Allogeneic versus Autologous: ethical issues in umbilical cord blood use

Abstract

OBJECTIVE. To analyse some ethical issues involved in umbilical cord blood (UCB)
collection, storage and use.
MATERIALS AND METHODS. Ethical issues were addressed in the light of the wellknown
fundamental ethical principles for biomedicine: beneficence/non maleficence, respect
for autonomy and justice. Specific issues that have been debated concerning the clinical utility
of autologous use compared with allogeneic use for transplantation, the validity of informed
consent, especially in private UCB banking, and finally the controversial question of private
UCB banking for-profit compared to public UCB banking non-profit.
RESULTS. Our ethical analysis has highlighted that the allogeneic UCB use for transplantation,
compared to autologous UCB use, seems to fulfil the principle of beneficence/non maleficence
as it provides “logistic” and clinical benefits and it decreases risks; the acquisition of informed
consent requires some counselling, particularly for autologous collection; finally, public UCB
banking seems to fulfil the criteria for justice more than private ones.
CONCLUSION. Present and future therapeutic UCB possibilities for treating a wide variety
of diseases need to increase the number of UCB units available. For this purpose, a “gift”
culture and a “solidarity chain” between donors and recipients are requested. Moreover, in
recent years, a further and emerging model of bank seems usable, i.e. “hybrid” banking.