Donated umbilical cord blood most often is used to treat young leukemia patients who don't have matching DNA from a brother or sister.

But while the blood inside the cord is rich with potentially lifesaving stem cells, the cords often are still tossed into the trash because most women don't know how or where to donate.

Meanwhile, families who do save umbilical cords often pay companies to store them for their own possible future use rather than giving them to public banks where they could be used now for people in need of stem-cell transplants.

Non-profit public banks say the lack of awareness and the explosive growth in private cord storage is hampering their effort to increase donations and diversify the national donor pool. The National Marrow Donor Program, a coordinated network of 14 public banks that provides a registry and search database for both cord blood and bone marrow, is working to have 150,000 blood units available in the US by 2007. Currently about 43,000 units are available.

Expensive Biological Insurance

"Private banks are big, they have a lot of advertising, and it's a high-pressure sell," said Sharon Bolster Mills, manager of the stem-cell program for the Institute of Transfusion Medicine (ItxM) Clinical Services in Glenview, Ill., the public bank for the Chicago area. "Many of the women having their first baby receive the information in the mail and are afraid not to do it."

But for-profit private banks say that they are providing an important insurance policy and that there is no telling what medical breakthroughs will bring for the private route.

"Our clients are looking to bank for what we know cord-blood stem cells can successfully treat today, in addition to the future potential value over the next 5-, 10- to 15-year horizon for therapies that may go far beyond bone-marrow transplants," said Mercedes Walton, chairwoman and interim chief executive officer of Cryo-Cell, a private family stem-cell bank based in Oldsmar, Fla., with 100,000 customers.

Both public and private storage provide benefits, but the difference often is misunderstood. Private cord-blood storage, which is discouraged by the American Academy of Pediatrics, is considered expensive biological insurance. It costs $1,000 to $2,000 upfront and about $100 annually to store cord blood.

The chances of a child needing a transplant are 1 in 20,000 to 25,000, said Patrick Stiff, director of hematology and oncology at the Loyola University Medical Center in Maywood, Ill.

Regardless, families hang on to their child's cord -- a perfect genetic match -- gambling that the stem cells someday will help cure diseases such as diabetes, Parkinson's and Alzheimer's. But so far applications are limited.

Advantages over Bone Marrow

The public banks, which could get a boost from federal legislation that would set up a National Cord Blood Bank network, collect cord blood free of charge. The only catch is that the expectant mother must make arrangements before her due date. The cord blood, immediately available for needy patients, most often is used to treat young leukemia patients who don't have matching DNA from a brother or sister.

These cancer-stricken children wouldn't necessarily benefit from private storage of their own cord blood because those stem cells also would be contaminated with the disease, an important point that critics of private companies say is overlooked.

"Parents should privately store the umbilical cord cells if they have another child who is affected with a genetic or hematological disorder or a cancer for which a transplant is a potential option," said Loyola's Stiff, director of the Cardinal Bernardin Cancer Center. "For all other cases, there is no reason to (privately) store umbilical cord-blood cells because much of the benefit of a transplant comes from the development of a new immune system that is different than the one the patient has."

Cord blood has two main advantages over bone marrow, the traditional source of cells used to treat patients with blood disorders. It doesn't require a perfect match and is more readily available.

Though the procedure most often is used with children because only a small amount of blood can be collected, Chicago's Rhonda Kottke received a double cord-blood transplant at age 29 through ItxM to treat acute myeloid leukemia. Her doctors feared her body would reject a bone-marrow transplant.

"It was a complete rebirth," said Kottke, 33, a strategic planner for a marketing communication company in Evanston, Ill., who recently celebrated the three-year anniversary of her transplant. "My immune system is as normal as anyone who never had leukemia."

Chicagoan Maggie Wade, 35, heard about Kottke through a friend and decided to donate the cord of her second child, PJ, now 5 months. Though Illinois has passed legislation to increase awareness of cord-blood donation, Wade couldn't get any information from her doctor's office. Through her own research she found ItxM.

"I've told every pregnant woman I know across the country to do it," Wade said.

To donate to a public bank:

Mothers must call the ITxM Cord Blood Program (877-GIV-CORD) before their due date. There is no cost, no pain and no interruption to the delivery process. LifeSource (go to www.lifesource.org and then click on "special programs") and the National Marrow Donor Program (www.marrow.org) also provide information on public cord-blood banking.

To privately store your child's umbilical cord: Three of the larger private storage companies are Cord Blood Registry (www.cordblood.com); Cryo-Cell (www.cryo-cell.com) and Viacord (www.viacord.com).

Page 2: The Difference in Stem Cells