Identifying Barriers to Umbilical Cord Blood Banking in Jordan
A Cross-Sectional Survey of Obstetricians
Background: The expansion of umbilical cord blood (UCB) banking necessitates a greater understanding among obstetricians, who are responsible for informing parents about UCB collection and storage. Gaps in knowledge can compromise public UCB banking efforts and result in missed opportunities and misguidance about UCB banking.
Methods: A cross-sectional survey was disseminated among obstetricians in Amman, Jordan. The questionnaire aimed to evaluate obstetricians’ knowledge of and attitude toward UCB storage and applications, as well as current practice patterns.
Results: Ninety-six obstetricians responded (55% response rate), most of whom were Jordanian (71%), female (83%), resident physicians (59%), and working in either private (43%) or public (42%) hospitals, with an average of 6.5 years in practice. Only 26% had personal experience in UCB collection, and only 20% had received education on UCB collection. Nearly three-fourths said their hospitals lacked standard operating procedures, guidelines, or infectious disease screening for UCB units. Overall knowledge about UCB was moderate, with the internet as the most common source (54%). Overall attitudes were positive, especially in desire to expand personal knowledge about UCB, integrate information into medical residency curricula, and establish a public UCB bank in Jordan. However, many believed that ethical (61%) and religious (56%) controversies surround UCB donation.
Conclusions: This study identifies deficiencies in quality control and experience in UCB collection in Jordan, as well as areas of inadequate knowledge, false beliefs, and negative attitudes among obstetricians. These issues can contribute to public misinformation and should be addressed through improved medical education on this topic.
1. Gluckman E, Broxmeyer HA, Auerbach AD, et al. Hematopoietic reconstitution in a patient with Fanconi's anemia by means of umbilical-cord blood from an HLA-identical sibling. The New England journal of medicine. 1989;321(17):1174-8.
2. Haw J. From waste to (fool's) gold: promissory and profit values of cord blood. Monash bioethics review. 2015;33(4):325-39.
3. Ballen KK, Gluckman E, Broxmeyer HE. Umbilical cord blood transplantation: the first 25 years and beyond. Blood. 2013;122(4):491-8.
4. Kurtzberg J. A History of Cord Blood Banking and Transplantation. Stem cells translational medicine. 2017;6(5):1309-11.
5. Waller-Wise R. Umbilical cord blood: information for childbirth educators. The Journal of perinatal education. 2011;20(1):54-60. Epub 2012/01/03. doi: 10.1891/1058-1243.20.1.54.
6. Cord Blood Banking: The American College of Obstetricians and Gynecologists (ACOG); 2016. Available from: https://www.acog.org/Patients/FAQs/Cord-Blood-Banking?IsMobileSet=false.
7. Ruggeri A. Alternative donors: cord blood for adults. Seminars in hematology. 2016;53(2):65-73.
8. Weiss ML, Troyer DL. Stem cells in the umbilical cord. Stem cell reviews. 2006;2(2):155-62.
9. Stem Cell Glossary-Cord Blood Stem Cells: The New York Stem Cell Foundation (NYSCF); 2017. Available from: https://nyscf.org/stem-cell-basics/glossary-terms/.
10. Munoz J, Shah N, Rezvani K, et al. Concise review: umbilical cord blood transplantation: past, present, and future. Stem Cells Transl Med. 2014;3(12):1435-1443.
11. Barker JN, Byam CE, Kernan NA, et al. Availability of cord blood extends allogeneic hematopoietic stem cell transplant access to racial and ethnic minorities. Biol Blood Marrow Transplant. 2010; 16(11): 1541-8.
12. Ahmed SO, Ghavamzadeh A, Zaidi SZ, et al. Trends of hematopoietic stem cell transplantation in the Eastern Mediterranean region, 1984-2007. Biol Blood Marrow Transplant. 2011;17(9):1352-61.
13. Brown C, McKee C, Bakshi S, et al. Mesenchymal Stem Cells: Cell Therapy and Regeneration Potential. J Tissue Eng Regen Med. 2019;13(9):1738-1755.
14. Zhang H, Tao Y, Ren S, et al. Isolation and characterization of human umbilical cord-derived endothelial colony-forming cells. Exp Ther Med. 2017; 14(5): 4160–4166.
15. Rao M, Ahrlund-Richter L, Kaufman DS. Concise review: Cord blood banking, transplantation and induced pluripotent stem cell: success and opportunities. Stem Cells. 2012;30(1):55-60.
16. Catherine Stavropoulos-Giokas DC, Cristina Navarrete. Cord Blood Stem Cells Medicine: ELSEVIER; 2015.
17. Surbek DV, Holzgreve W, Steinmann C, et al. Preterm birth and the availability of cord blood for HPC transplantation. Transfusion. 2000;40(7):817-20.
18. Gluckman E, Ruggeri A, Volt F, et al. Milestones in umbilical cord blood transplantation. Br J Haematol. 2011;154(4):441-7.
19. Mayani H, Wagner JE, Broxmeyer HE. Cord blood research, banking, and transplantation: achievements, challenges, and perspectives. Bone Marrow Transplant. 2020; 55(1):48-61.
20. Matsumoto MM, Dajani R, Matthews KR. Cord Blood Banking in the Arab World: Current Status and Future Developments. Biology of blood and marrow transplantation. Biol Blood Marrow Transplant. 2015;21(7):1188-94.
21. Tbakhi A. Cell Therapy and Applied Genomics: King Hussein Cancer Center; 2019. Available from: http://www.khcc.jo/en/section/cell-therapy-and-applied-genomics.
22. Narayanan DL, Phadke SR. Concepts, Utility and Limitations of Cord Blood Banking: What Clinicians Need to Know. Indian J Pediatr. 2019;86(1):44-48.
23. Peberdy L, Young J, Massey DL, et al. Parents' knowledge, awareness and attitudes of cord blood donation and banking options: an integrative review. BMC Pregnancy Childbirth. 2018;18(1):395.
24. Peberdy L, Young J, Kearney L. Health care professionals' knowledge, attitudes and practices relating to umbilical cord blood banking and donation: an integrative review. BMC Pregnancy Childbirth. 2016;16:81.
25. Moustafa MF, Youness EM. Nurses’ knowledge about umbilical cord blood banking and it’s barriers. IOSR J Nurs Health Sci. 2015;4(2):44-53.
26. Mohammed HS, El Sayed HA. Knowledge and attitude of maternity nurses regarding cord blood collection and stem cells: An educational intervention. Journal of Nursing Education and Practice. 2015;5(4):58.
27. Matsumoto MM, Dajani R, Khader Y, et al. Assessing women's knowledge and attitudes toward cord blood banking: policy and ethical implications for Jordan. Transfusion. 2016;56(8):2052-61.
28. Matsumoto MM, Dajani R, Matthews KRW. Public-private divide: cultural and social factors in women's attitudes toward cord blood banking in Jordan. Transfusion. 2018;58(8):1958-63.
29. Armson BA, Allan DS, Casper RF. Umbilical Cord Blood: Counselling, Collection, and Banking. J Obstet Gynaecol Can. 2015;37(9):832-844
30. Ethical guidelines on cord blood banking. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2013;120(2):208-9.
31. Sachdeva A, Gunasekaran V, Malhotra P, et al. Umbilical Cord Blood Banking: Consensus Statement of the Indian Academy of Pediatrics. Indian Pediatr. 2018;55(6):489-494.
32. Abdullah Y. Cord blood banking: what nurses and healthcare providers should know. MCN Am J Matern Child Nurs. 2011;36(6):344-50; quiz 351-2.
33. Tada N, Hinotsu S, Urushihara H, et al. The current status of umbilical cord blood collection in Japanese medical centers: survey of obstetricians. Transfus Apher Sci. 2011;44(3):263-8.
34. Hatzistilli H, Zissimopoulou O, Galanis P, et al. Health Professionals' knowledge and attitude towards the Umbilical Cord Blood donation in Greece. Hippokratia. 2014;18(2):110-5.
35. Cohen Y, Michaan N, Cohen A, et al. Umbilical cord blood collection carry increased maternal bleeding risk during cesarean section. J Matern Fetal Neonatal Med. 2012;25(9):1549-51.
36. Shearer WT, Lubin BH, Cairo MS, et al. Cord Blood Banking for Potential Future Transplantation. Pediatrics. 2017;140(5):e20172695.
37. ACOG Committee Opinion No. 771: Umbilical Cord Blood Banking. Obstet Gynecol. 2019;133(3):e249-e253.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.