The Counselling by CNT for the Exportation of Umbilical Cord Stem Cells for Autologous Use

The Italian law does not currently offer the service of collecting and preserving a cord blood unit for autologous use within Italy if there are no indications that these cells can be used for familiar use; whilst it allows for the exportation of these units to be stored in banks outside Italy. The authorisation for exportation is issued by the Ministry of Health, after counselling with the Centre National Transplantation. The counselling provides a telephone number for the user of this service (usually future mothers) to contact experienced personnel (medic and non) and it was intended to help make decisions based on accurate and complete information, with the appropriate support, including psychological support. From 2005 to July 2008, 13,400 counsels were made. The number of contacts has increased greatly over the years and they have increased from 58 in the first year to 6858 during 2007. During 2008 (January-July period) there were on average 31 contacts per day, for a total of 3760. During the interviews information was gathered on: personal data of the future mother, education qualifications, date of birth, name of the structure where the the birth was to take place and the name of foreign bank where the collected sample was to be exported to. The future mothers were also asked for their reasons to want the collection and autologous preservation. The average age of women who requested counselling was 34 years with a range from 18 to 58 years. 70% of women were primipare and here the demand for autologous conservation came from a desire to ensure a “biological insurance” for their child. The same reason was reported by the multiparous women, but often in this case the autologous conservation was motivated both by a voluntary donation to the previous pregnancy (30%) and by a disease present in their first or another child (15%). At the beginning of the exportation request, a clear prevalence of women with academic qualifications (degree) was revealed, whilst further into the procedure the female graduates accounted for 53%, those with diploma of higher education averaged at 42% and lower education at 40%. Most women liked the interview for the additional information that was provided further to that received from the private bank, not least because the information was supported by scientific data. This has meant that a small but significant number of women decided not to continue with the exportation procedure (53 women), whilst 63 decided to donate. One of the reasons for exportation was linked to the limitations of the opening hours of the structures where the cord blood units can be stored. However 37% of women who have given birth in structures equipped for donation, said they definitely did not take this hypothesis into account. In all cases where the pregnancy came about after artificial insemination, the parents opted for exportation.

Most pregnant women were informed of the possibility of exportation by their gynecologist or by the test laboratory, without being given any scientific information and there were a few cases where parents were also informed of the possibility of donation. It is necessary that in the future Italy enhances collection and donation and that the scientists and institutions make an effort to improve the quality of information along with the greater dissemination of the idea of donation, in contrast to the now growing tendency on the part of private companies to encourage a “biological insurance” where purely economic interests often come before any scientific aim or health protection.