Saving the Leftovers: Models for Banking Cord Blood Stem Cells

Kimberly J. Cogdell, North Carolina Central University

Abstract

This article draws an interesting comparison between material placed on the curb to be collected as garbage and the material (cord blood stem cells) removed during childbirth to be discarded by the hospital. The comparison is made based on the California v. Greenwood decision and deals with expectations of privacy in materials placed on the curbside as trash; search and seizure of materials obtained from a warrantless search and whether the use of this material violated the Fourth Amendment.

The use of embryonic stem cells is a highly publicized, politically-charged topic which implicates many ethical, legal and moral issues.   But cord blood stem cells have not received this same level of media attention. Cord blood stem cells exhibit many of the same therapeutic qualities as embryonic stem cells, with fewer ethical problems. The purpose of this article is to: 1) distinguish between cord blood stem cells and embryonic stem cells for non-scientists; 2) highlight the opportunities that exist to collect more cord blood stem cells; 3) propose consent models for their collection; and 4) provide guidance for future legislation.  Often cord blood stem cell publicity relates to private cord blood banking which is a very individualistic approach while public banking is based on a population approach.  By emphasizing the utility of cord blood stem cells as a therapeutic and research resource, providing a framework for the collection consent and drafting suggested guidelines for legislation this article lays the groundwork for creating a comprehensive program that will benefit many Americans. 

This article proposes a solution to collect umbilical cord blood and store it in a national public biobank for research and transplantation purposes.  First, background will be given for biobanking and the materials sought to be banked.  Next, parallels will be drawn between discarded biological materials and other generally discarded materials, and recommendations will be made about the type of consent necessary for placing these materials in a public bank.  Two models are proposed for the consent process in collecting and storing these materials:  presumed consent and informed consent during prenatal treatment on delivery intake.  The informed consent process includes giving the potential donor sufficient information to determine whether or not to donate.  This consent process will occur during visits to the doctor prior to birth or when the woman checks in to the hospital for delivery.  The classification of the material to be donated will affect the type of consent needed to store it.  By classifying the material like “trash”  or genetic material donated for research,  this forms the basis for establishing the consent process for biobanking.  In addition to determining classification of the genetic material, there are two other areas which affect the consent necessary for obtaining cord blood stem cell donations: the donors expectations of privacy and the donors beliefs about retaining ownership rights in the donated material. If there is no expectation of privacy in discarded materials, analogous to the trash classification this supports the presumed consent model.  This parallel will be discussed further in Section VI.  Similarly, if there is some consent to donate material for research purposes this supports the model for obtaining consent during prenatal screening.  Establishing a uniform system for consent to deposit cord blood stem cells in public biobanks will facilitate the use of these samples within ethical and acceptable legal standards.