- Umbilical Cord Blood
- Introduction
- Various advances in the field of medicine and tissue transplant have helped to indentify the importance of umbilical cord blood (UCB) as a valuable source of haematopoietic stem cell. This is because the umbilical cord blood is believed to be rich in multipotent stem cells, which include the CD34 and CD38 progenitor cells. These cells are known to have greater clonal expansion and proliferate capacity than other normal bone marrow cells. The UCB is therefore used in various clinical applications and in research where it is used in exploring the gene therapy, immune cell therapy, antibiotic efficacy and in indentifying new proteins. However the use of the UCB presents several ethical and regulatory challenges. One of the main reasons why the use of UCB presents ethical issues is the fact that obtaining it entails destruction of 4 to 5 day old human pre-embryo. This essay therefore presents some of the ethical dilemmas with regard to the use of the UCB and why such incidents occur. In addition the essay also present the possible ways of trying to prevent the various patients outcome. Most importantly the essay provides various future recommendations with regard to the use of umbilical cord blood banking.
- Collection and storage of cord blood
- In most case the cord blood is collected at the time of delivery. During the process of cord blood collection, the cord is usually wiped to avoid contaminations with the maternal blood (Querol, 2012). A large bore needle is then inserted in the umbilical vein, which is connected to a closed bag that contains anticoagulants. The cord blood is usually not collected from pregnancies of less than 34-week gestation due to the small amount of blood already present in the umbilical cord. With regard to the blood banks there are two types of storage the private and public. The first cord blood bank was established in 1991 in New York blood center (Martin ,Kurtzberg, & Hesse, 2011). However, it is important to note several other UCB banks have been established. With regard to the public banks the donor family as well as the expectant mother has no ownership rights. On the other hand the private UCB banks the donors families pays some amount of fee for the initials collection, processing and storage of the blood. The UCB blood stored in the private banks can be used in the treatment of the various in-born errors of metabolism or other genetic diseases in an individual. However it is important to note there are few chance that a donor will use the denoted blood is difficult to estimate and hence in most case the clinician uses the blood for the production of haematopoietic stem cells.
- The medical ethics dilemma with regard to UBC
- Beneficence and non maleficent
- With regard to the collection and use of the UCB blood the health providers are faced with ethical dilemmas related to the application of principle of beneficence and non-maleficent. This is because according to the principles of beneficence the actions need to be done for the benefits of others. In the clinical application of the principle of beneficence the clinicians are expected to refrain from causing any harm to the patient. This therefore implies that the clinicians are supposed to weigh the benefit against a possible risk of a certain actions. According to the principles of non-maleficent the physician must refrain from providing ineffective treatment to the patient (Valentine & Lowes, 2007).
- Use of the UCB-derived stem cells in the research has a potential to help in conquering a broad spectrum of certain condition that cause human suffering. However, it is important to note that the patient non-maleficence may be contravened if the effective quality control is not maintained during the collection of blood from the patient. This problem mainly occurs in the private banks since the health provider may opt to ignore some clinical procedure in order to maximize the profit. In the case most the UBC blood public bank this may not be a problem since most of them follow all the necessary procedure required in the collection of the blood. Another possible source of ethical dilemma with regard to beneficence and non-maleficence is the fact that failure of the health care providers to scan the genetic disorder on the donor may result in the transfer of abnormal cells. When such abnormal cells are transferred there a chance that they may cause harm to the patient.
- Patient autonomy and informed consent
- The health providers have the obligation of ensuring that they respect the patient autonomy. This therefore implies that the health providers should ensure that they promote the patient autonomy and autonomous choice (Gunning, 2007). With regard to the UCB the ownership may sometimes presents some ethical challenge. This is because in some case the umbilical cord is sometimes considered a property of the child however collected under the consent of the mother. In most cases the ownership of the cord is later transferred to the child once he or she reaches the required age. This therefore implies that it is possible to argue that since the baby is a legal person according to law then the storage of the UBC may be seen as manipulation of the human tissue without the consent of the owner.
- Another possible source of ethical dilemma in relations to the principle of patient autonomy can occur in the situation where the parents of authorizes the storage and the use of the UCB. In such case if a child who is considered the legal owner decides to change the terms when he or she attain legal age then the health provider may be faced with ethical dilemma of determining whose autonomy to take into considerations.
- Privacy and confidentiality
- Privacy and confidentiality of the patient is another major concern with regard to the collection, processing and storage of the UCB blood. This is because in some cases there is need to carry out some test on the child in order to establish whether the child has any genetic disorders. This kind of information is required in order to establish whether the cells obtained can be used. However it is important to note that it is unethical to try and test the children for the presence of genetic disorder. This therefore implies that trying to carry out surveillance may seem impractical and may in turn result to intrusion of privacy of the patient (Sugarman, et al,. 1998). Moreover according to the rules governing UCB private banks, the donors blood must be screened for the presence of the HIV/AIDS before the blood stored. This is because most of the private banks do not store HIV positive blood. However it is important to note that this may be considered as a form of discrimination to the patient.
- Distributive justice and human rights
- Various internationals ethical authority regards the use and the storage of the UCB as wasteful since in some cases it leads to social discrimination. This is because in many cases the wealth members of the society are the prime beneficially of these umbilical cord cells. In relations to this there also seems to be a kind of competition from the private and public banks for most valuable biological resource. However this is against the human rights provisions since everyone has the right to access those services. In addition various remunerations offered by the some private UCB bank also contravene the human dignity since the human tissue donation should be free and voluntary. Such acts of offering remuneration may also read to over exploitation of the disadvantaged members of the society.
- Why the events occurred
- The above presented ethical dilemmas may have occurred due to various reasons. First failure to adhere with the principle of informed consents before the donations and storage of the UCB may be one of the cause of the ethical dilemma. This is because according to the various rules governing the use of the umbilical cord blood a written permission to obtain the blood should be presented to the patient before the onset of the labor. This is to help the parents make a freely and responsible decision. In relation to this the actions of the private bank to try and coerce and manipulate the parents can also lead to dilemma related to the informed consent.
- Another possible cause of the dilemma related to privacy and confidentiality of the patient is the fact that once the ownership of the cord is passed to a child once he or she attains the legal age may pose a legal challenge. This is because in the event that the tissue is not used then there is no reason that can be used to justify this longtime storage. In some private banks the confidentiality of the donor information may not be kept private. For instance in Spain the health ministry had initially opposed the idea of creation of private banks however upon being required to store the tissue of daughter of prince of Asturias they allowed the development of the private banks (Serrano-Delgado, Novello-Garza & Valdez-Martinez, 2009).
- Moreover another ways that explain why the events occurred is the ignorance of the health providers mostly in the private sector to apply the principle of beneficence. This is because most of them make false promises to the donors that they may benefit from they may benefit from the tissue in future. However analysis of various cases it is evident that in many occasion the tissues are rarely used. In addition failure to adhere with the principle of non-maleficence is more common in the private banks where they fail to adhere to the quality control procedure and therefore ending up causing harm to the donor.
- What should have happened to prevent the patient outcome?
- In order to prevent these outcomes on the patient first there was need to ensure that the patient was informed that the umbilical blood would be store in the UCB bank. This could have helped to ensure that the patient was pre-informed on the procedure to be used in the collection of the blood. Availing such information to the patient can help to provide technical information regarding the help to alleviate the fears among the patients on the possibility of UCB interfering with delivery. This is because many women usually have the fear that the UCB may interfere with delivery. In relation to this is important to for the health provider to ensure that they gave the patient information regarding the privacy and storage of the UCB. This can help to eliminate the possible fears that the privacy of the stored blood can be breached. Moreover there was also the need to educate the patient the need and the importance of UCB this could have helped to promote a feeling of choice where the patient feels that they have been given power to make their own decisions (Sugarman, et al,. 1998).
- There is also need to ensure that the patients are given information regarding the difference between the policies and practices used in both public and private bank. This is because in most of the private banks the management rarely follows the laid down procedure of collecting and storing of the UCB. This is therefore implies that patient opting to go into the public bank is unlikely to experience problems associated with application of poor clinical procedures. Timing of the recruitment of the patient is also another factor that needs to be put into considerations before engaging the patient into UBC projects. This is because in most case the women only feel comfortable after their second or third trimester and only after getting enough information about UCB In addition, in order to avoid the adverse side effects related to UBC it is also important for the health providers to ensure that the women taking part in the projects are first screened on the possibility of having diseases such as the gestational diabetes (Huang, et al., 2006)
- Future recommendations in consideration of medical ethics
- Various factors must be put into consideration in order to manage the medical ethics related to the umbilical cord banking. First in order to ensure that the principle of beneficence is adhered there is need for the health providers to screen the donor for the presence of genetic disorders. This can help to prevent the transfer of abnormal cells. In relation to there is need for the various UCB bank to ensure that they implement the appropriate regulatory frameworks for the collections and storage. This can help to minimize the chances of harvesting abnormal cells, which may end up not benefiting anyone.
- In order to deal with ethical dilemma related to patient informed consent. There is need to ensure that clear regulations are laid down to govern the collection of patient UCB by both public and private banks (Spellman, et al., 2011). These regulations should outline the legitimate owner of the stored blood. In this case the laws should outline the various durations which the parent and the child can claim the ownership of the blood. In relation to this there is also need to ensure that the donors are informed on the ability to directly use the UCB stored. Moreover there is also need of the various UCB banks to inform the donor their intention to use the blood prior the delivery period. This is because in most cases it is unethical to obtain the consent of the women during the delivery period since the various emotional process of birth may negatively influence the mother ability to give a valid consent. In this case the health providers need to ensure that they inform the mother on the second or the third trimester of the intention to be part of the project.
- Carrying out various tests on mother in order to establish whether the baby has genetic disorders is considered unethical since it interferes with the patient privacy and confidentiality. In this case therefore there is need for development of clinical procedure that can allow the health provider to perform various genetic abnormalities test on the sample provided without carrying out test on ether the mother or the fetus. There is also need for the various private UCB banks to ensure that the practice justice to all. This is because in some cases the private UCB banks allow only the privileged members of the society to have considerable access to their services and hence denying the poor members this right (Vidalis, 2011).
- Moreover there is also need to ensure that the expectant mothers are given detailed and accurate information regarding cord blood. Giving the expectant mothers this information should also entails assuring the expectant mothers that she has the right to refuse to donate the blood. Due to the availability of the various pro and cons of both the private and the public banking the mothers should also be varnished with such information. This can help the patient to make informed consents. Most importantly the various governments need to regulate the types of advertisement used by the private banks to attract the donors to take part. This is because most of the private banks use the slogan “stop cord wastage” to attract the donors (Fadel, 2006). However the parents should be given the realistic assessment of the return on the investments to enable them make an informed decision.
- Conclusion
- From the above it is evident that the use of the umbilical blood has led to the emergence of various ethical dilemmas in the health profession. Failure of the UCB private banks to follow the laid down rule and regulation when collecting and storing the blood can be seen as the prime reason for the cause of ethical dilemma. In this case failure of the health provider to follow the laid down procedure for collection of the UCB may interfere with the donors non-maleficent since the blood may end up not benefiting anyone. In order to prevent the various possible outcomes on the patient it is important for the UCB bank to ensure that they provide the donors with the right information regarding the storage and use of the UCB. This can help to ensure that the donors are able to make an informed consent. Moreover, there is need for the various government and other regulatory bodies to implement some laws in order to regulate the practice of blood collection especially in the private banks. This is can help to ensure that the various private banks follow the required procedure in the collection and storage of the umbilical cord blood.
- References Review Article
- Gunning, J. (2007). Umbilical cord cell banking: an issue of self-interest versus altruism. Medicine And Law, 26(4), 769-780.
- Martin, P., Kurtzberg, J., & Hesse, B. (2011). Umbilical cord blood: a guide for primary care physicians. American Family Physician, 84(6), 661-666.
- Querol, S. (2012). Cord blood banking: current status. Hematology (Amsterdam, Netherlands), 17 Suppl 1S185-S188.
- Fadel (2006) Cord Blood Banking: Ethical Considerations article reviewVolume 38,
- Serrano-Delgado, V., Novello-Garza, B., & Valdez-Martinez, E. (2009). Ethical issues relating the the banking of umbilical cord blood in Mexico. BMC Medical Ethics, 1012
- Spellman, S., Hurley, C. K., Brady, C., Phillips-Johnson, L., Chow, R., Laughlin, M., & ... Kurtzberg, J.(2011). Guidelines for the development and validation of new potency assays for the evaluation of umbilical cord blood. Cytotherapy, 13(7), 848-855. Evi
- Sugarman, J., Kaplan, L., Cogswell, B., & Olson, J. (1998). Pregnant women's perspectives on umbilical cord blood banking. Journal Of Women's Health, 7(6), 747-757
- Valentine, F., & Lowes, L. (2007). Nursing care of children and young people with chronic illness. Oxford: Blackwell Pub.
- Vidalis, T. (2011). A Matter of Health? Legal Aspects of Private Umbilical Cord Blood Banking. European Journal Of Health Law, 18(2), 119-126 R
- Wu, J., Liao, C., Xu, Z., Chen, J., Gu, S., Huang, Y., & ... Tsang, K. (2006). Banking and transplantation of umbilical cord blood in Guangzhou, China. Cytotherapy,
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