THE NEW ZEALAND MEDICAL JOURNAL Vol 118 No 1208 ISSN 1175 8716 NZMJ 28 January 2005, Vol 118 No 1208 Page 1 of 4 URL: http://www.nzma.org.nz/journal/118-1208/1255/ © NZMA Volunteer cord blood banking and transplantation Hilary Blacklock, Lochie Teague, Nigel Patton, Peter Browett Cord blood banking is a prerequisite for cord blood transplantation, 1 which is used increasingly (mainly in children) to treat serious diseases of the bone marrow, blood, and immune system. Excellent outcomes are achieved using family or unrelated donations similar to allogeneic haemopoietic transplants from other sources (bone marrow or peripheral blood stem cells). 2,3 Placental blood has advantages; these include easy and prompt access, the absence of risk in the donation procedure (mother and baby), the need for less rigorous HLA-matching (improving the odds of matching for minority populations under-represented on adult donor registries), and reduced risks from transmitted viruses and graft versus host disease. 1–3 Trained personnel are needed to collect >80 ml of placental blood for banking—at least 2 x 10 7 nucleated cells/kg recipient’s weight are necessary in allogeneic transplantation to reduce the risk of rejection and disease relapse; the more the better. 4 Cord blood cells are viable after 15 years of storage 5 —however it is predicted that these will survive longer if kept under the right conditions. The success of paediatric cord blood transplantation has lead to the development of at least 37 volunteer cord blood banks in 21 countries, funded to varying degrees by governments and/or public donations. Accredited registries must comply to minimum standards and codes of conduct of their umbrella organisations, the Foundation for the Accreditation of Cellular Therapies and NETCORD. In this country, these are accessed for patients by the government-funded New Zealand Bone Marrow Donor Registry (NZBMDR) 6 through Bone Marrow Donors Worldwide (BMDW). In recent years, New Zealand patients have been treated using cord blood donations imported from the USA, Australia, Italy, Spain, and Japan. The Ministry of Health (MoH) and the NZ Blood Service (NZBS) have been reviewing the need for a national volunteer Cord Blood Bank since a proposal was submitted by the Leukaemia and Blood Foundation of NZ in 1999 (L Teague)–an outcome is still awaited. One aim was to increase potential donors for Maori and Pacific Islanders, children of mixed ancestry, and ethnic minorities who do not have a family donor. Such patients are less likely than Europeans to have a matched donor on the international bone marrow and cord registries, which allow access to more than 9 million marrow and cord donors currently. However, the recruitment of more than 7,000 healthy Maori and Pacific Island volunteer adults by the NZBMDR has improved the availability of unrelated donors for Polynesian patients. Some cord blood units contain insufficient cells to treat an adult. Thus cord blood transplantation has only been used in a small number of adults with high-risk disease lacking a histocompatible family or unrelated donor. There is ongoing research using multiple cord blood donations for one adult recipient (producing sustained donor