An umbilical cord blood transplant begins with a signature: the signed consent of expectant parents. "For us, it was no big deal, I just wish we could do more," says Kim, a Minneapolis woman who gave birth via cesarean section at the University of Minnesota Medical Center, Fairview.

She sought out umbilical cord blood donation because she has friends whose children suffer from diseases that may potentially be cured by an umbilical cord blood transplant.

However, her child's blood may eventually help more than one family because it is destined to be used for research.

The University of Minnesota bank is for donated cord blood that is a "directed" donation, i.e., for cases in which another child in the family needs a transplant. Like Kim, parents can also donate cord blood to a general cord blood bank.

The University of Minnesota Cord Blood Bank has been banking umbilical cord blood since 1992. In the event that there is a pressing need for such a service, the family or their doctor should contact the University of Minnesota Blood and Marrow Transplant Program at 1-888-601-0787 to make the necessary arrangements.

Kim feels it's important to do. "From talking to them, and from reading about umbilical cord blood transplant in parenting magazines, we were just convinced that we had to do this," Kim says.

The process is pretty simple. Once the baby is born and the umbilical cord cut, a nurse whisks away the umbilical cord and placenta, or afterbirth. This is the organ that supported the baby while in the womb.

The placenta and the umbilical cord are placed in a metal basin and covered with a sterile cloth. Then they are taken immediately from the birthing room to the lab.

Time is crucial.

Research shows that immediately after the cord is cut, blood can start clotting. Clotting reduces the amount that can be collected — which in turn limits the usefulness of a collection. (Small collections can only be used on the smallest patients.)

Once in the lab, the placenta and umbilical cord rest in a sling suspended several feet above a lab table. Gravity helps drain the blood into a sterile collection bag, while the nurse works to withdraw it with a needle.

With every cord and placenta, the hope is for a "big collection," that is, 50 milliliters or more (almost two ounces).

The reason big collections are so important?

The more blood collected, the more stem cells there are available to grow new blood in another person. Research done by Dr. John E. Wagner at the University of Minnesota shows the success of a cord blood transplant depends on the number of stem cells transplanted.

Just as each baby is a unique individual, each placenta and cord are different.

As a result, the amount of blood collected in each birth varies. Placentas and cords don't come pre-programmed with a set volume of blood. Add to that the variation in blood yield caused by clotting, and the collection process becomes even more unpredictable.

This is one of the obstacles to greater availability of cord blood transplants.

A low collection, say 40 milliliters, is usually suitable only for a very small child. Large collections are used for the largest patients. To date, the upper weight limit for which the procedure has been performed is 230 pounds.

But research at the University of Minnesota may change that.

Scientists are now developing ways to grow more stem cells in the laboratory from a single donation. This is a way to increase the number of stem cells without complicating the tissue match.

"There is such a need for it," agrees Administrative Scientist Mary Clay, who works in the Transfusion Medicine Department at the University of Minnesota. Her work as Manager of Research and Development for North Central Blood Services has furthered her understanding of the biology of blood and safe handling of blood products.

A member of several international panels studying cord-blood collection and handling, Clay centers her efforts on developing national standards for safe and efficient umbilical cord collection systems.

Working with umbilical cord blood, she says, is "part of the natural evolution of our programs. We've been looking at blood products and components and studying their 'traffic' — meaning, where cells go. And we've also always been the kind of research lab that looks to the application of our findings, so cord blood is a perfect fit."

Cord Blood Banking

When cord blood is banked at the University of Minnesota, the bag of fluid is taken by courier the same day it is collected to be stored in coolers at temperatures approximating -173 degrees celcius at the University of Minnesota Molecular and Cellular Facility in St. Paul. The 45,000-square-foot facility is designed for handling pharmaceutical-grade products, something most hospitals and universities can't offer. It is one of the first of its kind.

In the St. Paul lab, technicians add a preservative to the blood. They reduce the volume by spinning it in a centrifuge to separate stem cells, plasma, and red cells. Most of the fluid and red cells are discarded. Spinning umbilical cord blood in a centrifuge isolates precious stem cells for cold storage.