SINGAPORE – On Nov 30, the Ministry of Health (MOH) announced that licensed cord blood bank Cordlife Group Limited (CGL) had damaged cryopreserved cord blood units belonging to at least 2,150 clients by exposing them to sub-optimal temperatures.

But what is cord blood, and what recourse do those affected by damaged units have? The Straits Times takes a look.

Q: What is cord blood, and what are its uses?

A: Blood is obtained from the umbilical cord of a newborn baby. It contains blood stem cells that could be used for future cell therapies.

“The most developed of these applications is the use of umbilical cord blood as an alternative to bone marrow transplantation, which is an established treatment for certain types of haematopoietic cancers (blood cancers),” said Dr Yen Choo, founder and executive chairman of Plasticell, a biotech firm specialising in cell and gene therapy research.

Q: How is cord blood stored?

A: Cord blood is cryopreserved, meaning it is stored at a low freezing temperature in clinically compliant freezers, said Dr Yen.

There are several cord blood banks here, namely the Singapore Cord Blood Bank – the only public bank in the Republic – as well as private cord blood banks Cordlife, Cryoviva and Stemcord.

Cordlife is the longest-operating cord blood bank here, with over 600,000 clients since it was incorporated in 2001.

Q: How beneficial is cord blood storage, and what is the difference between private and public cord blood banks?

A: Dr Yen noted that while cord blood storage is often marketed to parents as a way of preserving umbilical cord blood stem cells for future therapeutic use, there are currently few treatments that use autologous cord blood, where an individual uses his own cord blood stem cells.

“Most current applications of cord blood stem cells work best if the stem cells originate from a different individual, or allogeneic transplant,” he said.

Media outlet Today reported in 2016 that privately banked cord blood had a low rate of use here, with experts noting that an individual’s cord blood could contain the genetic abnormality that caused the blood disease or cancer.

The article noted that associations such as the American Society for Blood and Marrow Transplantation have guidelines encouraging parents to instead store cord blood with a public bank, where it could benefit more patients.

Q: How can improper storage damage cord blood?

A: When exposed to temperatures above the acceptable limits of below minus 150 deg C, the cord blood units will start to thaw, potentially damaging the stem cells in the cord blood.

This can result in differentiation – a process by which stem cells develop and mature into various types of cells – or even cause the stem cells to die, said Dr Yen, who is also an associate professor at Nanyang Technological University’s Lee Kong Chian School of Medicine.

MOH said on Nov 30 that it had received a complaint in July alleging that cord blood units stored in a Cordlife Group tank had been exposed to temperatures above 0 deg C, as well as other service quality issues.

The ministry then conducted unannounced audits on the company in August, and again between Nov 16 and Nov 21.

Between those occasions, MOH inspectors contacted Cordlife on multiple occasions to request reports and documents, and asked for further explanations where discrepancies were noted.

These audits found that cord blood units in seven of 22 storage tanks had been exposed to temperatures above acceptable limits at different periods since November 2020.

Q: What recourse is available to parents affected by the Cordlife incident?

A: Lawyer Nicolas Tang said Cordlife customers will have to examine the terms and conditions of their contract with the company to determine the extent of their rights, as well as whether they can start legal action and their chances of success.

“Even if customers are successful in establishing liability against CGL, they will need to be able to quantify their loss suffered in monetary terms against CGL before they can be awarded damages,” said the managing director of Farallon Law Corporation, adding that damages could be capped by limitation of liability clauses in the contracts.

He said that it would be premature to determine whether such legal action would be successful, given that MOH is currently conducting investigations.

Concerned customers should contact Cordlife directly to inquire if their cord blood units are impacted, and to see if compensation can be given for the lapses, Mr Tang added.

“If negotiations between affected individuals and CGL are unsuccessful, the parties should consider mediation at the Singapore Mediation Centre to see if the matter can be settled privately, instead of commencing legal proceedings that would be costly and should therefore be a measure of last resort,” he said.