Cord blood banking: public, private and hybrid models explained

After a baby is born and the cord is cut, some blood is left in the cord and placenta, and in most births it is thrown away. That leftover blood is rich in blood-forming stem cells, the same kind found in bone marrow, and since the first cord blood transplant in Paris in 1988 (for a child with Fanconi anemia) it has been used to rebuild the blood and immune systems of people with leukemia, inherited blood disorders and some metabolic diseases. By 2019 the American College of Obstetricians and Gynecologists (ACOG) estimated that more than 35,000 cord blood transplants had been performed worldwide.

A family has four choices: donate to a public bank, pay a private bank, use a directed or hybrid arrangement, or let the cord blood be discarded with the placenta. The last is common and perfectly reasonable.

What happens in the delivery room

The process is short and painless, because the blood is taken from the cord and placenta after they are no longer attached to the baby.

1. Consent comes first. The American Academy of Pediatrics (AAP) says written permission should be obtained before active labor starts.
2. The birth parent fills in a health history similar to a blood donor's and gives a blood sample that is tested for infections such as HIV and hepatitis.
3. The baby is delivered and the cord is clamped and cut as usual.
4. A trained nurse, midwife or doctor drains the blood from the cord's vein into a sterile bag containing anticoagulant. It takes a few minutes.
5. The sealed bag travels to the bank's lab, usually within a day or two, where staff count the cells, test for contamination, add a cryoprotectant and freeze the unit in liquid nitrogen storage below minus 150 degrees Celsius. Our stem cell technology page explains how cryopreservation keeps cells alive for years.

Not every collection becomes a stored unit. A transplant needs enough cells for the patient's body weight, so public banks set minimum cell counts. In its 2017 policy statement, the AAP noted that only about 25 to 40 percent of collected units meet the criteria for public storage, while most private banks store a unit regardless of its cell count. Units that fall short may go to research if the parent agreed, or be discarded.

Public donation

In a public bank, the family donates the unit. It costs the family nothing and the unit becomes anonymous. If it qualifies, its tissue type (HLA type) goes onto registries, and any patient who matches can receive it. In the United States, units from public banks are searchable through the registry operated by NMDP, the nonprofit formerly called the National Marrow Donor Program.

Two practical points:

• Not every hospital collects. Public banks work with specific hospitals, because they need trained collectors and a fast courier. Ask early in the third trimester, not in the delivery room.
• You give up the unit. If your child later needs a transplant, the registry is open to them like anyone else, but the original unit may already have gone to another patient.

Public units matter most for patients who struggle to find an adult donor. Cord blood tolerates a less precise tissue match than adult marrow, which helps patients from groups that are underrepresented on donor registries. ACOG's 2019 opinion stresses the importance of donations from all ethnic and racial backgrounds, and our piece on cord blood, genetic diversity and finding a match explains why.

For unrelated patients, the FDA requires units to come from a licensed product (listed as "HPC, Cord Blood") or to be used under an investigational application. The first license went to Hemacord in 2011, and the FDA's list of approved cellular products now includes nine licensed cord blood products.

Private family banking

A private bank stores the unit for the family that paid for it. According to the FDA's consumer page on cord blood banking, that means potential use by the child it came from or by first- or second-degree relatives.

The costs are not covered by insurance. When the AAP updated its policy in 2017, it cited first-year fees of roughly $1,350 to $2,300 and yearly storage of about $100 to $175. Prices change, so treat those figures as a historical guide.

The harder question is whether the unit will ever be used. Three facts weigh against it:

• A child's own cord blood usually cannot treat that child's genetic disease, because it carries the same gene variant. ACOG adds that it may also contain the premalignant cells behind a later leukemia.
• For blood cancers and inherited disorders, transplant doctors generally want healthy donor cells, and they may prefer a well-matched unrelated unit or a sibling's cells.
• The American Society for Blood and Marrow Transplantation, quoted in the AAP statement, described therapeutic use of privately stored units as rare, on the order of one in several thousand.

Private banks are also regulated more lightly. They must register with the FDA, screen and test donors and follow tissue-handling rules, but they do not need a biologics license. The FDA notes that registration "doesn't mean a firm is 'endorsed' by the agency."

Some brochures point to regenerative medicine. ACOG's 2019 opinion states that there is no current evidence to support using a child's own stored cord blood for that purpose; studies in conditions such as cerebral palsy remain research. Many private banks also sell storage of cord tissue, which no approved treatment uses.

Directed donation and hybrid models

Directed family donation

This is the one situation where both medical societies support keeping a unit for a specific family. If a sibling or parent already has a disease that a transplant can treat, such as sickle cell disease, thalassemia or certain immune deficiencies, the newborn's cord blood can be collected for that relative. A full sibling has a one in four chance of being a complete tissue match. The AAP notes that these programs are usually run at university medical centers, and sometimes within private banks. Several waive or reduce fees when there is a documented medical need.

Hybrid arrangements

Hybrid models mix the public and private approaches. Common patterns:

• The family pays for storage, and the unit is also tissue-typed and listed on a registry. If an unrelated patient matches, the family is asked whether to release it.
• Storage is free or discounted in exchange for the family agreeing that the unit can be offered to the public.
• Families with a medical need get storage paid for by a charity or the bank.

Before joining a hybrid scheme, find out who decides whether a unit is released, whether fees are refunded if it is, and whether the unit meets public-bank quality standards.

The models side by side

Delayed cord clamping: the trade-off

ACOG recommends waiting at least 30 to 60 seconds before clamping the cord in vigorous term and preterm babies. In that time more blood moves from the placenta into the baby, which improves iron stores in term infants and is linked to fewer transfusions in preterm infants.

The catch is arithmetic: blood that goes to the baby is no longer in the cord, and smaller collections are more likely to fall below a public bank's threshold. ACOG's position is that collection should not compromise obstetric or newborn care or change routine delayed clamping, except in the rare case of a medical reason for directed donation. If you plan to bank or donate, tell your care team ahead of time and ask the bank how it handles smaller units.

Questions to ask any bank

1. Accreditation: is the bank accredited by AABB, by FACT (the Foundation for the Accreditation of Cellular Therapy) or both? The AAP says every program should meet FACT or equivalent standards.
2. FDA status: is the bank registered, licensed or both? Registration is not approval.
3. State rules: does the bank hold any license your state requires?
4. Track record: how many units has it released for transplant, and how many failed to engraft?
5. Reporting: will you receive the cell count and test results, and what is refunded if the unit falls short?
6. Storage safety: is there backup power, round-the-clock monitoring and a second storage site?
7. Full costs: enrollment, collection kit, courier, processing, annual storage, prepaid plans, how price rises work and how to cancel.
8. Closure: if the bank is sold or goes out of business, where do the units go and who pays? Is there a written agreement with a successor bank?
9. Control: who decides how the unit is used, and does that right pass to the child at 18?
10. Conflicts of interest: is your doctor, midwife or hospital paid by the bank? The AAP says clinicians who recruit families for for-profit banks should disclose it.

A few common questions

What diseases can cord blood treat?

Mainly blood cancers, marrow failure, inherited blood and immune disorders, and a few metabolic diseases. Our page on what "80 diseases" lists really mean explains why those long lists can overstate things.

Is one unit enough for an adult?

Often not, which is why transplant teams sometimes use two units or an expanded product such as Omisirge, which the FDA approved in 2023. Our explainer on expanding cord blood cells outside the body covers how researchers grow more cells from a single unit.

Our hospital does not collect. Is there another way to help?

Ask public banks in your region whether they run anything for non-partner hospitals. Otherwise, the most direct route comes later: adults can join the NMDP registry as potential blood stem cell donors (new members currently need to be 18 to 35), and our piece on what blood stem cell donors go through describes what a match would involve.