State of the Inventory: How the Banking Business Is Growing to Meet Increased Demand
After the first successful cord blood transplant in 1988, it became apparent that the future for cord blood was, and still is, endless. Since then, the collection, processing and storage of cord blood has become a business for many companies, and efforts to build a national inventory also have been established. Some companies operate as independently owned banks that collect units for public use in unrelated transplants. These units are registered in national and international databases where transplanting physicians can search for an ideal match. Other companies provide families with the opportunity to privately store units for future use. The private storage model often is used by families who have an older child with a known disorder that can be treated by a cord blood transplant.
With exploding growth in the community, it is a unique time to evaluate the state of the cord blood industry — and inventory — by recognizing achievements but remembering the challenges that still lie ahead.
Developing a Database
As the cord blood industry began to grow in the 1990s, the National Marrow Donor Program — which historically coordinated unrelated bone marrow transplants — recognized its potential and established a cord blood center to facilitate unrelated cord blood transplants. “Before this, the search was fragmented, and transplant centers had to search multiple databases to try to find the best unit,” explained Kathy Welte, MBA, BSN, of NMDP. This center develops and manages relationships with independently owned banks that collect units for public use.
NMDP does not collect or store units. Instead, it serves as a coordinator for physicians and families searching for the highest quality unrelated cord blood unit. According to Welte, banks that are members of NMDP are responsible for recruitment, collection, processing, testing and storage. Information about the unit — including the final cell count, the ABO and Rh type, HLA type, infectious disease test results, and answers to the maternal and family health history questionnaire — is uploaded to the NMDP software system, where it automatically is transferred to the national search database. “It is a real-time electronic system, which allows centers to search and identify the best possible unit for transplantation,” she said.
NMDP established the centralized cord blood registry in 1998-99, and it facilitated its first transplant in 2000. A total of 95,000 domestic cord blood units can be found in the database today. “Last year 20,000 units were added, and we expect 20,000 to 35,000 new units this year,” Welte said.
A Cord Blood Stimulus
Recognizing the value of cord blood for unrelated transplants and the financially precarious nature of a new and growing industry, the U.S. Congress enacted the Stem Cell Therapeutic and Research Act of 2005, establishing a National Cord Blood Inventory and appropriating federal funding for public cord blood banks that would collect and register donated units for public use. The framework of the NCBI focuses on building an inventory of high-quality cord blood units collected from an ethnically diverse population. Congress set into the law a target of 150,000 new units for the inventory to be made available through the C.W. Bill Young Cell Transplantation Program, which is structured to expand access to and facilitate transplants of cord blood, bone marrow and peripheral blood stem cells for patients without a family member donor by helping banks recruit cord blood donors, performing tissue typing and entering the results into a searchable national registry. NMDP serves as the Cord Blood Coordinating Center for the program by maintaining the national registry and improving the search capabilities.
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