Ethical issues in umbilical cord blood banking. Working Group on Ethical Issues in Umbilical Cord Blood Banking
J. Sugarman, V. Kaalund, E. Kodish, M. F. Marshall, E. G. Reisner, B. S. Wilfond and P. R. Wolpe
Division of General Internal Medicine, Duke University Medical Center, Durham, NC 27710, USA.
OBJECTIVE: Banking umbilical cord blood (UCB) to be used as a source of
stem cells for transplantation is associated with a set of ethical issues.
An examination of these issues is needed to inform public policy and to
raise the awareness of prospective parents, clinicians, and investigators.
PARTICIPANTS: Individuals with expertise in anthropology, blood banking,
bone marrow transplantation, ethics, law, obstetrics, pediatrics, and the
social sciences were invited to join the Working Group on Ethical Issues in
Umbilical Cord Blood Banking. EVIDENCE: Members were assigned topics to
present to the Working Group. Following independent reviews, background
materials were sent to the Working Group. CONSENSUS PROCESS: Individual
presentations of topics at a 2-day meeting were followed by extensive group
discussions in which consensus emerged. A writing committee then drafted a
document that was circulated to the entire Working Group. After 3 rounds of
comments over several months, all but 1 member of the Working Group agreed
with the presentation of our conclusions. CONCLUSIONS: (1) Umbilical cord
blood technology is promising although it has several investigational
aspects; (2) during this investigational phase, secure linkage should be
maintained of stored UCB to the identity of the donor; (3) UCB banking for
autologous use is associated with even greater uncertainty than banking for
allogeneic use; (4) marketing practices for UCB banking in the private
sector need close attention; (5) more data are needed to ensure that
recruitment for banking and use of UCB are equitable; and (6) the process
of obtaining informed consent for collection of UCB should begin before
labor and delivery.
