quickly, this should happen well before the birth, with written as well as verbal explanations in language the parents can understand.
3. Any explanation should cover both public and private banking and the benefits and burdens of each, in particular making sure private banks don’t offer more than they can deliver. There are detailed documents available which outline the information that should be covered.[13]

Theologian Andrew Cameron notes that this subject may bring an ancient biblical theme to mind: that the life of the creature is in the blood (Lev 17:11; cf. Gen 9:4; Lev 17:10-14; Deut 12:23). It is well known that some religions still regard this teaching as prohibiting treatment with blood products. But evangelical Christians will resist this interpretation, since we know that the laws of ancient Israel have been fulfilled in Jesus Christ. They are no longing binding on us (Gal 5:18).[14]