Cord Blood Banking and Donation

What cord blood is

NHS Blood and Transplant defines it simply: "Cord blood is the blood that remains in the placenta and umbilical cord after the birth of your baby." It is rich in blood-producing stem cells, which NHSBT describes as "special 'building block' cells in the body that can develop into many different types of cell".

NHSBT also states the default plainly: "Once your baby has been born, your placenta is normally thrown away along with the cord blood that's in it."

What it is used for

NHSBT lists the categories of condition that cord blood transplants have been used to treat: cancers of the blood such as leukaemia or lymphoma; bone marrow failure; blood disorders such as sickle cell anaemia or thalassaemia; immunodeficiencies; and metabolic disorders.

Matching matters. NHSBT: "Stem cells taken from the donated cord blood must match the patient's tissue type as closely as possible to give the best chance of successful treatment. To give patients the best chance of a match we need to store as many cord blood donations as possible."

How a donation is collected

The part that reassures most people is the timing. NHSBT: the collection "is made from the placenta: after your baby is born; after the cord is cut and; after the placenta has been delivered".

Nothing is taken from your baby, and nothing happens during the birth itself. NHSBT: "Your donation is handled independently by our dedicated staff, leaving your midwife completely free to care for you and your baby. Donating your cord blood does not interfere with your chosen birth plan, the management of labour and delivery, or with the aftercare of you or your baby."

The mechanics, from NHSBT: once your baby is born, your midwife confirms consent has been given and passes the placenta to NHSBT staff along with the consent form. The placenta goes to a dedicated collection room within the delivery suite, is placed in a sterile supporting structure, the cord is cleaned, and a needle is inserted so blood "naturally flows into a collection bag". NHSBT needs at least 60ml from one donation and can collect up to 150ml.

The one birth choice that changes the odds

Delayed cord clamping and cord blood donation pull in opposite directions, because both want the same blood. NHSBT says so honestly: "Please be aware that if you have chosen delayed clamping as part of your birth plan, this may impact on the chances of us being able to make a successful collection, however, in many cases we are still able to collect a viable amount of cord blood."

You do not have to choose one over the other. NHSBT's own framing is that a collection may still succeed. But if delayed clamping matters to you, it is worth knowing that a failed collection is a possible outcome and not a mistake by anyone.

Who can donate

NHSBT's criteria: you must be aged 17 or over. Most people can donate, but lifestyle and medical questions are asked to make sure each donation is safe for the recipient.

Two specifics worth knowing:

• "Unfortunately, we cannot collect your cord blood if you are carrying twins or other multiples", because the placenta is smaller and the volume collected would not be enough for transplant.
• You may donate after IVF, including with a donor egg or donor sperm, "as long as the donor's medical history can be provided at the time of collection or soon after".

A caesarean is not a barrier: NHSBT can collect after an elective or emergency caesarean, "as long as there is no medical reason that the midwife needs to retain your placenta".

The largest practical limitation is geography. NHSBT collects at a small number of hospitals, so the first question is whether yours is one of them.

Consent, and when it has to happen

Before the birth, and there is a legal reason. NHSBT: an EU Directive on tissue and cells, in effect since April 2007, requires that "consent for the use and testing of your cord blood must be obtained prior to the birth of your baby (which includes active labour)".

That is why cord blood donation cannot be decided on the day. You register your interest in advance, receive information, and consent before labour is established.

Public versus private

NHSBT sets out the difference, and it is a difference of purpose rather than of technique.

The NHS Cord Blood Bank is a public bank. "We do not charge you to collect, test or to store your donation." Donations "are made available for public use and are not kept specifically for individuals or their families". If you or a family member later needed a transplant, the registries would be searched for the best match from any source — which could be your own donation, unless it has already been issued to another patient.

Private banks store a unit solely for the donor or their family, "in the hope that if, in the future, a member of their family becomes sick with a stem cell-treatable disease, there might be a perfectly matched unit available to them". NHSBT states the commercial model without editorialising: "For this service they charge an up-front collection fee and typically charge a yearly rate for ongoing storage of the cord blood unit."

NHSBT points readers to the Human Tissue Authority for guidance on all aspects of cord blood banking, and describes a public donation as "a purely altruistic act, solely for the benefit of others" that could still help the person who donated it.

No UK national body publishes a figure for the likelihood that a privately stored unit will ever be used by the family who paid for it, and we are not going to guess one.

Where this sits in the third stage

The third stage of labour — delivering the placenta — happens the same way whether or not cord blood is being collected. The HSE describes the two approaches, physiological and active, and notes that active management involves an injection to help the uterus contract. NICE's intrapartum guideline covers cord clamping and asks that a second clamp be available in all birth settings, and that paired cord-blood samples for blood gas analysis are not taken routinely but are taken if a baby is born in poor condition — a different procedure from donation, and worth not confusing.

The NHS's description of what happens straight after the birth covers the same first minutes. If you are donating, none of that changes; the collection happens afterwards, in another room, to an organ that would otherwise be discarded.