Cords that bind: Umbilical transplantation and transnationalism
Sarah Ping Nie Jones’s new film Umbilical Cords explores the fraught transnational relationships between six women–three mother-daughter pairs. They criss-cross all over the globe, but their stories all intersect in South Africa.
The title alludes to the cord that biologically links us to our mothers, but also more broadly asks how we intertwine inextricably, how we might re-tie what is severed, and when there might be irrevocable breakage. Although the film doesn’t explicitly deal with transplantation, in its title, Umbilical Cords directly connects to our work here at TransplantInformers. Umbilical cord blood is a viable source of haematopoeitic (blood producing) stem cells that can be used for transplantation. They are stored or “banked” at time of birth and can be used up to 20 years after the initial donation.
Cord Blood: A primer
There are hopes to develop a public bank in South Africa. As the South African Bone Marrow Registry (SABMR) states:
A study is currently underway to determine the feasibility of establishing a public cord blood stem cell bank in South Africa. The study was commissioned by the Department of Health and is funded by the Medical Research Council. Professor Michael Pepper, University of Pretoria, is leading the project, which also has the support of the South African National Blood Service. The South African Bone Marrow Registry supports the establishment of a public cord blood stem cell bank in South Africa as a complementary service for patients requiring unrelated haematopoietic stem cell donors.
In South Africa there are currently only a couple of private cord blood banks. They field high demand yet are unregulated. Without regulations on stem cells in the country, there is the danger of commodification and highly unequal access. While the costs to found a public bank in South Africa are significant, as a 2010 op-ed in the South African Medical Journal points out:
The initial capital outlay, however, will be recovered in due time if the programme continues to expand and the cord blood units can be sold on a cost-recovery basis.
The authors also argue that
The voluntary donation of cord blood cells to public UCB banks, resembling blood donation practice, is an example of a social justice health model that encompasses ethical citizenship and altruism.
But until a public cord blood bank becomes a reality in South Africa the next best thing to do right now is to join the South African Bone Marrow Registry by signing up via the Sunflower Fund (call +27 (0)800 12 10 82), or your local registry. Bone marrow/haematopoietic stem cells and cord blood cells are used in a similar way, transplanted in order to treat patients with leukaemias, lymphomas and various blood disorders. The directors of the South African Bone Marrow Registry and Europdonor also assert the need to balance the advantages of establishing a public cord blood bank with crucial considerations about its feasibility.
Elsewhere, there are already efforts underway to increase cord blood donations and thereby diversify the range of genetic tissue types in banks. This widens the possibilities for patients seeking a stem cell transplant match, and there are far less donor risks as cord blood is more easily procured. In the United Kingdom, the ACLT, one of our regular contributors, is working to increase awareness around this. The NHS in the UK has made some exciting strides in building their public cord blood bank.
Umbilical Cords as biosocialities: Revised kinship, pregnant possibilities, and border crossings
Aside from the literal connection to Umbilical Cords, the thematic preoccupations of the film hold a significant bearing on concerns we also share in transplantation. Ruminations on both motherhood and transplantation inevitably compel us to consider how we are biosocially linked to one another. With the rise of new reproductive technologies (often facilitated by donors and surrogates) we must also revise notions of motherhood and kinship.
Some immunologists who research transplant compatibilities and the prevention of engraftment rejection, study pregnancy as an ideal model of immunological tolerance and actively exchange ideas with obstetrics and gynecology colleagues. A mother’s womb is hospitable to her child during pregnancy but after birth, there is not only a bodily estrangement, there is a immunological one; were a child’s adult stem cells transplanted to their mother there may be rejection, depending on immunogenetic inheritance. From a social and familial perspective, might we entertain how these biological occurrences are metaphors for other ways that we may drift apart or lose some tolerances between mother and child over time? Just as immunological research seeks to apply those processes of pregnancy to improve transplantation, we may also try to recover some semblance to maternal closeness we have lost.
While it is certainly true that cord blood transplants may happen internationally, couriers also facilitate international bone marrow and organ transplants. In a context of limited availability of donors, and rarity of some registered tissue types that determine transplant compatibilities, sometimes international transplants are the only viable option for patients who have access to those resources. Or, an available organ has the best recipient on the list in another country from the donor. Aside from the complicated issue of organ trafficking, many legitimate transplants cross international borders. Here we see the transnational negotiations of the social aspects of transplantation–from networks of international cooperation to how recipients and donors may biosocially link with one another across national, racial, familial and/or genetic boundaries. Likewise, Umbilical Cords actively interrogates staid notions of identity with regard to nationality, race, ethnicity, family.
Nor can we deny the connection between ethical issues surrounding parents who decide to have an additional child as a possible donor for an existing child. The circumstances of the Flynn v. Holder case is an obvious recent and highly visible example of the fatal repercussion that this sort of hope can generate. Or in the fictional universe, Jodi Picoult’s My Sister’s Keeper is the most notable instance. These scenarios lay bare some daring choices that compel us to step into the journey of motherhood. In a similar vein, the journeys the mothers and daughters make in the stories of Umbilical cords, sometimes together, sometimes apart, reveal that the ways we relate to one another are highly contingent, but also incredibly profound.
See Umbilical Cords during the Encounters South African International Documentary Festival:
V&A Nu Metro, Fri 8 June 6.45pm with Q&A
Fugard Theatre, Thu 14 June 6.30pm
V&A Nu Metro, Sun 24 June 8pm
Hyde Park Nu Metro, Mon 11 June 6.30pm
Bioscope, Sat 23 June 6pm
Buy tickets at the Encounters website