Collection and Cryopreservation of blood

Public banks

Public cord blood banks function like public blood banks, in that they accept donations from anyone, discard donations that fail to meet various quality control standards, and use national registries to find recipients for their samples. Since patients who need cord blood frequently need more cells than a single collection would have provided, public banks frequently combined multiple samples together when preparing the treatment for a single patient. Unlike bone marrow transplantation, cord blood transplantation doesn't require an exact genetic match, which makes it easier to provide patients samples form unrelated donors.The percentage of public bank donations discarded as medical waste is often cited to be between 60 and 80%. Some of this is due to contamination that occasionally occurs during collection or complications arising from shipping, though this is mostly due to the fact that most cord blood collections fail to collect enough usable cells. Because matches are almost always likely to be better in a public than a private bank, and cord blood from public banks doesn't suffer from the problems it commonly suffers from at private banks (such as potential lower quality control and lower medical usefulness of using a patient's own potentially diseased cord blood), public cord blood banking has been more widely accepted by the medical community. One important obstacle facing public banks is the high cost required to maintain them, which has prevented more than a handful from opening. Because public banks do not charge storage fees, medical centers do not always have the funds required to establish and maintain them.

A recent large study by the journal Pediatrics concluded that almost all cord blood transplants come from public banks:

In the Pediatrics study, transplant specialists who collectively have performed thousands of stem cell transplants for childhood leukemia and other illnesses report that only 50 involved privately banked blood. (Support for public cord-blood banking is widespread in the medical community.) Forty-one cases involved blood used to treat a family member, often a sibling; in 36 of those cases the need for a transplant was known before the cord blood was collected. Only nine cases involved giving cord blood back to the donor, a practice known as autologous transplantation and the chief selling point for private cord-blood banking.

Private banks

Private banking is typically costly to parents and not covered by insurance. The ability to use the cord blood may also depend on the long-term commercial viability of the enterprise. Accordingly, whether cord blood banking is a worthwhile expenditure for the expectant parent depends in part upon whether the expenditure is offset by the likelihood of ultimately using the cord blood and by the benefits of such use. It is important to ensure the credentials of any potential private bank. In the United States, the Food and Drug Administration regulates cord blood under the category of “Human Cells, Tissues, and Cellular and Tissue Based-Products”. Since the FDA considers cord blood stored at public banks to be "drugs", but doesn't consider cord blood stored at private banks for use by the donor to be drugs, private banks are held to a lower regulatory standard.

Cord blood transplants require less stringent matching between the tissue types of the donor and patient, known as their human leukocyte antigen (HLA) types. Bone marrow transplants require a complete match on six key antigens, which are measures of graft-versus-host reaction, known as a 6/6 match. Cord blood transplants achieve the same medical success with only a 4/6 match. HLA type is inherited from both parents, so siblings are particularly likely to be a match, and people from the same ethnic heritage are more likely to match. Minority ethnic groups have difficulty finding a perfectly matched transplant donor. Studies have found that allogeneic transplants have a better outcome when the donor and patient are related. The odds that two siblings will have the 6/6 match required for a bone marrow transplant are 25%. The odds that two siblings will have the 4/6 match required for a cord blood transplant are 39%.

The policy of the Society of Obstetricians and Gynaecologists of Canada (SOGC) supports public cord blood banking (similar to the collection and banking of other blood products, i.e. altruistic, anyone can use it), as well as stating that it should only be considered under certain circumstances. The policy of the American Academy of Pediatrics states that "private storage of cord blood as 'biological insurance' is unwise" unless there is a family member with a current or potential need to undergo a stem cell transplantation. Private storage of one's own cord blood is unlawful in Italy and France, and it is also discouraged in some other European countries.

The American Society for Blood and Marrow Transplantation states that public donation of cord blood is encouraged where possible, the probability of using one's own cord blood is very small, and therefore storage of cord blood for personal use is not recommended, and family member banking (collecting and storing cord blood for a family member) is recommended when there is a sibling with a disease that may be treated successfully with an allogeneic transplant.