Health Committee on Nov. 23rd, 2010

[Marco Décelles]

In terms of cord blood, Dr. Wall, in Winnipeg, has done searches for some of her patients, but we have not found any compatible units so far. You always need to find the most compatible unit. People in British Columbia have also done searches as recently as the beginning of last week. Our bank is becoming more popular, and we are now able to begin meeting all of the demand.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

During your presentation, you said that there are few transplants, as we can see from your chart.

Why are there so few, when banks seem to be so generous in terms of donors?

[Marco Décelles]

It is a phenomenon in Canada, and especially Quebec, which was the leader. You can even see it in the volume. Historically, nearly 50% of transplants were done in Quebec. In Canada, it has to do with the culture of transplant specialists. Last year, 90 transplants were performed, and that figure was in line with the trend. This year, we are not sure what is happening in Canada, or even Quebec, because we have seen a significant drop, even though the number of units transplanted around the world has grown.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Very well.

I have a question for you, Dr. Lebrun, further to something you said in response to a previous question. You said that certain rules needed to be relaxed in order to build a much more ethnically diverse bank. Could you elaborate on that? Is that really a barrier for you? According to your presentation, you want to recruit donors in specific regions, in order to significantly improve your bank's ethnic diversity.

[Dr. André Lebrun]

I will use the Black community as an example. For a few years now, we have been trying to raise awareness in the Black community about blood donation and cord blood donation, to try to encourage people to ultimately donate to the international registry. We encounter challenges that are very specific to that type of community. The members of that community have blood types that are quite different than those in other communities. According to the New York Blood Center's National Cord Blood Program, 16% of units come from Black donors, and 60% of those units will be used because of their compatibility. You will not find that in the Caucasian population.

I identified one problem, but you will appreciate that there are also regulations on the screening of viruses, including HIV Group O, an especially prevalent strain in Africa. It is just as easy to screen for that strain of the virus as it is for the others, such as HIV-1 or HIV-2. The same goes for malaria; we know that Europe has testing, and we would really like to see that happen in Canada, as well.

So there are a number of factors that can serve as barriers. We know that our Black donors, at least those in Quebec's Haitian community, very often travel abroad, to Haiti or elsewhere. As a result, they are exposed to certain illnesses, especially in countries where the incidence of malaria is higher. All of that creates a barrier for us.

Discussions on that topic have only just begun with Health Canada. But, since you asked, I can tell you that this is precisely the kind of thing we want to talk to Health Canada about, in order to make it easier to recruit donors.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

In fact, we have an official from Health Canada here today. Could she explain why there are barriers in this respect?

[Liz Anne Gillham-Eisen]

The cell tissue and organ regulations are different from the blood regulations; they don't have the same criteria. There is no exemption for people who have lived in Africa or outside the country, or travelling restrictions, which there are currently for blood. So that is not a restriction to cord blood donors in Canada.

There's also the provision of exceptional distribution under the CTO regulations, which allows for the collection and distribution of blood that doesn't meet all the requirements of the regulations, based on the clinical judgment of the transplanting physician and the informed consent of the recipients, so they are made aware that the specimen they are receiving might be of slightly higher risk, but it is not that it is exempted and cannot be used. It can be used in Canada. We have done this under the CTO regulations, because of the life-saving issue around all cells, tissues, and organs, so this is permitted to be collected and used. The requirements are not as strict as for blood, and there are not the geographic referrals for HIVO under the CTO regulations, as we find with blood. So I hope that clarifies it.

[The Chair, Conservative, Joy Smith]

Thank you very much, Ms. Gillham-Eisen.

Now we'll go to Ms. Leslie, please.

[Megan Leslie, NDP, Halifax, NS]

Thank you, Madam Chair.

Thank you to all of you for being here today.

I have two questions about the accessibility of cord blood collection.

The first would be, what are some of the barriers to collection in rural settings? I don't even know if you need specialized facilities or how that works.

Then my second question relating to that is, do you see an increase in problems or barriers with the rise of midwifery and home births? Is that impacting your ability to collect?

[The Chair, Conservative, Joy Smith]

Who would like to answer that question?

Doctor.

[Dr. John Akabutu]

I'll answer the last one first.

We don't allow home deliveries, the reason being that we are not able to certify the home environment as being safe for the collection of cord blood. However, midwives can collect cord blood for us if they work in hospitals, where hospitals are already accredited, so that's how we get around that.

As far as the other question about the rural collection, this is where expense comes in, and especially if you want to include, say, aboriginal populations. They are located in far-off places in Canada, sometimes with a very harsh climate where things might freeze up. So collecting cord blood from that population is very difficult and very expensive. I think what will dictate whether we are able to do it or not is going to be the resources that are available to do it. It can be done.

[The Chair, Conservative, Joy Smith]

Mr. Décelles.

[Marco Décelles]

From a different perspective, everything is a matter or logistics. In order to create or preserve a unit of cord blood, bank operators have to work within a 48-hour time frame. Obviously, there are issues surrounding proximity to the processing site and airport accessibility. That is one reason why collection is concentrated primarily in major urban centres. So we need to improve the logistics in terms of facilitating access.

[Megan Leslie, NDP, Halifax, NS]

Thank you.

My next question is this. Ms. Gillham-Eisen planted this firmly at the feet of the provinces and the territories, and I want to put it to the other witnesses, if you agree with that, if you think there is a federal role here. Maybe this is something that could be orchestrated by public health versus Health Canada. So if you have thoughts about what the federal role is, and also if you think there are federal regulations that would need to be changed to support a national bank....

[The Chair, Conservative, Joy Smith]

Dr. Sher.

[Dr. Graham Sher]

Thank you, Madam Chair.

Briefly, Ms. Leslie, I think Liz Anne was pointing out the different roles of the federal government as regulator and the provinces and territories as funders of the service provision, which I completely concur with, and hence our business case has gone to the provinces and territories and the ministers of health in those jurisdictions for approval.

I believe this committee and the federal government have continued to support the need for a national bank. I think the federal government can continue to play a role there, but ultimately the funding and delivery thereof is something that falls firmly within the health care provision of the constitutional differences that we have in this country with respect to health care.

I believe the current regulations in place from Health Canada, as Liz Anne has summarized, are adequate. They support the appropriate respective views of safety. They allow sufficient access. They are there to protect Canadians, and as she said, they also have the flexibility that distinguishes cell tissues and organs from the more rigid rules that apply to blood, where we have a very different donor-recipient relationship. So we believe, at Canadian Blood Services, it is the role for the provincial governments to approve and fund this. The federal government can certainly continue to support and champion it, but we also believe the federal government's regulatory oversight is appropriate.

[Megan Leslie, NDP, Halifax, NS]

Thanks.

[The Chair, Conservative, Joy Smith]

Yes?

[Dr. John Akabutu]

I can see a role for the federal government in the field of innovation. Stem cell therapies as we know them today are going to be something different in a few years. Without support and innovation, we will not be able to harness the resource appropriately.

[Megan Leslie, NDP, Halifax, NS]

Thank you.

[The Chair, Conservative, Joy Smith]

You have another minute, Ms. Leslie.

[Megan Leslie, NDP, Halifax, NS]

My next question is, would placenta stem cell collection fall within the mandate of a cord blood bank? I'm not sure who could answer that.

[Dr. Graham Sher]

It's one and the same thing.

[Megan Leslie, NDP, Halifax, NS]

It's one and the same? My understanding is that it's much more complicated. It doesn't matter? There are no problems with it?

[Dr. Graham Sher]

I think I can answer on behalf of all of us. Placenta and umbilical cord blood bank are one and the same thing.