Parents bank kids umbilical cord blood

Mon, 19 Feb 2007 21:46:37 GMT
By LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - Flyers in upscale doctors' offices portray it as the hot new baby-shower gift: a registry where friends and family chip in almost $2,000 to start privately banking a newborn's umbilical cord blood, just in case of future illness.
That idea of biological insurance is a long shot that most mothers-to-be can safely ignore, say new guidelines from the nation's pediatricians that urge more parents to donate their babies' cord blood — so that it might save someone's life today.

The guidelines come as the government begins setting up the first national cord-blood banking system, aiming to prevent some 12,000 deaths a year — if public banks can compete with marketing-savvy private companies that now house the bulk of the world's preserved cord blood.

Cord blood is rich in stem cells, the building blocks that produce blood — and the same stem cells that make up the bone-marrow transplants that help many people survive certain cancers and other diseases. But cord blood has some advantages: These younger stem cells are more easily transplanted into unrelated people than bone marrow is, and they can be thawed at a moment's notice, much easier than searching out a bone-marrow donor.

There should be plenty for both private and public banking, says an optimistic Dr. Elizabeth Shpall of the public M.D. Anderson Cord Blood Bank. After all, cord blood from most of the nation's 4 million annual births is thrown away.

Chief hurdles: Improving consumer awareness — and the small number of hospitals that allow donations.

Her own work illustrates the industry's stark socio-economic contrasts: At Houston's Ben Taub General Hospital, Shpall finds the mostly Hispanic mothers-to-be not only unable to afford private banking — few have even heard that cord blood has a medical use.

Armed with a $3 million federal grant to improve much-needed minority donations, she is working with Spanish-language TV and radio programs that in a few months will begin telling Houston moms about their cord blood choices, and which hospitals allow donations.

Her message: "Unless you have a family member with cancer, it's unlikely you would ever need it, and you would be doing a service to humanity to donate it."

Today, about 50,000 cord blood donations are stored in more than 20 public banks around the country. The new National Cord Blood Inventory aims to triple that number, enough that virtually anyone who needs stem cell treatment could find a match — especially minority patients who today seldom can as most bone marrow donors are white.

Private banks have an estimated 400,000 units stored.

What's the controversy? Deciding who really needs to store a child's own cord blood for later use. Private storage costs $1,500 to $1,900 up front, and about $125 a year thereafter, although some offer special programs for lower-income families.

Guidelines published last month by the American Academy of Pediatrics say:

_Parents should consider private storage only if an older sibling has cancer or certain genetic diseases that cord blood is proven to treat.

_Everyone else should consider donating their child's cord blood. The odds that a child would need an infusion of his or her own cord blood later in life are slim, between one in 1,000 and one in 200,000.

Private banks vehemently disagree, arguing that as scientists learn more about stem cells, the blood could create personalized treatments for heart disease or other more common killers.

"That's still considered very experimental," counters Dr. Mitchell Cairo of Columbia University Medical Center, who co-authored the new guidelines.

Also, doctors don't even know if cord blood remains usable after being stored for decades.
Still, last month Illinois doctors reported the first apparent success in treating a child's leukemia with her own cord blood — something usually impossible because that blood so often carries the cancer-triggering genetic defect.
The report has expectant parents calling Advocate Hope Children's Hospital to ask if they, too, should store their babies' cord blood, says Dr. Ammar Hayani, who performed the transplant only after genetic testing showed that patient's cord blood was defect-free.
"It's probably overadvertised by some of these companies as this biological insurance. That's probably overdramatization of its potential," says Hayani, who advises parents of the pediatric academy's guidelines. "But I think parents need to know" both sides' arguments, he says.
About 11 states have recently passed legislation to try to increase the information that expectant parents receive about their cord blood choices: store it, donate it, or discard it.
It's no different than how families choose between public or private schools, says Steve Grant of Cord Blood Registry, which began offering the baby-gift option last year after noticing grandparents putting up the money.
"The competitive nature seems misplaced to me," he says. "Family banking is not in any way detracting from the ability to build a public system."
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EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

Most U.S. women face heart stroke risk

Tue, 20 Feb 2007 03:55:10 GMT
By MARILYNN MARCHIONE, AP Medical Writer
Nearly all American women are in danger of heart disease or stroke and should be more aggressive about lowering their risk — including asking their doctors about daily aspirin use, the http://www.americanheart.org
Government prevention advice: http://www.cdc.gov/dhdsp
Ongoing hormone study: http://www.keepstudy.org

Increase in egg donors raises concerns

Mon, 19 Feb 2007 07:04:25 GMT
By MARTHA IRVINE, AP National Writer
CHICAGO - Human egg donation was a rarity not so long ago. But heightened demand for eggs — and rising compensation for donors — are prompting more young women to consider it.
Jennifer Dziura, a 28-year-old New Yorker, is one of them.

She received $8,000 to donate her eggs in the fall of 2005 and hopes she'll be chosen again before the private egg broker she's registered with considers her too old. She realizes prospective parents who view her profile might think it a minus that her father is adopted, allowing for little medical history from his side. She also figures some are looking for a blonde, instead of a brunette.

"But, hey, I have perfect SAT scores," Dziura, an aspiring comedian and model, says with a slight chuckle.

As more older moms look for help getting pregnant, younger women have become increasingly willing to part with their eggs. Some do it to help relatives and friends, or from a sense of altruism, but others openly acknowledge money is a big factor in their decision, prompting critics to worry that they're helping drive an unregulated market for human tissue.

In 1996, women in federally monitored programs donated eggs just over 3,800 times. That number has risen steadily, to more than 10,000 in 2004, the most recent year for which the Centers for Disease Control has compiled data.

A decade ago, Dr. Joel Brasch, a fertility specialist in the Chicago area, had to work hard to recruit five or 10 young women for his own practice's donor pool — but not anymore.

The money is seen as compensation for time and trouble. Among other things, donors learn to inject themselves with hormones and, eventually, have a needle inserted through their vaginal wall so eggs can be harvested.

"Everyone does it for the money," says Dziura, the egg donor in New York. "No one would do that for free — maybe for your sister, but not for a stranger."

The American Society of Reproductive Medicine, or ASRM, has set a compensation guideline of $5,000, with a limit of $10,000 for special cases — if, for instance, a recipient wants eggs of rare ancestry.

The president of the Society for Assisted Reproductive Technology, an affiliate of ASRM, argues that if women were just motivated by money, they wouldn't get past the psychological screening to become a donor. And, he says, researchers who've surveyed donors have found another strong motive.

"They're very altruistic and very willing to help a couple who's trying to conceive," says Dr. David Grainger, who's also a reproductive endocrinologist at University of Kansas medical school in Wichita.

Still, some egg brokers — particularly those in the East and West — are ignoring suggestions for a cap on compensation, and paying women more.

"Egg Donors Wanted" ads are common on the Internet, in college newspapers and on city trains. And with no federal laws limiting donor fees — and fertility doctors conceding the difficulties of policing their own industry — one ethicist says that eggs have quickly become "commoditized."

"It does feel a little more like the Wild West than it ought to," says Dr. Jeffrey Kahn, director of the University of Minnesota Center for Bioethics. And he only sees the problem growing as states such as California move closer to funding major stem-cell research, requiring more donor eggs.

"We worry that we offer people so much money that they are blind to the risk and their motivation is strictly the money," Kahn says.

That's the very reason, he notes, that it is illegal to sell an organ, such as a kidney, for donation. "So I'm not comfortable saying we should start that with human eggs," he says.

A small survey from an Illinois clinic, included at a recent ASRM meeting, found that donors used compensation for everything from savings and down-payments on property to school expenses and car payments. Half of them also used some of the money to pay credit card debt and other loans.
Kristin McKenna, a 25-year-old project manager at a marketing company in suburban Atlanta, donated eggs to help build her savings.
"It does feel weird to know there's a child out there," says McKenna, who's signed up to donate again. "But I'm just a small piece of the puzzle.
"If those two people weren't there wanting a child, that child would not exist."
Dr. Lorna Marshall, a fertility specialist in Seattle, says egg recipients often ask to write letters of gratitude to their donors, who remain anonymous in most cases.
But when it comes to money, she asks them to steer clear of donors who get more than $5,000, no matter the circumstances.
Occasionally, Marshall also has had to reject eggs from donors who've been OK'd by a private egg broker, but are younger than 21, the minimum age recommended by the ASRM. The thought is that, by that age, a young woman is old enough to better understand the choice she's making.
But Grainger and some others in the field concede that even the most careful guidelines can't absolutely prevent regrets later in life. That was the case for one young woman who initially told herself she was donating to help prospective parents.
"But if I'm honest, I did it for financial reasons; I wanted to travel," says the 31-year-old woman who lives in New York and works for an international nonprofit. She asked to remain anonymous since her family doesn't know she donated eggs three times.
"It would be a relief to know that my eggs were being used to find medical cures," she says, "rather than being used to produce additional kids for well-to-do American families."
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On the Net:
Society for Assisted Reproductive Technology: http://www.sart.org/
American Society for Reproductive Medicine: http://www.asrm.org/
___
Martha Irvine is a national writer who specializes in coverage of people in their 20s and younger. She can be reached at mirvineap.org

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