Controversies in hybrid banking: attitudes of Swiss public umbilical cord blood donors toward private and public banking

Abstract

Purpose Umbilical cord blood (UCB) stored in public inventories has become an alternative stem cell source for allogeneic stem cell transplantation. The potential use of autologous UCB from private banks is a matter of debate. In the face of the limited resources of public inventories, a discussion on ''hybrid'' public and private UCB banking has evolved. We aimed to explore the attitudes of the donating parents toward public and private UCB banking. Study design and methods A standardized, anonymous questionnaire was sent to the most recent 621 public UCB donors including items regarding satisfaction with recruitment process, the need for a second consent before release of the UCB unit for stem cell transplantation, and the donors' views on public and private UCB banking. Furthermore, we asked about their views on UCB research. Results Of the questionnaires, 48% were returned, and 16% were lost due to mail contact. Of our donors, 95% would donate to the public bank again. As much as 35% of them were convinced that public banking was useful. Whereas 27% had never heard about private UCB banking, 34% discussed both options. Nearly 70% of donors opted for public banking due to altruism and the high costs of private banking. Of our public UCB donors, 81% stated that they did not need a re-consent before UCB release for stem cell transplantation. In case of sample rejection, 53.5% wanted to know details about the particular research project. A total of 9% would not consent. Conclusions Almost all donors would choose public banking again due to altruism and the high costs of private banking. Shortly after donation, mail contact with former UCB donors was difficult. This might be a relevant issue in any sequential hybrid banking.

Family-directed umbilical cord blood banking

“…[10][11][12][13] One driver for these models is to improve the financial viability of the CBBs. A number of models for combined banking have been developed, including joint marketing of separate banking operations, opportunities to split units for private and public use, and the offer to initially bank units as either public or private, but with the potential of converting their status at a later date or event.…”

“Good Mothering” or “Good Citizenship”?

“…This view is supported by the fact that there are an estimated 800,000 cords stored in private banks, which far exceeds that number of cords available for public access (Gluckman et al 2011;Manegold et al 2011). To date, however, there has been a paucity of empirical research into prospective mothers' motives for and decisions about opting either to donate or store UCB.…”

Are hybrid umbilical cord blood banks really the best of both worlds?

“…Given the substantial cost and low probability of using the product, the American Academy of Pediatrics, the American Society of Blood and Marrow Transplantation and the Society of Canadian Obstetricians and Gynecologists have clear position statements recommending against elective private UCB banking unless a family member is at high risk of needing a transplant in the future 13–15. Furthermore, critics have suggested that private UCB banks may overemphasise unproven possible future indications beyond HSCT 2 14…”

“…A hybrid (or dual) UCB bank is a new model of UCB banking in which elements of private and public banking coexist 2 20. For the purposes of this discussion, a hybrid UCB bank is a private institution in which an UCB product is stored for possible public or private use.…”

“…Some models of hybrid UCB banks require a second consent from the client immediately prior to release of an UCB product to an HSCT centre for allogeneic use 2. In contrast, Virgin Health Bank currently requires consent for the donation of a portion of the product to an unrelated recipient at the time of collection.…”