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Challenges to the Sustainability of the U.S. Public Cord Blood System

A report published by the RAND Corporation

A point of view

We asked one of our AABB members, Karen Ballen, MD, who is also the chair of the cord blood advisory committee for the National Marrow Donor Program, to give her point of view on the RAND report. Read Dr. Ballen’s responses to a few questions.*


Purpose of report described by RAND (
To fill knowledge gaps by:

  • Describing the existing public Cord Blood Bank (CBB) system
  • Assessing current trends and economic relationships from perspectives of key stakeholders in the public CBB system
  • Providing recommendations to improve the economic sustainability of the public CBB system

Question:  Of the key findings, what stood out to you?
Karen Ballen (response):

  1. Cord Blood serves a critical need for a diverse group of patients, but public cord blood banking is expensive.
  2. The increase in haploidentical transplantation has led to a decrease in cord blood transplants. An ongoing randomized study (CTN 1101) compares cord blood to haplo transplant.

Question:  What are the implications of the findings?
Karen Ballen (response):

  1. There continues to be a need for public cord blood banks, but certain changes may be needed.
  2. Cord blood banks may need to consolidate or make contingency plans.

Question: The RAND report listed a few key recommendations. Could you briefly comment on them?
Karen Ballen (response):

  1. Increase diversity of national inventory. There need to be more incentives to encourage banks to collect, high quality minority cord blood units. This means that 80-90% of units collected from certain populations will be discarded due to low cell dose.
  2. Standardize and consistently fund the NCBI contracts. This is important, not to decrease competition, but because best practices cannot always be shared in there are different, competitive models.
  3. Prepare contingency plans. There should be plans for banks to consolidate or partner with industry as needed.

Question: How do you see the future of cord blood banking?
Karen Ballen (response):

The Rand report emphasizes the importance of public cord blood banks as providing an essential resource to a diverse group of patients. I think we will see newer applications of cord blood, such as regenerative medicine that may help to energize the field. 

*These statements represent the member’s view and not necessarily those of AABB. 



Karen Ballen, MD
Professor of Medicine, UVA School of Medicine
Section Chief, Hematologic Malignancies and Stem Cell Transplantation
Director, Stem Cell Transplantation Program

Dr. Ballen studied Medicine at Dartmouth College, completed an internship and residency at Beth Israel Hospital in Boston, and fellowship at Brigham and Women’s Hospital in Boston. Her clinical and research interests focus on care of patients with leukemia and patients undergoing bone marrow or stem cell transplants, and novel therapies for leukemia and transplantation. An area of her specialty is cord blood transplantation for those patients who do not have matched related or unrelated donors.

 Report’s Key Findings

  • Demand has stagnated, costs and competition have increased
  • Relative clinical effectiveness remains unclear
  • Cord blood transplantation is not a panacea treatment, but has significant societal value

​(Source: RAND Report)

 Recommendations Listed in Report:

​National Cord Blood Inventory (NCBI) Program (US government's Health Resources and Services Administration (HRSA) should:

  • Focus on efforts to increase diversity of the national inventory by providing funding to encourage collection for -minority units – consider increasing minimum TNC
  • Consider trade-offs between increasing TNC-count threshold and revising way subsidies are paid in conjunction with program objective
  • Standardize and consistently fund NCBI contracts to extent possible. Uncertainty in how contracts will be funded and frequency of funding results in market instability.

Public Cord Blood Banking

  • Stakeholders can work together to strengthen the industry by making changes to payment, research funding and knowledge sharing

(Source: RAND Report)