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Monday, 25 October 2010
Page: 1507


Mr LAMING (8:16 PM) —I congratulate the member for Petrie for bringing this issue to the attention of the House. The Australian Cord Blood Collection Network has been doing fine work over the past 10 years. I also thank the member for introducing the acronym HSC so that I do not have to wrangle with the almost impossible-to-pronounce word ‘haematopoietic’! All the diseases that have been shown since the early 1980s to respond to cord blood have seen significant improvements in survival ratios over the past two decades. I can recall that, during my training in 1988, cord blood was first used in a transplant. By 1990, things had moved very fast. There was already then a very good understanding of human lymphocyte antigen markers on the outsides of cell walls, which basically determine whether cells are recognised as foreign or not when they are transferred or transplanted between hosts. That applies to cord blood as it does to every other organ. I will make just a couple of comments on cord blood before moving to the more general issues of transplantation.

Cord blood banks were set up as early as 1992, I think. Eurocord was among the first of those, a few years later. By 1995 it was quite common in Europe to have access to those kinds of procedures. Australia leads the way outside Europe, in general, with about 168 procedures last year, making us probably the third or fourth outside Europe but still a long way behind nations like France and Spain that lead the world. It needs to be remembered that these stem cells are not quite the same as an embryonic stem cell, in that they have already been through one series of differentiation, so they are not quite as plastic as one would hope. But there is some positive news that there may be some use for them as stem cells in that truly plastic sense that they can actually differentiate into different tissues.

The main focus is on the treatment of aplastic anaemias and the family of anaemias and a whole range of blood-borne cancers for which the key treatment is systemic chemotherapy followed by a bone marrow transplant. That is what cord blood is all about. The key issue at the moment around cord blood is not so much HLA antigen compatibility—which is always really important—but, as we are now realising, the volume of blood and the amount of packed cell that is actually collected. There is very little point in collecting less than 60 millilitres. We are now finding that we are pushing higher and higher in Australia to 60-, 80- and ultimately 100-millilitre minimum collections as a useful sample for use in therapeutics. We are now discovering worldwide in the most recent research that it is not so much HLA compatibility as it is the amount of blood that can be collected from a placenta. As has already been pointed out by the previous speaker, we are avoiding a lot of the ethical and moral issues around the destruction of an embryo. By the same token, apart from some fairly unusual peri-Mediterranean traditions around the placenta, the placenta is normally discarded in Australia, which makes collection of the blood from a placental cord almost without concern—apart from the fact that you need skilled people to do it. If you are not able to collect 80, 90 or 100 millilitres of cord blood there is a real problem, because much of our collection consists of samples of less than 80 millilitres, which is very problematic in therapeutics.

We are also seeing, if you draw a bell curve of the volumes of blood that are being collected, a real depletion at the high end of the large collections. There is a real chunk coming out, because these collections are being deployed clinically and where there is a real gap in these large-volume collections. This is another very good reason for supporting the previous speaker, who talks about having specialised staff who are able to collect this blood in adequate volumes all around the country in as many hours of the day as is clinically and financially feasible.

There has been a tenfold increase in collection of cord blood over the past 10 years, and that matches what is happening overseas. We also know that there is increased storage and more rapid availability, and all of these elements are really important in our ability to treat people who need it. The benefit of cord blood cells is that they are a fairly immature cell—we call them immunogenically naive—and that makes them far more able to be used more broadly. They have a good gene transfection rate, longer telomeres and a higher expansion potential, which is always good if you are trying to maximise your clinical results.

Of course, for the banks themselves we need an ability to store these cells for years but to use them immediately, and that is why nothing else is going to work. That is why it was recognised as early as 2000 that we needed a well-funded cord blood collection network to support the work of the banks, which had been around but had not really grown to a point where there were enough samples to remove concerns around HLA matching. The problem is that, if you move to an Indigenous network or to Indigenous mums who have completely different HLAs, it is even harder to find a useful match. That is why it is a real challenge to move into some of the minority populations and expand the bank accordingly.

Moving more broadly to organ and tissue, work in encouraging people around the country to be donors is very important work of both governments as well. In Australia, even though we almost universally accept the importance of organ donation and the fact that it saves lives, we are still very, very low in the numbers. My general rule is 20-40-60, which means that only 20 per cent of Australians can actually recall an explicit conversation with family members about whether to become organ donors, around 40 per cent of people simply do not know and 58 to 60 per cent of people agree to it at the time when that very, very tough decision to allow a loved one to donate their precious organs has to be made.

What we do know is that if Australians do take that step then our rates are exceptionally good in regards to the number of organs that are harvested. At the moment, we have around 13 per million Australians in the population being organ donors. But once that decision is made, a large number of organs can be harvested and deployed in a clinically appropriate way within the time frame. That speaks to how well our system is operating. There are 1,700 people sitting on waiting lists for organs right now. Less than half of them receive a clinical operation in each year. Around 450 are required to provide 800 people with a life-changing organ transplant.

Right now, we know that there are up to 4,000 skin and tissue transplants per year and around 1,100 corneal implants, which can help around 1,600 people for the obvious reasons. I can tell you that talking to families about the very tough decision of whether or not to donate corneas is intensely personal and a very difficult conversation to have at that most difficult of times. But obtaining those corneas within a six- or 12-hour time period, being able to keep them cold, transport them and deliver them to where they are needed—to the entire surgical team that is ready to put those corneas in—is no mean feat. What we know is that that is working exceptionally well, particularly around the larger centres in Australia. We are now seeing around 1,600 people a year having their sight restored thanks to corneal transplants.

It is worth nothing that there is a bit of variation between states. A gold star goes to South Australia for having 38 donors per million. Bringing up the rear is Western Australia—and I am sad to see that there are no Western Australians in the chamber at the moment to take that message back to their state government—with eight donors per million. They really can do better. All of these figures improve slightly each year. That is very much due to the strong work that has been done by federal governments to encourage organ donations. The previous Prime Minister made that a particular focus during his tenure. That was much appreciated.

I will close where we began: with cord blood. There is one thing that we know: the collection of cord blood that occurs at every location where there is an obstetrics service. That should be the goal. We can train existing clinical staff to become specialised at collecting cord blood to maximise the odds that, if a mum decides to donate cord blood, she is able to. Finally, we need to make sure that that cord blood is available in a large enough sample to make it a clinically useful one. We face the challenge that there is a real deficiency of high-volume samples, because they are being heavily utilised. We have a library now that is skewing back towards having the smaller samples that are less and less clinical useful. I support the motion.