Blood Simple

The fact remains that cord-blood stem cells are a proven lifesaver, particularly for children who have been treated for cancer. Three years ago, it was Champagne who urged Héma-Québec, the province’s counterpart to Canadian Blood Services, to establish Canada’s only comprehensive publicly supported cord-blood bank. “I don’t know why there is not more interest in cord blood in the rest of Canada,” he says. More than one-third of terminally ill Canadian children who needed transplants from an unrelated donor could not find a match in 2005, reports Dr. Lothar Huebsch, former president of the Canadian Blood and Marrow Transplant Group. Huebsch estimates that each year, a matching source of hpcs from an unrelated donor cannot be found for between fifty and seventy-five children (and more adults) with acute leukemia, most of whom die from their illness. (The best source of hpcs is an hla-identical sibling without the disease, but only about a quarter of those who need transplants have such a sibling.)

A large supply of publicly banked cord blood would significantly improve the odds that children in need of a transplant could find a suitable match. The Society of Obstetricians and Gynaecologists of Canada supports public banking, stating in their 2005 clinical-practice guidelines that cord-blood stem cells “have greater potential as a collective asset than as an individual asset.” The guidelines go on to recommend that eligible pregnant women be encouraged to consider public cord-blood donation by their prenatal providers. Currently, doctors estimate that less than 1 percent of cord blood is banked in Canada; most is simply discarded.

Importantly, routine umbilical cord-blood collection would mean the banked blood would match the genetic heterogeneity of the population. What’s more, a large Canadian cord-blood bank could, because of the diversity of the population, be a resource for the rest of the world, according to Dr. Paul Caulford, head of family medicine at Scarborough Hospital, which services people from more than ninety different countries of origin.

The United States already has twenty-two large public cord-blood banks, and Congress recently allocated $12 million (US) to establish a national cord-blood inventory and help build a public stock of 150,000 cord-blood units. This initiative came in the wake of a landmark 2005 report from the Washington, DC-based Institute of Medicine, which provides expert advice to the government and the public. The report concluded that by increasing the size and quality of the cord-blood inventory, nearly 90 percent of all patients who need a transplant should be able to find a suitable hla match in either the bone-marrow or cord-blood inventories—three times the number who find unrelated donors in the United States. In fact, as doctors and advocates have repeatedly pointed out, Canada lags behind much of the developed world on this issue.

Canadian Blood Services, funded by the provinces and territories (excluding Quebec), is the obvious body to set up a national public cord-blood bank. Indeed, the deputy ministers of health have asked cbs to assess the need for, and costs of, establishing such a bank. Presentation of a feasibility report, originally scheduled for last year, has been delayed until probably the middle of this year. If the report recommends a national bank, and the provinces and territories agree to fund the project, it will take time to get it established and build up inventory. (Héma-Québec was able to act relatively quickly because only one province is involved; national health initiatives and reforms in Canada are often slowed or stymied by the need for agreement among the provinces.)

For the foreseeable future, then, Canadians outside of Quebec who want to donate to a public bank have essentially one option, the Alberta public bank, and transplant surgeons will continue to rely on other countries to obtain cord blood. This means that some patients who need hpcs from an unrelated donor—those who aren’t as lucky as Francheska Peña in finding a match—may well die waiting.