Eight years ago, Ashley Tamucci, MD, an OBGYN at Brookwood Baptist Medical Center, was talking with an expectant mother who wanted to donate her umbilical cord blood (UCB) to a donor bank. This was new territory for Tamucci.
The patient worked as a nurse at Children's Hospital. "She told me that she saw kids die every day because they couldn't get a match for a bone marrow transplant," Tamucci says.
Bone marrow and umbilical cord blood (UCB) hold the same ability, through stem cells, to help rebuild healthy cells in diseased blood. "But cord blood has not been exposed to very many antigens, so it has much less chance of being rejected," Tamucci says.
The patient had found a company to accept her cord blood donation, but because she delivered her baby on a Saturday, the courier service was unable to pick up the sample. "It was a very disappointing day," Tamucci says.
That's when Tamucci made it her mission to create an UCB donor program at Brookwood Baptist that would leave no donation wasted. "We wanted it be easy for the patients, where they didn't have to do anything but sign a piece of paper," she says.
It took years for the collection process to be organized and implemented. But in 2014, Tamucci, along with her OBGYN colleague Sarah Aultman, MD, succeeded in starting the only hospital-based, free UCB donation program in Birmingham. Last year, the program collected more than 750 cord blood samples.
"I just thought it was common sense," Tamucci says. "If you can save lives with something that we're disposing of, why wouldn't we do it."
UCB transplants are easier to administer than bone marrow transplants. "They don't have to place the cord blood into the bone marrow. They just put it in the patient's vein, and it helps them regrow healthy cells," Tamucci says. Umbilical cord blood is also known to have up to 10 times more stem cells than adult bone marrow.
The collection process is straightforward. "Once the baby is delivered, whether C-section or vaginal, the baby is placed skin-to-skin with its mother," Tamucci says. "We can then collect the blood from the cord, and the mother isn't even aware that I'm collecting the donation.
"It only takes 60 seconds to make the collection. The nurses have the kit laid out and all I have to do is stick a needle in the cord, draw the blood, and hand the bag off to the nurse." The quantity normally gathered from a cord runs between 200ml and 300ml."
The kits are given to the hospital for free by the donation bank, LifeCord, who also processes and provides the UCB to recipients at no cost.
Tamucci points out that drawing blood from the cord is already part of every birth. "We normally take a specimen anyway to get the baby's blood type and do a blood gas test for the hospital. Then what's left is either collected or thrown out. We might as well utilize this resource to save a life."
The donation process does not require a physician's involvement other than drawing the blood. All of the OBGYN nurses at Brookwood Baptist are trained in the process. They can provide expectant mothers with the materials and informed consent to sign. All of the supplies are then already available in each delivery room.
The interest in umbilical cord blood has spread worldwide. More than 100 UCB banks exist for public use in North America, South America, Australia, Europe, Asia, and the Middle East.
In the U.S. last year, an estimated 700,000 UCB units had been donated for public use and another four million units had been stored for private use. With 15,000 people needing bone marrow transplants each year, according to the Health Resources and Services Administration, and only 30 percent have a matching donor in their families, umbilical cord blood can fill a massive void.
Currently just 13 percent of transplant patients receive cord blood from a public cord blood bank and the FDA has only approved the use of UCB transplants to treat leukemia and lymphoma in adults and children. But interest in its potential is evolving fast.
Medical research is in place for testing UCBT as a treatment for anything from autism and arthritis to irritable bowel syndrome and corneal disease. Outcomes from transplants continue to improve with advancements in human leukocyte antigens matching, cord blood unit selection, refinement of conditioning regimens, and expanded infection prevention. "The research may not be there today to support other uses yet," Tamucci says, "but who knows where this will end up."
Tamucci has received multiple calls from health professionals seeking to set up UCB donation programs. "Doctors have also called to find out how to get a program in their hospital," she says. "So we know there's an interest."