The neglect of the umbilical cord: Ohio's failure to adequately promote banking of umbilical cord blood stem cells and the need for new legislation.

Author:Folger, Shannon
 
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  1. INTRODUCTION II. STEM CELLS III. UMBILICAL CORD BLOOD STEM CELLS: COLLECTION AND STORAGE IV. HISTORY OF C BLOOD TRANSPLANTS AND THE CURRENT DEMAND FOR DONATIONS V. CURRENT FEDERAL AND STATE LEGISLATION VI. OHIO HOUSE BILL 237 ORGAN DONATION LAWS VII. ORGAN DONATION LAWS VIII. PROPOSED OHIO LEGISLATION: DISTRIBUTION OF INFORMATION AND DONATION SERVICES PROVIDED TO EVERY PREGNANT PATIENT IX. CONCLUSION I. INTRODUCTION

    Over the past few years, the stem cell debate has grown heated, becoming one of the most controversial topics addressed in the United States today. However, the current debate, centering primarily on embryonic stem cells, neglects to recognize and address the significance of a different type of stem cell that is less controversial and is already being used to treat and cure a variety of diseases. (1) Stem cells located in the blood of the umbilical cord of a newly delivered infant can be easily and painlessly harvested from the cord (2) and then donated by the mother to a public or private bank for future use in treating the diseases of matching recipients. (3) More specifically, cord blood stem cells can be transplanted into individuals suffering from certain cancers or blood disorders as a way to treat and cure their condition. (4)

    Although these stem cells have significant medical potential, lack of awareness of donation and failure to provide donation services results in missed donation opportunities. (5) While there is legislation at both the federal and state levels encouraging information to be provided to expecting mothers as a means to increase donation, such legislation falls below that necessary to truly promote and increase donations. (6) Current legislation, including Ohio's proposed legislation, Ohio House Bill 237 ("OH H.B. 237") tends to encourage, rather than require, that information about cord blood donation be provided, and there is no requirement that donation services be made available to each patient. (7) Because there are no assurances that information and donation services will actually be provided to pregnant women, the legislation cannot realistically improve the number of donations.

    Because current legislation, including OH H.B. 237, is insufficient in that it does not have the potential to significantly increase the number of cord blood donations, it will be necessary to enact legislation that is more demanding. Such legislation should be modeled after current "required request" organ donation laws, which mandate that health professionals actively pursue organ donations by expressly asking the family to consent to donation. (8) Modeled after these laws, better legislation will not only require that state health departments generate information about donation opportunities, but also that health professionals then provide each maternity patient with materials about cord blood donation and, if desired, donation services.

    This note will discuss the use and donation of umbilical cord blood stem cells and explore the insufficiency of current legislation intended to promote public donation. Part II will provide an explanation of stem cells and umbilical cord blood stem cells and will discuss the specific use of umbilical cord blood stem cells to treat different diseases. Part III will discuss the collection and storage of umbilical cord blood stem cells. Part IV will address the history of cord blood transplants and the current demand for donations. Part V will discuss the current proposed and enacted legislation regarding umbilical cord blood stem cell awareness and donation at the federal and state levels. Part VI will discuss OH H.B. 237, explaining both the content of the proposed legislation and its shortcomings. Part VII will focus on current organ donation laws, detailing the transition in the United States from encouraged voluntarism to routine inquiry and required request. Finally, Part VIII will detail a more appropriate, sufficient piece of legislation, modeled after the required request laws, which Ohio should adopt in lieu of OH H.B. 237.

  2. STEM CELLS

    Stem ceils are cells within the human body that have the potential to develop into many different cell types. (9) Because stem ceils have the ability to develop into other types of cells, they are able to serve as a sort of repair system for the body, developing without limit to replenish other ceils that have been damaged or no longer function as a result of disease. (10) Scientists can work with stem cells in the lab and engineer them to become a specific type of tissue, cell, or organ to be used in transplantation or treatment of specific diseases. (11)

    Human stem cells can be totipotent, pluripotent, or multipotent. (12) Totipotent cells give rise to all the different types of cells in the body and therefore have the potential to develop into a fully formed human being. (13) Totipotent cells, which are found in fertilized human eggs, "are created at fertilization and are present for four days immediately following conception, after which they become pluripotent cells." (14) Pluripotent cells are able to give rise to any type of cell in the body except those needed to develop a fetus, and are found in human embryos and fetal tissue. (15) Multipotent stem cells, on the other hand, are only able to give rise to a smaller, limited number of different cell types. (16) Because totipotent and pluripotent stem cells have the potential to develop into a greater number of different cell types, they have greater therapeutic potential. (17) More specifically, pluripotent stem cells may have the potential to create replacement cells and tissues to treat diseases and conditions including Parkinson's and Alzheimer's diseases, spinal cord injury, stroke, burns, heart disease, diabetes, osteoarthritis, and rheumatoid arthritis. (18)

    Embryonic stem cells, which are pluripotent stem cells extracted from human embryos, "are derived from a cluster of cells called the inner cell mass of the blastocyst, located within a fertilized egg." (19) The cluster of cells from which the stem cells are taken exist only throughout the first few days of development. (20) If the cells are extracted within those first few days before the cells begin to differentiate, they can be kept as undifferentiated stem cells, retaining their potential to develop into any type of cell. (21) However, because removing the cluster of cells from the blastocyst destroys the embryo, widespread ethical concerns over the use and destruction of human embryos arises. (22)

    Federal funding for the use and development of embryonic stem cells is limited (23) as a result of these ethical concerns. (24) Throughout the 1980's, both former Presidents Reagan and Bush Sr. strongly opposed embryonic stem cell research. (25) Former President Clinton, however, was supportive, and after his election in 1994 he lifted the long-standing ban on federal funding of embryonic stem cell research. (26) The National Institute of Health ("NIH"), however, was still unable to gain the approval of Congress for federal funding of embryonic stem cell research. (27) In 2000 the NIH Guidelines were released, which encouraged federal funding for research done on embryonic stem cells that were originally created for the purposes of fertility treatment, (28) but rejected federal funding for research done on cells created solely for research purposes. (29) However, President Bush rejected these guidelines in 2001 when he announced his decision on federal funding for embryonic stem cell research. (30)

    President Bush's policy allows federal funding for research on cell lines that have already been developed from embryonic stem cells, but does not allow funding for the creation of additional cell lines. (31) More specifically, the policy limits funding to stem cells that were removed from the embryo before August 9, 2001, the date on which the President outlined the policy. (32) Furthermore, the embryo must have been created for reproductive purposes but no longer needed, and the embryo itself must no longer have the possibility of developing into a human being. (33) "Because many academic researchers rely on federal funds to support their laboratories," such a limitation on research funding results in tremendous focus on embryonic stem cell research. (34)

    When President Bush's policy was announced in 2001, there were approximately 60 stem cell lines already in existence that met the federally mandated criteria and were available for research. (35) Since then, many of these lines have been damaged or have died, and as of March 2007, there were only 21 available lines, (36) leaving scientists limited to an even smaller number of cell lines. (37) To alleviate this problem, Congress passed The Stem Cell Research Enhancement Act of 2005, which allows federal funding for research done on stem cells harvested from surplus embryos created in fertility clinics. (38) Even though most of the surplus cells would be discarded if not used for research, President Bush vetoed the legislation, stating that he would not force taxpayers to "fund the deliberate destruction of human embryos." (39) The House of Representatives passed the legislation again in 2007, but did not have enough votes to overcome the President's promised veto. (40)

    Although embryonic stem cells have great medical potential, by focusing solely on embryonic stem cells, the current debate neglects a highly significant source of similarly valuable, but different, stem cells. (41) Certain types of multipotent blood forming stem cells known as hematopoietic stem cells are currently being used to treat human diseases. (42) These stem cells, found in bone marrow and umbilical cord blood, (43) are being transplanted to treat more than 75 life-threatening diseases, including several types of cancer, bone marrow failure syndromes, blood disorders, and immunodeficiencies. (44) Patients with these diseases are ill because normal cells of the blood...

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