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. 2010 Feb;10(1):97. doi: 10.7861/clinmedicine.10-1-97

Using umbilical cord blood stem cells for myocardial infarction and stroke is ethically challenging

Susan Bewley 1, Judith Mercer 2
PMCID: PMC4954500  PMID: 20408322

Editor – It is disingenuous for stem cell researchers such as Copeland et al (Clin Med August 2009 pp 342–5) to claim that ‘hUCB (human umbilical cord blood) is readily available, and presents little ethical challenges’. They must be aware that until the feto-placental circulation is interrupted by human professional intervention, that blood has a life-sustaining function. Without cord clamping, placental transfusion occurs and most of the blood then resides in the neonate. Pressure to separate mother and baby has created an apparent ‘waste product’ that may be valuable to researchers (and vested commercial interests). The earlier the cord is clamped, the more hUCB is ‘readily available’ for collection and the less is available for the neonate. Growing awareness of the impact of this irreversible intervention during the transitional circulation has led professionals responsible for the health and wellbeing of the new mother and baby to take a more cautious view.1 In view of findings of long-term developmental problems in children apparently successfully resuscitated after birth, we hypothesised that early clamping may lead both to neonatal depression and inadequate cerebral oxygenation.2,3 Physicians caring for adults and concerned about the alleviation of damage to adult vital organs must be aware of the ethical concerns about the use of vital material taken at birth.

Conflict of interest: SB was a member of the Royal College of Obstetricians and Gynaecologists working party on umbilical cord stem cell collection. JM is PI of a research study into the protective effects of delayed cord clamping in very low birth weight infants.

References

  • 1.Scientific Advisory Committee. Opinion paper 2. Umbilical cord blood banking. London: Royal College of Obstetricians and Gynaecologists, 2006. [Google Scholar]
  • 2.Odd DE.Lewis G.Whitelaw A.Gunnell D. Resuscitation at birth and cognition at 8 years of age: a cohort study. Lancet 2009; 373: 1615–22. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Mercer J.Bewley S. Could early cord clamping harm neonatal stabilisation? Lancet 2009; 374: 377–8. 10.1016/S0140-6736(09)61410-0 [DOI] [PubMed] [Google Scholar]
Clinical Medicine. 2010 Feb;10(1):98.

Using umbilical cord blood stem cells for myocardial infarction and stroke is ethically challenging

Mohamed Gaballa 1, David T Harris 2, Nathan Copeland 2

Our comments were meant to indicate that cord blood stem cells, as compared to embryonic stem cells, present ‘little ethical challenge’ (particularly in the USA). Cord blood is readily available with more than four million births per year in the USA; many more than there are monies available for collection in both public and private banks. Therefore, in the USA it is common practice to not alter in any fashion the standard birthing procedures for the collector. If for some reason, inadequate volumes are collected the samples may be discarded. We firmly agree that the health and well being of the infant and mother are always of primary importance. Further, as was noted in our article, cord blood stem cell therapies have shown promise for treatment of adult as well as neonate disease such as cerebral palsy.1

Having said that many professionals argue that early clamping (within the first 30 seconds of birth) allows for more immediate care of the newborn and mother while others argue that late clamping (after two minutes or more) may allow for increased transfer of blood from the placenta to the newborn. There is evidence to support both sides of this argument, derived from studies conducted in North America, England, Australia and South America, including increased deleterious haemoglobin content, increased incidence of jaundice and polycythemia in infants delivered using late clamping.2–5 However, early clamping has been thought to possibly deprive the newborn of potentially needed red cells and iron.2–5

Regardless, in the USA it has been common practice for more than 50 years to deliver infants utilising what would be termed early clamping. Anecdotally, there has been no evidence of significant harm to these infants. Scientifically, the changes that have been noted are of arguable long-term medical consequence. If it were clearly detrimental to the health of the child to perform clamping in one fashion or another, surely legislation would have been instituted by now. Therefore, we leave the decision of when to clamp and collect the cord blood up to the preferences of the mother and her physician or midwife. In our experience, we have not found that the difference in time involved makes for a significant difference in collection.

References

  • 1.Meier C.Middelanis J.Wasielewski B, et al. Spastic paresis after perinatal brain damage in rats is reduced by human cord blood mononuclear cells. Pediatr Res 2006; 59: 244–9. 10.1203/01.pdr.0000197309.08852.f5 [DOI] [PubMed] [Google Scholar]
  • 2.Ceriani Cernadas JM.Carroli G.Pellegrini L, et al. The effect of timing of cord clamping on neonatal venous hematocrit values and clinical outcome at term: a randomized, controlled trial. Pediatrics 2006; 117:e779–86. 10.1542/peds.2005-1156 [DOI] [PubMed] [Google Scholar]
  • 3.Hutton EK.Hassan ES. Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials. JAMA 2007; 297: 1241–52. 10.1001/jama.297.11.1241 [DOI] [PubMed] [Google Scholar]
  • 4.McDonald SJ.Middleton P. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Sys Rev 2008;[2]:CD004074. [DOI] [PubMed]
  • 5.Neilson JP. Cochrane update: effect of timing of umbilical cord clamping at birth of term infants on mother and baby outcomes. Obstet Gynecol 2008; 112: 177–8. [DOI] [PubMed] [Google Scholar]

Articles from Clinical Medicine are provided here courtesy of Royal College of Physicians

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