Health Policy 104 (2012) 296–303

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Health Policy
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Giving to receive? The right to donate in umbilical cord blood banking

for stem cell therapies
Laura L. Machin a,∗ , Nik Brown b , Danae McLeod b
a
Division of Medicine, School of Health and Medicine, Lancaster University, Lancaster LA1 4YB, United Kingdom
b
Science and Technology Studies Unit, University of York, York YO10 5DD, United Kingdom

a r t i c l e i n f o a b s t r a c t

Article history: Objectives: To explore the views of lay and professional stakeholders about the donation of
Received 28 June 2011 cord blood to public banks in England and the policies surrounding it.
Received in revised form Methods: Qualitative in-depth interviews were undertaken between April 2009 and August
23 November 2011
2010 with 62 participants based in England who play a key role in cord blood banking
Accepted 26 November 2011
and therapy. All interviews were recorded, transcribed in full, and coded and analysed
thematically.
Keywords:
Cord blood
Results: Participants claimed pregnant women had a right to know of the value of cord blood.
Cord blood banking This highlighted the flaws of the existing donation infrastructure, which was portrayed as
Donation playing a significant role in determining public health. Participants called for a right to
Rights donate cord blood to readdress the inequity in healthcare services for pregnant women
and transplant recipients. Donors maintained a sense of right over their donation when
they discussed cord blood donation as potentially benefiting their family as well as society.
Conclusion: In order to keep receiving donated body parts, tissue and blood, there is a need to
take into account the way in which donation operates within a prevalent ‘rights’ discourse.

© 2011 Elsevier Ireland Ltd. All rights reserved.

1. Introduction such as leukaemia, sickle cell anaemia and thalassaemia.

In recent years there has been increased political and
social interest in cord blood banking, with some coun-
tries announcing their first public cord blood bank, such as
Canada [1] or other countries developing a national strat-
egy for cord blood donation and transplant, as in the UK
[2,3]. Donation to public banks is possible when a woman
agrees to have the blood collected from the umbilical cord
after her baby has been born. The stored cord blood in pub-
lic banks can be used instead of bone marrow in stem cell
transplants worldwide to treat those with blood disorders,
∗ Corresponding author. Tel.: +44 01524 594 973; fax: +440 1524 593
747.
E-mail addresses: l.machin@lancaster.ac.uk (L.L. Machin),
Nik.Brown@york.ac.uk (N. Brown), Danae.mcleod@york.ac.uk
(D. McLeod).
Cord blood can also be stored in commercial banks whereby
family members can opt to pay for it to be collected and
stored for the sole future use of their family, something
that France has recently prohibited [4,5] claiming they
“take away a valuable resource from the public banks,
undermines solidarity and risks exploitation of parents at
a vulnerable time” [4, p. 175].
In relation to other countries, the UK offers a unique
case in terms of models for collecting and banking cord
blood. Commercial banking is permitted within some NHS
hospitals [6] despite reservations from the Royal Colleges
[7,8] over the therapeutic value of cord blood stored solely
for family use [9]. Until recently, the UK had two public cord
blood banks, one funded by the NHS and the other funded
by the Charity, the Anthony Nolan Trust. In Summer 2011, it
was decided that the efforts of both public banks would be

0168-8510/$ – see front matter © 2011 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.healthpol.2011.11.011
 L.L. Machin et al. / Health Policy 104 (2012) 296–303
combined and the Trust would be the main point of contact
for requests for cord blood units [10].
Currently, the UK public cord blood bank contains
approximately 15,500 units. Recent figures suggest that
the UK public collection has been relatively small com-
pared to other countries, such as Germany, Australia and
Italy [11], particularly when factoring in that not all cord
blood collected meets the standard required to be used in
transplants and therefore is not banked. Prominent mem-
bers of the cord blood banking community have argued
that in order to provide cord blood units for transplanta-
tion for approximately 95–98% of the UK population, the
bank needs to contain 50,000 units [12]. In their recom-
mendations at the end of 2010, the expert forum agreed
that cord blood collection should be increased so the pub-
lic bank contains approximately 50,000 units by 2018, of
which between 30% and 50% of these units should be from
Black and Minority Ethnic (BME) donors by 2018 [13].
BME groups are found to have a higher propensity for
sickle cell anaemia and thalassaemia [14–16], but are cur-
rently under-represented on the bone marrow registry.
This has influenced the location of the eight collection sites
for the UK public cord blood bank, which are in areas –
mainly London-based – known to have high ethnic diver-
sity. As a result, 40% of all banked cord blood units are
currently from BME donors [13]. Collection is conducted by
dedicated donor co-ordinators and cord blood is only col-
lected during the co-ordinators’ hours of work, although
the Anthony Nolan Trust has expressed their wish to offer
collection ‘round-the-clock’, which would enable an addi-
tional 2000 cord blood units to be banked a year [10].
Pregnant women therefore are only able to donate cord
blood to the public banks if they live within the areas of
collection and give birth during the hours of collection.
Recent studies have shown that pregnant women would
prefer to donate cord blood where possible [17], which is
reflected in the UK expert forum’s acknowledgement of
the need to manage the expectations of those wanting to
donate cord blood, but may be unable to, and ensuring cost
efficiency in public banking.
The cord blood donation infrastructure and potential
donors’ wishes to donate are explored in this paper to argue
that the calls for a right to donate cord blood found in this
study are attempts to draw attention to, and redress, the
inequity in healthcare services for pregnant women and
transplant recipients. The authors conclude that in order to
keep receiving donated body parts, tissue and blood, there
is a need to take into account the way in which donation
operates within a prevalent ‘rights’ discourse.
1.1. Donation in context
Currently, the donation of body parts, tissue and blood
in the UK operates within the framework of anonymous
altruistic gift giving. The system relies on donors providing
their body parts, tissue or blood freely, giving up control
over how the donation is, or is not, used. The reported low
organ and blood donation rates would suggest that altruism
has been in decline over recent decades [18] with the UK
thought to have one of the lowest organ donation rates in
297
Europe [19,20], therefore drawing attention to the needs of
those donating.
Previous studies have explored a variety of incentives
to encourage the donation of body parts, tissue and blood,
which have been based upon reciprocity, whereby the
donation is mutually beneficial to the donor and recipient,
such as egg sharing programmes [21]. In Autumn 2011, the
Nuffield Council of Bioethics discussed the use of limited
NHS resources to pay the funeral costs of organ donors [22].
Others have considered the donor benefiting from their
donation in some way, for example people registered as
donors in the Netherlands are considered a priority if they
require a donated organ in the future [23]. Many studies
have explored the low donation rate in Singapore and the
various ‘incentives’ considered, such as presumed consent
for deceased donation [24], those who opt out of deceased
donation are considered a lower priority if requiring an
organ themselves [25], and donors receiving financial pay-
ment for their organs [26] suggesting the moral saying of
not “giving to receive”, may well be outdated.
Whilst some commentators have argued in favour of
rewarding donors [27], recent studies with donors of var-
ious body parts suggest that how the donations are used
can also play a significant role in motivating donors [28].
So much so, donors are increasingly making claims over
how their donation is used, such as directing who receives
their donation according to the recipients’ ethnicity, sex-
ual practices, marital status, or religion [29,30] suggesting
donors continue to have a sense of right over their donation
[31].
Donors’ requests regarding their donation could be an
attempt to draw attention to and redress the balance of
existing policies surrounding the donation of blood prod-
ucts and body parts, which have been thought to favour the
needs of transplant patients over those of donors [32–34].
This has been most apparent in the calls for gay men to
have the right to be able to donate their blood, and more
recently, for pregnant women who have had sexual inter-
course with a gay man to be able to donate their cord
blood. Frith [35] makes the distinction between legal and
moral rights in the context of the donation of body parts,
which highlights the moral authority embedded in such
‘rights’ discourse. Understanding rights in this way chal-
lenges previous portrayals of donors as a “means to an end”
[34], who simply require a safe and efficient service. In fact,
Warnock [36] concludes that claims to rights are actually
requests for people’s needs to be met, which are currently
being overlooked. She argues that these needs are likely
to change over time and the claims increase in frequency,
as the emerging rights discourse surrounding cord blood
found in this study demonstrates.
2. Methods
2.1. Study background
This paper is the result of a two-year project, funded
by the Economic and Social Research Council to explore
the political and moral economy of cord blood banking
in the UK. The project was made up of three overlap-
ping work packages, which broadly considered the policy
298 L.L. Machin et al. / Health Policy 104 (2012) 296–303

Table 1
Participant groupings and interviewed.

Participant groups Participants interviewed Number of participants interviewed

Regulating and making policy Members of Parliament, regulatory bodies, civil 4

Collecting cord blood
Donors and depositors
Representing interest groups
Using cord blood in research
Maternal and fetal care
Working in the banking sector
Representing professional groups
servants
Donor co-ordinators, phlebotomists 3
People donating to public banks, people paying to 10
store cord blood in commercial banks for their own or
familial use
Senior representatives for public interest groups 8
relating to diseases that can be treated by cord blood
transplants, senior representatives for interest groups
promoting public cord blood collection
Directors of stem cell laboratories, stem cell scientists 4
Senior midwives, midwives, obstetricians, 18
neonatologists
Directors of public cord blood banks, Directors of 12
commercial cord blood banks, Directors of cord blood
storage companies
Senior members of Royal Colleges 3

and practices surrounding cord blood banking, and key
stakeholders’ demand for, and expectations of, cord blood
banking. A particular aim of the project was to explore how
those involved in the collection, donation and banking of
cord blood portrayed the act and purposes of the donation,
the cord blood itself, and the public banks and subsequent
access to them.
2.2. Sampling
A wide range of ‘relevant social groups’ [37] were iden-
tified. These ‘groups’ were deemed relevant after reviewing
the literature, due to their role in shaping the develop-
ment of cord blood banking. Key stakeholders were then
identified from these ‘groups’ according to their histori-
cal or present prominent role in cord blood collection and
banking. Some additional groups also became aware of the
project through marketing material and approached the
research team due to their specific interest in, or expe-
rience of, cord blood. Such groups, including a group of
independent midwives based in the North of England,
were also followed up in efforts to gather a comprehen-
sive understanding of cord blood within the given time
and financial limits. Participants were also asked for sug-
gestions regarding additional participants, which proved
highly effective in terms of recruiting midwives, obstetri-
cians and senior members of the cord blood banks. The
sampling was deemed complete once repetition was found
in the data being collected and no new names of potential
participants or suggested groups were being provided by
participants to the research team.
2.3. Ethical approval
Ethical approval was granted by the University of York
Humanities and Social Science Ethics Committee and the
NHS National Research Ethics Committee. The individ-
ual requirements were met for ethical clearance at nine
NHS hospitals in England. The hospitals varied accord-
ing to whether the maternity units were midwifery-led or
obstetric-led, and their policies on cord blood collection for
public and commercial cord blood banks.
2.4. Recruitment
Donors and depositors were recruited through advertis-
ing on local and national websites and in parent and baby
magazines and with the assistance of cord blood banks.
Attendance at conferences, workshops and meetings on
cord blood collection, banking and transplantation were
also useful in selecting and recruiting additional partici-
pants to those already identified. Sixty-eight participants
were approached and, after a further or telephone call, six
declined to take part either through non-response or time
commitments.
2.5. Data collection
A total of 62 interviews were conducted between April
2009 and August 2010 (see Table 1). Semi-structured inter-
views were conducted as they allowed the participant and
the interviewer the freedom and flexibility to follow up
topics that might not initially have been on the inter-
view guide (see Table 2), as well as providing rich and
in depth data [38,39]. Participants read and signed a con-
sent form, and were told that they could withdraw their
consent at any point throughout the interview and that it
was completely confidential and anonymous. Only mini-
mal identifying details of participants have been referred
to in this paper to allow for the data to be read in its wider
context. Participants are identified in the text by a code
that refers to their role or position and the number of the
transcript.
2.6. Data analysis
The interviews lasted between 1 and 2 h, were recorded,
transcribed in full and coded for themes using the quali-
tative data package, Atlas ti. The analysis was an iterative
process. The codes initially derived from the research ques-
tions and were based upon very broad themes, such as
‘portrayal of cord blood banks’ and ‘portrayal of cord blood’
(see Diagram 1). New codes emerged with each reading
of the transcript, such as ‘portrayal of donors’ or existing
codes became more refined, such as ‘portrayal of public
 L.L. Machin et al. / Health Policy 104 (2012) 296–303 299

An example of refining
themes

Portrayal of cord blood banks

Portrayal of public cord blood Portrayal of commercial cord

banks blood banks

For family storage? An alternave to public cord

blood banks?

“…if my children needed it that either “I would prefer that we have access to a
nobody else would have matched their private bank rather than try and rely on
ssue type and it would sll be there for public at the me should we need it,
them to use…” heaven forbid”

An alternave to commercial cord

blood banks?

“If it wasn’t that expensive…maybe a

couple of hundred pounds then it might
have been something that was sll on the
table”

Diagram 1. Decision tree to visually illustrate coding of data.

banks’ and ‘women’s rights’. Importantly, any “unexpected
issues” [40] that emerged during the reading of the data
were also acknowledged, which resulted in further refine-
ment of the codes. A number of approaches were adopted to
ensure the quality of the data analysis. The interviews were
conducted over a period of time, thereby allowing for initial
observations to be confirmed and emerging analytical find-
ings to be tested. Furthermore, members of the research
team read the transcripts, assisted with the coding of the
data and discussed the resulting analytical summaries.
3. Results
3.1. A right to know about cord blood?
All participants were aware of the potential value
of cord blood for transplantation. However, participants’
responses varied when asked if every pregnant woman
should be made aware of the value of cord blood and
donation to the public bank. A senior policy maker was par-
ticularly keen to raise awareness of the value of cord blood,
claiming
. . .I want everyone to be informed. It doesn’t mean that
everyone is going to be able to or want to but they should
know that the cord blood, which is going to be thrown
away, that that has a value and that has a value maybe
for their own family but particularly to others. . .So,
yeah, I think there is a right to know. (P-M 07)
A similar position was adopted by members of the
commercial banking sector who each discussed pregnant
women’s right to know about the value of cord blood within
a legal context. Two cord blood collectors for commercial
banks and a director of a commercial bank discussed how
there was a need for obstetricians and midwives to discuss
cord blood banking with pregnant women in order to avoid
any future litigation charges against them,
. . .there’s a big issue about patient rights here. . .[if]
the kid gets leukaemia and could have been treated
with cord blood, [t]hey’re going to come back to the
obstetrician and say why didn’t you tell me about that?
(Com-bank 03)
By discussing every pregnant woman’s right to know of
the value of cord blood it enabled both the policy maker and
those within the commercial banking sector to indirectly
draw attention to the flaws in the current donation infras-
tructure. In both quotes the pregnant woman’s family’s
health was referred to, and depicted as being in jeop-
ardy due to the infrastructure. Therefore the participants
implied that the infrastructure played a significant role
in determining public health, a notion also presented by
midwives and representatives of genetic interest groups
when discussing a right to donate.
300 L.L. Machin et al. / Health Policy 104 (2012) 296–303

Table 2 . . .the first time I wanted it [name of daughter] was born

Example questions from the interview guide relating to the aims of the
on a Saturday and it was: “we don’t collect on the week-
research project.
ends” so it didn’t happen. Pathetic!. . .my son was born
Research aims Interview guide – example at 10 to 2 or 10 to 3 on a Monday morning, which is
questions essentially still the weekend, yet they still managed to
To explore the cord Can you explain your role in the collect it. So it’s obviously just the fact that they haven’t
blood banking sector cord blood banking process? got the staff. . .It’s ridiculous. Because I think it should
Do you think attitudes towards
be done as a matter of process. . . (Donor 01)
cord blood banking has altered
over the years? On one level, the basis for the demand found in the data
Is cord blood the future for stem
cell research and/or transplants?
appeared to be attempts to redress the inequity in health-
To explore the policy Is there enough regulation care services. Yet, the donors’ negative reference to the lack
and practice around the cord blood banking of collection at weekends suggested that participants per-
implications arising industry? ceived the current cord blood infrastructure as poor as it did
from the
not reflect the therapeutic value of cord blood. In essence,
introduction of cord
blood banks if cord blood had life-saving potential, why is more not
What implications could arise being collected? This was apparent when a representative
from the current drive of the of a genetic interest group described her members as being
public cord blood banks to amongst those most deprived within society in terms of
increase recruitment from
healthcare. For this participant, cord blood held great future
members of the Black and Ethnic
Minority groups? potential for her members who had illnesses that could
Do you believe having cord blood be treated through cord blood transplants, therefore she
collected is an extension of claimed that its collection should be universal regardless
consumers’ rights or be
of the financial implications,
associated with reproductive
rights? . . .the communities that we deal with are from some
To explore the views of How did you first hear about cord
of the most disadvantaged in society. They have poor
parents and those blood banking?
using the cord blood access to health overall. . .I think cord blood storage is
banks something that is very valuable. Who knows what uses
Was your choice of hospital we could have for it in the future. . .I would definitely
influenced in any way by your state it should be offered universally. (GIG 39)
decision to bank cord blood?
Do you think all women should Whilst the lack of infrastructure for cord blood to be col-
be given the option of donating
lected widely was discussed in relation to pregnant women
cord blood to public banks?
and transplant recipients being disadvantaged by the cur-
rent healthcare system, potential donors also considered
3.2. A right to donate cord blood? their own family’s health being neglected in some way if
unable to donate to the public bank.
Both those who had and had not been able to donate
cord blood implied a need for cord blood donation to
be made available to every pregnant woman, in order to
meet the demand for it. For midwives, current policies and 3.3. A right over the donated cord blood?
practices of cord blood collection were a source of dis-
crimination between those women who had had the cord A number of donors described how their donation to the
blood collected and donated and those who had not, as a public bank could prove beneficial if a member of their fam-
senior midwife argued when discussing whether midwives ily became ill in the future, “. . .if my children needed it that
should collect cord blood for banks, either nobody else would have matched their tissue type
and it would still be there for them to use. . .” (Donor 01).
. . .why should a select band of people be entitled to it?. . . Therefore donors, along with some members of the cord
the general public of women who are having babies blood banking sector, viewed the public bank as a source of
have to have access to the same things, the same ben- ‘personal’ storage for those who had donated to it, “The way
efits that those women who can pay to have their cord I see it is if you’re on the NHS register and they need to do a
blood. . .let’s have a national cord blood bank that all match if I’d donated, mine will be on there, so I should come
women will donate to altruistically and any child who up” (Donor 03). Similarly, a senior policy maker explained
needs stem cell transplant will have access to it. . . (Mid- how there was a need to manage pregnant women’s expec-
wife 10) tations of the purpose of the public bank when they found
Pregnant women who had agreed to donate cord blood out it was not possible to donate,
when their child was born, expressed frustration when the A lot of the expectation came from parents, especially
timing of the delivery of their babies had not coincided first time parents, about what the potential was around
with the working hours of the staff employed to collect it. A the use of their baby’s cord blood in the future for their
donor who had given birth to her two children at the same child. . .If they couldn’t have their child’s cord blood
hospital explained, collected then their child would be at some sort of
 L.L. Machin et al. / Health Policy 104 (2012) 296–303
disadvantage or maybe susceptible to a debilitating dis-
ease which they could have prevented. (P-M 13)
From these quotes, it is possible to infer that donors had
continued a sense of right over their donation to the public
bank, albeit due to the immunological compatibility of the
cord blood for themselves and their family. This portrayal
of the public bank was also reflected in the decision-making
of pregnant women over the storage arrangements of the
cord blood.
Depending upon whether women had chosen to store
in public or commercial banks, the financial costs associ-
ated with collection and storage of cord blood or having
guaranteed access to the blood were emphasised. The
‘unreliability’ around gaining access to their donated cord
blood if needed, was put forward by members of the com-
mercial banking sector and depositors as reason for paying
to store with a commercial bank, as a depositor explained,
“I would prefer that we have access to a private bank
rather than try and rely on public at the time should we
need it, heaven forbid” (Depositor 01). Whilst two donors
explained that they decided to store the cord blood in the
public bank as it was “a free alternative” (Donor 05) to
commercial banks, which they each considered too expen-
sive, “I heard about the private banks. . .it makes sense but
probably this is quite expensive” (Donor 03). Their deci-
sion to donate was less about disagreeing with the purpose
of commercial banks, but was camped within the finan-
cial aspects of collection and storage, “If it wasn’t that
expensive. . .maybe a couple of hundred pounds then it
might have been something that was still on the table”
(Donor 05).
For donors and those in favour of increasing cord blood
banking, it appeared from the data, that the public bank
was viewed as offering personal storage to donors as well
as helping society. Donation to the public bank was in effect
mutually beneficial: it enabled the cord blood to be there
for donors’ family’s future use in the unlikely event it was
required, and in the meantime, available to those who were
immunologically compatible and required a transplant.
4. Discussion
Discussion around a right to donate is not new. There
have been calls for a clear framework around what body
parts, tissue and blood may be covered by a possible right
to donate in light of the increasing attention being drawn
to those segments of society who claim discrimination at
being unable to donate [32–34]. In support of this has
been the rhetorical question regarding for whom these ser-
vices are intended – recipients or donors of the donated
body parts or tissue. It is perhaps as a consequence of
the focus of this study being on cord blood banking that
the demands of both donors and recipients have been dis-
cussed by participants. Whilst the safety concerns of the
blood being donated are of considerable importance, what
these statements do is prioritise the recipient above the
donor. Franklin [34] and Annas [33] have proposed that
whilst donors are a “means to an end”, there is a need to
ensure “a good service” is offered to donors. However, what
this study has shown, as have others elsewhere [28,41],
301
is that donors actively engage with the donation process
rather than playing a passive role. They consider what is
being donated, how their donation relates to their relation-
ships with their significant others, and what it means for wider
society. Donors, and other participants, accepted the ther-
apeutic value of cord blood and therefore perceived the
infrastructure around cord blood collection as lacking.
Findings from this study support Waldby’s [31] claims
of donors maintaining a sense of right over their dona-
tion as donors and those in favour of universal collection
appeared to do so, albeit on very practical terms. It was
apparent that they perceived their donated cord blood as
being more immunologically compatible for their family
members compared to other donated cord blood samples
available in the public bank. Put simply, they believed their
sample to be best suited for their family’s health needs
and therefore unlikely to be used by other members of
society. By default, the cord blood sample would be avail-
able for themselves in the future if required. This was
supported when those who had donated cord blood dis-
cussed paying to store their cord blood in commercial banks
to guarantee access to their cord blood, but the financial
implications of this decision restricted them from doing
so. That said, donors in this study did place emphasis upon
wishing to help society and expressed frustration when
unable to do so. The perception of the public bank as offer-
ing ‘personal’ storage was portrayed as a consequence of
the donation. Alternatively, it is possible that those who
felt discriminated against by not being able to donate and
called for universal collection, might have been motivated
by what could be benefited for themselves and their family
by donating to the public bank.
Throughout the data, a moral undertone to the discus-
sions around the donation and potential future use of cord
blood was apparent. In particular, donors made reference
to the cord blood sample being available for their children
or family if they ever needed it, and therefore had acted in
the best interests of their children. Conversely, those who
were unable to donate cord blood at all or for all of their
children, implied that their children were being denied the
health benefits associated with cord blood and the calls to
donate cord blood universally was a reaction to this. Sim-
ilar to Frith’s [35] observations when exploring the right
of donor-conceived people to know of their origins and
donors, a moral authority was apparent in the rights dis-
course found in this study.
As Warnock [36] states, ‘rights’ are merely requests from
people wishing for their needs to be met. In the case of cord
blood, it is the potential future health needs of donors, their
children and their family. Potential transplant recipients
were also portrayed as not having their health needs met
when a genetic interest group representative portrayed her
members as being deprived the health benefits that could
arise from universal cord blood collection. The potentiality
surrounding such stem cell therapies as cord blood trans-
plants means that societal expectations can be high, with
no one wishing to miss out on any possible future benefits.
So, what does this rights discourse around donation
mean for how ‘donation’ is understood? Currently, dona-
tion in UK means that a body part, tissue or blood is given
with the donor renouncing any authority, whether legal or
302 L.L. Machin et al. / Health Policy 104 (2012) 296–303
moral, over it. However, in the case of cord blood dona-
tion, potential donors and donors are assuming that their
‘donation’ will be available to their family if required in
the future, as opposed to giving it away ‘freely’. Further-
more, those in favour of universal cord blood collection
perceived donors as gaining something in return for their
donation. This again challenges the existing notion of dona-
tion, whereby donors are meant to give altruistically, with
no incentive or benefit in return for their donation, some-
thing that the French government appear keen to maintain
[4].
However, it is short-sighted to believe that donors
receive nothing from the donation process, whether that
is a sense of happiness [27,42] or access to a health ser-
vice that they might not otherwise [23]. The findings from
this study suggest that altruism and egoism are interwo-
ven with each other as others have noted when discussing
donation programmes such as egg sharing [21]. Titmuss
[43] argued that the gift of blood should be an act of pure
generosity, yet to expect donation to be driven by solely
altruistic tendencies, if it ever was, could be considered
naïve [44,45], something which is becoming increasingly
recognised worldwide [22,26]. The debates around altru-
ism have a long history [46], which cannot be resolved in
this paper. In fact, there is a bigger question at stake: should
altruism be expected, given what is being asked of people
to do, what is being donated, and in the case of cord blood,
the timing of the collection i.e. immediately post-partum.
Arguably, in order to keep receiving donated body parts,
blood and tissue there is a need to review the policies and
procedures around donation. In the context of cord blood
banking, the grounds upon which donation is restricted
needs to be transparent and explained clearly in existing
policy and promotional literature. Secondly, information
on the immunological compatibility of cord blood when
used in transplants needs to be available to pregnant
women when cord blood banking is discussed with them.
Finally, findings from this study suggest there is a need
to reflect upon how ‘donation’ is currently understood,
in particular how (potential) donors can engage with the
donation process. It is then, that the services reliant upon
donations, and the policies around donation of body parts,
blood and tissue, can truly offer a “good” [23] service to
both recipients and donors.
Acknowledgements
We would like to thank all the participants who gen-
erously gave up their time to be interviewed and for their
continued interest in the project. The research would also
not have been possible without the funding from the Eco-
nomic and Social Research Council (RES 062–23-1386).
Finally, thank you to Michael Morrison and Catherine
Montgomery who read drafts of the paper as it developed
and made very valuable and insightful comments.
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