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                                                                                           Resolution: 503

     Introduced by:      Young Physicians Section

     Subject:            Cord Blood Banking

     Referred to:        Reference Committee E
                         (Mary G. Armstrong, MD, Chair)

 1   Whereas, Pregnant women receive many solicitations from private cord blood banking companies
 2   encouraging them to pay thousands of dollars to collect and store their newborn’s cord blood at the
 3   time of delivery, as well as solicitations from public banks which charge no fee but do not necessarily
 4   store the blood for later use by the donating person; and
 6   Whereas, Many ethical issues remain regarding the implications surrounding issues of informed
 7   consent and aggressively marketing expensive services to pregnant women; and
 9   Whereas, Many physicians and patients do not understand the different cord blood banking options
10   that exist for preserving cord blood; consequently, a growing number of states have adopted
11   legislation as a way to educate physicians, inform pregnant patients, and encourage birthing women
12   to donate or bank lifesaving newborn stem cells; and
14   Whereas, The National Marrow Donor Program (NMDP), established by Congress in 1986 and now
15   an independent nonprofit organization, maintains a roster of more than 5.5 million volunteer donors
16   and more than 40,000 cord blood units on the NMDP Registry, the largest donor registry in the
17   world; and
19   Whereas, In 2005, recognizing the need for a national system for the collection, distribution, and use
20   of cord blood, the US Congress asked the Institute of Medicine to review the options for such a
21   system and to make recommendations on the ideal structure of a national program; the committee
22   recommended that the US Department of Health and Human Services establish a new National
23   Cord Blood Policy Board to set rules for the banking and use of lifesaving stem cells derived from
24   donated umbilical cord blood; and
26   Whereas, Our American Medical Association is committed to working with appropriate organizations
27   to educate physicians and the public about the potential benefits of, and limitations to, umbilical cord
28   blood transplantation as an alternative to bone marrow transplantation; therefore be it
30   RESOLVED, That our American Medical Association continue to study cord blood banking in this
31   country, and work with appropriate specialty societies and organizations, such as the National
32   Marrow Donor Program, to develop and disseminate materials to educate physicians and the public
33   about the issues of marketing cord blood banking services directly to patients, the informed consent
34   process, and the existence of federally mandated regulatory oversight of these processes to ensure
35   safety and compliance with specific uniform standards. (Directive to Take Action)

     Fiscal Note: Estimated cost of $24,554 includes letters to appropriate organizations to identify
     existing content on cord blood banking. Staff will adapt content to target physicians and the public,
     and then develop, produce and disseminate appropriate materials.

     Received: 4/19/06
                                                                               Resolution: 503 (A-06)
                                                                                              Page 2


E-2.165 Fetal Umbilical Cord Blood
Human umbilical cord blood has been identified as a viable source of hematopoietic stem cells that
can be used as an alternative to bone marrow for transplantation. It is obtained by clamping the
umbilical cord immediately after delivery. The use of umbilical cord blood raises two main ethical
problems. First, the exact timing of the clamping has a significant impact on the neonate. Studies
indicate that early clamping may cause an abrupt surge in arterial pressure, resulting in
intraventricular hemorrhage (particularly in premature infants). Second, there is a risk that the infant
donor will develop a need for his or her own cord blood later in life. If that child was a donor and this
later need arises, he or she might be without blood, when he or she could have had his or her own
blood stored. To avoid health risks, normal clamping protocol should be followed and not altered in
such a way that might endanger the infant. Additionally, parents of the infant must be fully informed
of the risks of the donation and written consent should be obtained from them. The second concern,
that the child may need the blood later in life, is more complex. The possibility that an infant donor
would be in need of his or her own umbilical cord blood is highly speculative. There are a number of
reasons why the infant may not need the blood later. The diseases that are treated by bone marrow
transplantation are not common, and there may be other treatment alternatives available, particularly
in the future when the illness would occur. Additionally, the demand for fetal umbilical cord blood will
increase as it becomes medically certain that the blood may be used in persons unrelated to the
donor. This situation will reduce the need to store a particular infant’s blood since umbilical cord
blood from other donors would be available. If the blood is sufficient for use in unrelated individuals,
then the donor may obtain the cord blood from another donor later in life, making the need to store
his or her own blood unnecessary. These original donors, however, should be given priority in
receipt of such blood if they need a donation later in life. For all of these reasons, it would generally
not be unethical to use the cord blood. However, if the child-donor is known to be at risk for an
illness that is treated by bone marrow donation, the child should not be used as a donor, and his or
her blood should be stored for future use. (I, V) Issued June 1994; Updated June 1996.

D-370.990 Umbilical Cord Blood Transplantation: The Current Scientific Understanding
Our AMA will: (1) encourage continued research into the scientific issues surrounding the use of
umbilical cord blood-derived hematopoietic stem cells for transplantation, including the ex vivo
expansion of umbilical cord blood-derived hematopoietic stem cells; the combination of multiple units
of closely matched, unrelated umbilical cord blood cells for transplantation; and the improvement of
umbilical cord blood cells collection techniques; and (2) work with appropriate organizations to
educate physicians and the public about the potential benefits of, and limitations to, umbilical cord
blood transplantation as an alternative to bone marrow transplantation. (CSA Rep. 2, A-03)

H-370.970 Umbilical Cord Blood Transplantation: The Current Scientific Understanding
Our AMA: (1) urges physicians to recognize that umbilical cord blood transplantation is a viable
alternative to bone marrow transplantation in appropriately selected patients; and (2) encourages the
development of national standardized guidance to address the ethical, economic, and social issues
surrounding umbilical cord blood transplantation. (CSA Rep. 2, A-03)

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