PPP Reading C01

Reading C01

Text: 1 Umbilical cord blood banking in Australia: Public good or private gain?

Allogeneic haematopoietic stem cell transplantation (HSCT) is a curative therapy for many
malignant and non-malignant conditions, including leukaemia, bone marrow failure
syndromes, immunodeficiencies and inborn errors of metabolism. Unfortunately, only 30% of
patients in need of HSCT will find a suitably matched related donor. The only option for other
patients is to search for an unrelated volunteer donor. Over the past decade, these

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difficulties have led to umbilical cord blood (UCB) being increasingly used as an alternative

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source of stem cells for HSCT in patients who do not have a matched bone marrow or blood
donor. Over 7000 UCB transplants have now been performed worldwide, with more than

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150 paediatric UCB transplants performed in Australia alone. Successful UCB transplant
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programs have led to the establishment of two types of UCB banks: public banks and for-
profit private banks. In the case of Australia, I argue that there is adequate social and
medical justification for public UCB banks; however, based on current knowledge of the
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therapeutic uses of UCB stem cells, private UCB banking is not similarly justified.

The two types of UCB banks in Australia differ in both their scientific rationale and their
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medical utility. Public UCB banks are altruistic, store donated UCB for public access, and are
analogous to volunteer bone marrow donor registries. In contrast, private UCB banks will,
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for a fee, store a child’s UCB for personal or family use. It should be noted that transplant
centres themselves also store directed family UCB donations if a family member is known to
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have (or potentially has) a disease that can be treated with transplantation. Public UCB
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banks have, for the most part, been very successful in making HSCT a real option for
Australian patients who require a transplant. These banks attract considerable public support
and donation from a broad range of Australians. However, there are a number of political
and structural challenges facing public UCB banking in Australia.

Firstly, collecting and storing UCB is expensive and requires considerable and continuous
government support. In addition, there are only a limited number of collection centres and
these tend not to be located in regional or culturally diverse areas, resulting in continued low
donation and recruitment rates from ethnic minority and indigenous groups. Although
Australian public UCB banks show significantly more ethnic diversity than their bone marrow
registry counterparts, public UCB banks are still characterised by under-representation of
many ethnic groups, particularly Aboriginal Australians and Pacific Islanders. Given the
increase in UCB transplantation and the persistent under-representation of indigenous
Australians and ethnic minorities in UCB banks, recruitment strategies that best meet the
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 PPP Reading C01
needs of potential transplant recipients need to be developed. This will not be a simple task,
as such policies must take account of equity concerns and specific population needs.

In contrast to public UCB banking, questions have been raised about the assumptions upon
which private UCB banking is based. These assumptions include: that UCB will provide a
valuable and appropriate resource for use in transplantation and regenerative medicine; that
stem cells present in UCB could not easily be collected from other sources (e.g., from
peripheral blood or bone marrow) at the time that they are needed; and that the likelihood of
needing UCB stem cells is sufficiently great to justify the expense of long-term storage of
UCB. Each of these assumptions is questionable — the promise of regenerative medicine is

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yet to be shown in clinical trials; the conditions for which HSCT is performed often require
stem cells from allogeneic sources rather than from the patient, and stem cells can generally
be obtained from alternative sources when required for HSCT; and the vast majority of

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people will never develop a haematological malignancy or any other indication for HSCT, so
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will never require the use of their own haematopoietic stem cells (estimates of the likelihood
of requiring one’s own stem cells for autologous transplantation later in life vary between 1 in
20,000 and 1 in 200,000).
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Much of the excitement surrounding UCB research is based on hope, rather than evidence.
However, should UCB stem cells prove to have wider therapeutic application, another set of
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different but equally serious questions will surely arise regarding the maintenance of social
equity in health care. For example, only a small proportion of the population may be able to
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afford UCB storage for personal or family use. While state-provided storage of all UCB for
personal use may, although extremely costly, satisfy social justice concerns, such a solution
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may also threaten the real and symbolic value attached to altruistic donation of tissues and,
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perhaps in the end, the very existence of public UCB banks.

Word count: 777

Source: https://www.mja.com.au/journal/2008/188/9/umbilical-cord-blood-banking-public-good-
or-private-benefit

©Cambridge Boxhill Language Assessment Pty Ltd 2020

 PPP Reading C01

1. In the first paragraph, what does the phrase ‘these difficulties’ refer to?

A discovering cures for malignant and benign conditions

B differences between bone-marrow and UCB treatments
C finding a suitable related or non-related donor
D low numbers of both family and volunteer donors

2. In the first paragraph, we are told that the author’s main argument will be that

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A private UCB banks have more social value than public UCB banks.

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B both private and public UCB banks have a beneficial role in society.
C advances in stem cell therapies will impact private and public UCB banks.

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ut en D public UCB banks have a valid purpose but private UCB banks do not.

3. In the second paragraph, the word ‘analogous’ suggests that public UCB banks and
bone marrow donor registries are
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A different.
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B comparable.
C helpful.
D connected.
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4. The author suggests that public UCB banks in Australia

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A provide a satisfactory resource for transplant patients.

B are in direct competition with transplant centres.
C face significant challenges that make them ineffective.
D require greater public support and gifts of money.

5. According to the author, why will it be challenging to improve the ethnic diversity of
stocks at public UCB banks?

A Certain ethnic groups are reluctant to donate their UCB.

B Governments are unlikely to provide sufficient funds.
C It will be hard to achieve fair outcomes for everyone.
D Recruiting staff for regional centres will be difficult.

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 PPP Reading C01

6. Regarding the three assumptions that underlie private UCB banking, the author

A explains why none of them is valid.

B states that further research is required.
C questions the evidence used to support them.
D uses statistical data to support them.

7. What is the author’s attitude towards the future use of UCB stem cells?

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A optimistic about the many possible uses

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B cautious about issues of fairness
C dismissive of the long term relevance

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ut en D confident about research outcomes

8. What concern does the author express about publicly-funded storage of UCB for
personal use?
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A It creates problems with regard to equality.

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B People will no longer see the benefits of donating tissues.

C The costs may outweigh the benefits.
D It could cause both public and private UCB banks to close.
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©Cambridge Boxhill Language Assessment Pty Ltd 2020

 PPP Reading C01

Key

1. C

2. D

3. B

4. A

5. C

6. A

7. B

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8. B

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st or
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N

©Cambridge Boxhill Language Assessment Pty Ltd 2020