BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: ACR 74
A
AUTHOR: Portantino, Hill
C
AMENDED: February 24, 2010
R
HEARING DATE: June 16, 2010
CONSULTANT:
7
Tadeo
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SUBJECT
Umbilical cord blood banking
SUMMARY
Makes a number of legislative findings and declarations
related to public and private umbilical cord blood
collection as a means of providing treatment for blood
cancers and other diseases. States that the Legislature
desires to find ways to help California gain a viable
public umbilical cord blood banking system to ensure that
all races and ethnicities have an equal probability of
finding a match when medically necessary.
CHANGES TO EXISTING LAW
Existing federal law:
Establishes a national umbilical cord blood network and
authorizes funding to collect and maintain human cord blood
stem cells for the treatment of patients and for research.
Includes a process for maternal donors to be informed of
all medically appropriate options for cord blood banking
and includes additional directives for cord blood donation,
education, and advocacy.
Existing state law:
Continued---
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Requires the California Department of Public Health (DPH)
to establish, by January 1, 2010, and until January 1,
2015, the Umbilical Cord Blood Collection Program (UCBCP)
for the purpose of collecting and storing umbilical cord
blood and increasing the amount of umbilical cord blood
that is donated in the state and added to the National Cord
Blood Inventory (NCBI).
Authorizes the UCBCP, to the extent private or public funds
are identified and secured for these purposes, to contract
with blood banks that are licensed or accredited to provide
umbilical cord blood banking storage services, for the
purpose of collecting and storing umbilical cord blood for
public transplantation services. Permits DPH to implement
any
additional standards for blood banks to collect and store
umbilical cord blood through the adoption of regulations.
Requires DPH, contingent upon private funding, to conduct
the Umbilical Blood Community Awareness Campaign to provide
awareness and information regarding umbilical cord blood
banking options using print media, radio, the Internet,
outdoor advertising and other media, to establish an
Internet website, and to undertake public education
activities related to umbilical cord blood donation to
targeted populations, as appropriate.
This resolution:
Makes a number of legislative findings and declarations
related to:
the history of umbilical cord blood transplants,
research and treatment;
public and private umbilical cord blood collection
industry as a treatment for blood cancers and other
diseases;
the lack of public knowledge about the differences
of the public and private umbilical cord blood banking
systems;
the lack of genetic diversity of public umbilical
cord blood inventories;
the importance of using umbilical cord blood that
is not suitable for transplantation for research
institutions to explore the potential of umbilical
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cord blood stem cells to treat medical conditions;
and,
the importance of building a viable public banking
system.
States the Legislature's desire to find ways to help
California gain a viable public umbilical cord blood
banking system to ensure that all races and ethnicities
have an equal probability of finding a match when medically
necessary.
States the Legislature's support for research being done
with collected units that are not suitable for
transplantation.
FISCAL IMPACT
This resolution is keyed non-fiscal .
BACKGROUND AND DISCUSSION
According to the author, most cord blood is collected for
private usage and although this service is a great benefit
to individuals, it does not ensure the general public has
access to this potential treatment for a variety of medical
conditions. The author believes that
this resolution will help increase awareness for the need
to create a public cord blood banking system that will
bring the benefits of this resource to a broad and more
diverse group of Californians.
Umbilical cord blood
According to information from the National Marrow Donor
Program (NMDP), cord blood, which is the blood collected
from the umbilical cord and placenta after a baby is born,
is rich in blood-forming cells that can be used in
transplants for patients with leukemia, lymphoma, and many
other life-threatening diseases. Cord blood is one of
three sources of cells used in transplants; the other two
are bone marrow and peripheral blood stem cells. The NMDP
estimates that, on any given day, more than 6,000 patients
around the world are searching the NMDP's registry for a
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matching bone marrow or cord blood donor. Since cord blood
is stored and ready to use and it does not require a
perfect donor match, the NMDP states that it is especially
useful for patients who need a transplant quickly, patients
who have difficulty finding a matched bone marrow donor,
and patients from racially diverse communities who often
have uncommon tissue types. Patients are more likely to
match someone who shares their racial and ethnic heritage.
The NMDP reports that, in 2008, 36 percent of the 90,000
cord blood units in its registry went to patients from
racially or ethnically diverse communities, and the need
for cord blood donations from these populations remains
high.
In January 2007, the American Academy of Pediatrics (AAP)
issued an updated policy statement on cord blood banking
for potential future transplantation. The AAP estimates
that the chances of a child needing his or her own cord
blood stem cells in the future range from 1 in 1,000 to 1
in 200,000. In the event that a child requires a stem cell
transplant, the AAP indicates that it is unlikely that the
child's own cord blood would be the desired source of stem
cells because the cells would reintroduce the disease into
the child's body. In these cases, a sibling donor is ideal
and usually still alive and available as a donor so banked
blood is not needed. AAP states that storing a child's
cord blood is only worthwhile when there is a sibling with
a disease that can be treated by a transplant. Under these
circumstances there is a one-in-four chance that the new
baby will be a match for his or her sibling. Given that
the probability of using one's own cord blood in the first
20 years of life is very small, the AAP does not favor
storage of cord blood for personal use and encourages
families to donate their newborn's cord blood to public
banks, if accessible in their area, for use by other
individuals in need.
Public and private cord blood banks
Public and private banks provide for the collection and
storage of cord blood. Public
banks promote related and unrelated donation, similar to
the collection of whole blood units in the U.S., for
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transplantation or research purposes. Private banks store
cord blood from an individual for subsequent use by the
same individual, or his or her family members, should the
need arise. Private banks typically charge between $1,000
and $2,000 in collection fees and between $50 and $125
annually for storage. Public banks do not charge for cord
blood that is donated for public use. The American
Association of Blood Banks (AABB) and the Foundation for
the Accreditation of Cellular Therapy (FACT) provide
voluntary accreditation of cord blood banks using standards
governing all aspects of operation, including collection,
processing, and transplantation. According to their
respective websites, twenty-five facilities nationwide are
currently accredited by the AABB and eight currently have
FACT accreditation.
California banks
According to the NMDP, there are currently two
participating public banks in California, StemCyte
International Cord Blood Center in West Covina, which
provides both public and private banking services, and
Children's Hospital of Orange County Cord Blood Bank.
Another public bank in San Diego, the Ashley Ross Cord
Blood Program,
participates in the NMDP, but it is not actively collecting
cord blood at this time due to funding shortages.
According to the nonprofit, Parent's Guide to Cord Blood
Foundation,
there are currently four private banks operating in the
state: CordBancUSA in Monterey, Cord Blood America and
FamilyCord, both based in Los Angeles, and Cord Blood
Registry in San Bruno.
California Umbilical Cord Blood Collection Program
AB 34 (Portantino), Chapter 516, Statutes of 2007, creates
the California Umbilical Cord Blood Collection Program
(UCBCP) for the purpose of collecting and storing umbilical
cord blood. The UCBCP is permitted to contract with
licensed and accredited blood banks to provide cord blood
storage services, to the extent that public or private
funds or grants are available and creates a special fund
for donations and grants. According to DPH, it has not
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received public or private funds or grants to establish the
UCBCP and has not received notice from the Department of
Finance that any funds were deposited into the UCBCP Fund.
However, DPH did report receiving a one-year grant of
$471,240 from HRSA in September 2009 to collect, process,
and store cord blood from minority populations in order to
diversify the national inventory of umbilical cord blood
stem cell units that are available for transplantation.
This appropriation is currently awaiting authorization
through the budget process.
National Cord Blood Inventory (NCBI)
The NCBI, administered by the federal Health Resources and
Services Administration (HRSA), was formed in 2006 to build
a genetically and ethnically diverse inventory of 150,000
new units of high-quality umbilical cord blood for
transplantation and make these cord blood units available
to physicians and patients for blood stem cell transplants,
and for research focusing on cord blood stem cell biology
and the use of cord blood for human transplantation and
cellular therapies. The NCBI works to achieve these goals
by providing funds to reimburse a network of eight
participating cord blood banks nationwide for the
collection and storage of qualified cord blood units. HRSA
has requested nearly $12 million in funding for the NCBI in
2009 to add approximately 8,650 new units of cord blood,
for a total of approximately 37,280 units collected to
date.
Related bills
AB 52 (Portantino) requires DPH is required to establish
the UBCBP from January 1, 2011, until January 1, 2020, for
the purpose of collecting and storing umbilical cord blood
for public use. Additionally the bill requires DPH to
establish the California Umbilical Cord Collection Board
which would administer the program, and requires the
collection of a nine dollar fee for certified copies of
birth certificates until January, 1, 2020, two dollars of
which would be paid to the Umbilical Cord Blood Collection
Program Fund. AB 52 is set to be heard in the Senate
Health Committee on June 23, 2010.
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Prior federal legislation:
H.R. 2520 (Smith) of 2005 establishes a national umbilical
cord blood program and provides federal funding to expand
and administer umbilical cord blood transplants and
research.
Prior legislation
AB 34 (Portantino), Chapter 516, Statutes of 2007, directs
DPH to establish the UCBCP by January 1, 2010, and permits
the UCBCP, to the extent public or private funds or grants
are identified, to contract with blood banks that are
licensed and accredited to provide cord blood storage
services.
SB 962 (Migden), Chapter 517, Statutes of 2007, requires
DPH to provide umbilical cord blood samples to the Birth
Defect Monitoring Program, for storage and research, as
specified.
SB 1555 (Speier), Chapter 484, Statutes of 2006, requires
blood banks to be licensed in order to provide umbilical
cord blood banking storage services and directs the
Department of Health Services (now DPH) to conduct the
Umbilical Blood Community Awareness Campaign, contingent
upon private funding.
SB 253 Ortiz, Chapter 789, Statutes of 2002, permits all
forms of stem cell research in the State of California, and
requires certain health care providers to provide patients
with information relating to the disposition of any human
embryos remaining following fertility treatment.
SB 617, Speier, Chapter 464, Statutes of 2003, requires
tissue banks to inform donor families of all uses of
donated tissues, including for-profit uses.
Arguments in support
The American Congress of Obstetricians and Gynecologists,
District IX, California (ACOG), sponsor of this resolution,
states that a general public awareness of what cord blood
is, what it can do, and a nonbiased explanation of the
differences between private and public cord blood banking,
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brings clarity and support to umbilical cord blood banking.
The University of California (UC) states that increasing
umbilical cord banking for public use, such as for
transplant or for research, is an important policy goal
that the University is familiar with and supports. UC
notes that the UCLA campus was selected by the National
Institutes of Health, as one of two sites, to build a
national cord blood bank system in the late 1990s, which
was shut down in April, 2001 due to funding limitations. UC
contends that ACR 74 highlights the financial challenges
faced by public umbilical cord blood banks.
PRIOR ACTIONS
Assembly Health Committee: 18-0
Be adopted by a voice vote on the Assembly Floor
POSITIONS
Support: American Congress of Obstetricians and
Gynecologists, District IX
Association of Northern California
Oncologists
Bay Bio
Blood Centers of California
California Academy of Physician Assistants
California Chronic Care Coalition
California Catholic Conference
National Bone Marrow Program
University of California
Oppose: None received
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