capstone project
TRANSCRIPT
INDEX
Sr. No. Table of contents Page no.
PART 1
1.1 Introduction
1.2 Objective of study
1.3 Need of project
1.4 Scope of project
1.5 Research Methodology
1.6 Limitation of project
PART 2 2.1 Company profile
2.2 Organization Chart
2.3 Benefits given by company
PART 3
3.1 Theoretical aspect of field research
3.2 Data analysis and Interpretation
3.3 Findings
3.4 Suggestions and Recommendation
3.5 Bibliography
3.6 Annexure
PART 1: INTRODUCTION
The size of the Indian biotechnology industry is estimated at $1.3 billion. It is expected to increase to $3.5 billion by the year 2008-09. These figures include several segments of the industry bio-healthcare, bio-agriculture, bio-industrial, bio-informatics, and contract and clinical research markets.
In line with the global markets the Indian market for recombinant products is showing considerable growth. The Department of Biotechnology (DBT) has estimated the Indian market for recombinant therapeutics products at $90 million, which is growing at a rate of 30 percent per annum.
Stem cell preservation is a huge business opportunity in the international market and as per estimates the global stem cell market is expected to become USD 10bn opportunity over next 10 years. Due to high birth rates, India presents lucrative opportunity for stem cell banking business. With 43 million births a year, the Country is poised to become the largest supplier of umbilical cord blood in the world. Leading cell banking companies are keenly eying the Country’s potential and are contemplating to enter Indian market preferably via joint venture with a local firm.
Further, India offers unmatched advantages in terms of land and manpower cost competitiveness, availability of technical workforce with high skill sets and regulated market. The Country has all the essential ingredients to emerge as a key repository of cord blood for companies across the globe. Leveraging the well developed logistics infrastructure, leading companies can create huge storage capacities for their global and Asia pacific operations in India.
With rapid economic growth, widening base of high income group couples, the Country has huge target population that could be enticed towards the benefits of cord blood storage. Estimated cost of cord blood storage cost around USD 1,500 to USD 2200 for a 20 year period and India has huge customer base which could afford this.
Presently, lack of awareness and highly technical nature of the process is the key reason for a small customer base in the Country. However, the market has tremendous potential that could be tapped by initiating an awareness campaign and a customized marketing plan. The main objective of this project was to develop market of stem cell banking for Cryobanks Int. Ltd. In Nasik
OBJECTIVE OF STUDY
To check the awareness of expected mothers regarding cord blood banking.
To study Cryobanks International as a case.
To analyze the proportion of the doctors for acceptance of the concept
NEED OF PROJECT
To identify the areas not yet served by the company.
To analyze the awareness and acceptance of the concept by the patients.
To locate the potential customers to be targeted by the company.
To analyze the extent of the competition.
To analyze the role of price factor in a stem cell Banking business.
To identify the potential doctors to be targeted by the company.
To make marketing strategies for Cryobanks Int. in Nasik on the basis of competitor
analysis.
SCOPE OF PROJECT
To provide market exposure to stem cell banking.
To work for emerging biotech industry.
RESEARCH METHODOLOGY
MARKETING STRATEGY
“A marketing strategy is a process that can allow an organization to concentrate its limited resources on the greatest opportunities to increase sales and achieve a sustainable competitive advantage. A marketing strategy should be centered on the key concept that customer satisfaction is the main goal.”
A marketing strategy is most effective when it is an integral component of corporate strategy,
defining how the organization will successfully engage customers, prospects, and competitors in
the market arena. Corporate strategies, corporate missions, and corporate goals. As the customer
constitutes the source of a company's revenue, marketing strategy is closely linked with sales. A
key component of marketing strategy is often to keep marketing in line with a company's
overarching mission statement.
A marketing strategy can serve as the foundation of a marketing plan. A marketing plan contains a
set of specific actions required to successfully implement a marketing strategy.
A strategy consists of a well thought out series of tactics to make a marketing plan more effective.
Marketing strategies serve as the fundamental underpinning of marketing plans designed to fill
market needs and reach marketing objectives. Plans and objectives are generally tested for
measurable results.
A marketing strategy often integrates an organization's marketing goals, policies, and action
sequences (tactics) into a cohesive whole. Similarly, the various strands of the strategy, which
might include advertising, channel marketing, internet marketing, promotion and public relations,
can be orchestrated. Many companies cascade a strategy throughout an organization, by creating
strategy tactics that then become strategy goals for the next level or group. Each one group is
expected to take that strategy goal and develop a set of tactics to achieve that goal. This is why it
is important to make each strategy goal measurable.
Marketing strategies are dynamic and interactive. They are partially planned and partially
unplanned.
TYPES OF STRATEGIES :
Marketing strategies may differ depending on the unique situation of the individual business.
However there are a number of ways of categorizing some generic strategies. A brief description
of the most common categorizing schemes is presented below:
Strategies based on market dominance –
In this scheme, firms are classified based on their market share or dominance of an
industry. Typically there are three types of market dominance strategies:
o Leader
o Challenger
o Follower
Porter generic strategies -
strategy on the dimensions of strategic scope and strategic strength. Strategic scope
refers to the market penetration while strategic strength refers to the firm’s sustainable
competitive advantage.
o Product differentiation
o Market segmentation
Innovation strategies -
This deals with the firm's rate of the new product development and business model
innovation. It asks whether the company is on the cutting edge of technology and
business innovation. There are three types:
o Pioneers
o Close followers
o Late followers
Growth strategies - In this
scheme we ask the question, “How should the firm grow?”. There are a number of
different ways of answering that question, but the most common gives four answers:
o Horizontal integration
o Vertical integration
o Diversification
o Intensification
Marketing strategy implied by CRYOBANKS INT LTD.
Company follows two types of Marketing Strategies -
Direct Marketing Strategy Indirect Marketing Strategy
1) Direct Marketing Strategy :
OPD Interactions
Calls / mails
Appointments
Follow up
Newspapers/ TV ads
Patients/ Relatives
Doctors
Cryobanks Int. Ltd
2) Ind irect Marketing Strategy :
SALES STRATEGY
Is it an art or a science? In business, that question is frequently, and fittingly, asked of Sales and
Marketing. Good marketing and sales people know how to work the “magic” that creates good
leads and closes sales. If you ask them how they do it, however, they may not be able to explain
it. Many sales and marketing veterans operate through an intuitive feel they have created through
observation and experience, but it is not something they can easily define or describe.
Sales & Marketing Procedures and Tactics - Introduction
This section provides an introduction and overview of the basic concepts of Sales and Marketing.
The Sales and Marketing field is broad, complex, and dynamic, so no document can claim to be
absolute in capturing every possible issue, policy, or procedure and remain current. The concepts
discussed in this manual cover the common, basic elements of a Sales and Marketing System.
Sales & Marketing Introduction -
Who Needs Sales & Marketing Policies and Procedures?
Sales & Marketing – A Business Process
A Disciplined Approach to Sales and Marketing
A Historical Perspective
The Past
The Present
The Future
Connecting the Sales and Marketing Pipeline
Making the Connection
The Importance of Process Feedback
Understanding the Sales Cycle
Using Benchmarks and Measurements
Achieve Continual Improvement
OPD Interactions Appointments
Face to faceMeet Follow ups
Recognizing the Subjective Side
Sales & Marketing Procedures
Marketing Planning and Tactics
Sales
Sales & Marketing Administration
Product Management
Sales strategy implied by CRYOBANKS INT. LTD.
FIELD RESEARCH:
Field research/primary market research has traditional been thought different from methods of
research conducted in a laboratory or academic setting. It was developed originally from
anthropology and is sometimes know as participant research, or as ethnography in anthropology. It
has been adapted to the business world as well as some of this article points out.
It is less technically known as field work, a term originating in farm and plantation labor, and a
term sometimes used to refer to the temporary fortifications constructed prior to battle.
Participant observation, data collection, and survey research are examples of field research, in
contrast to what is often called experimental or lab research.
Steps involved in marketing research:
1. Problem definition: Market awareness of stem cell banking
2. Developing an approach to problem: articles, advertisements, questionnaire, conferences
& market survey.
3. Cost-benefit worthiness of the research study:
4. Research design formulation: By the use of secondary source of information.
5. Fieldwork or data collection: by interview, phone, direct meeting, mails
6. Data preparation and analysis: editing, transcription, verification of data
7. Report preparation and presentation: to the company as well as in college
PRACTICAL APPROACH TO THEORY :
Objective:
Market development of stem cell banking in Nasik
Awareness about stem cell banking in common people as well as in doctors
Find out market potential of Nasik as compare to metro cities
Maintaining database for company
Research approach: Survey Research
We did analysis of stem cell banking in Nasik by market survey through face to face met with various Big shot gynecologists & obstetrician from different places of Nasik.
Collection of data:
- From Internet – mails, websites
- From Previous Database of company
- From face to face meet at different hospitals during OPD
- From face to face meet with Gyn/Obs. at different Hospitals
- By giving corporate presentations at various seminars, functions etc.
- Data Collected from various Data base as follow:
Research instruments:
Questionnaire
Feedback forms
LIMITATION OF PROJECT
Commercial cell banks are charging high prices to store stem cells for therapeutic applications
that may never be realized
One of the biggest limitations for private storage for many families today is the cost.
Enrollment and collection fees run from $600 to as much as $2,000 with yearly storage fees of
about $100 per year.
Most cord blood storage companies do not tell prospective customers that the cord blood
drawn from a newborn often cannot be used to treat illnesses for the same child. Some doctors
say that in the cases of genetic diseases such as sickle cell anemia or even for other non-genetic
diseases like cancer, the disease is present in the blood and cannot be used for the child it was
meant to treat.
Another possible limitation is that the amount of cord blood drawn may only be enough to treat
another child. My only personal experience was with a former client who was planning to have
her baby's cord blood saved since her mother-in-law had just been diagnosed with leukemia.
They were told by the cord blood company that the amount of stem cells drawn from the
umbilical cord blood would be insufficient to treat an adult.
Legal implications of parental requests to take cord blood
The point at which the fetus becomes a person legally is when it emerges fully from the
mother's body. Until that moment, the doctor is bound to respect the autonomy of the mother
and she has an unfettered right to consent to everything that is done to her body.
PART 2:
COMPANY PROFILE
Cryobanks International India a JV between Cryobanks International USA and RJ Corp founded in 2006. Cryobanks International USA is a leader in the stem cell banking. Under the able guidance of Dr. Naresh Trehan, one of the country's best-known cardiac surgeons, this joint venture has set up the first modern, state-of-the-art cord blood stem cell bank in North India at Gurgaon. It aims to become one of the largest cord blood stem cell bank and a highly specialized training centre in the field of cord blood banking.
Cryobanks India will have special focus on research of stem cell therapies as a potential treatment for cardiac diseases and diabetes.
Cryobanks India has set up 28,000 square feet, state-of-the-art stem cell processing and banking facility in Gurgaon Haryana. Cryobanks India with an initial investment of 25 crore has stored more than 1000 stem cells in one year of operations. The company is working towards national and international collaborations to provide the “best of class” facilities in stem cell industry in India. Cryobanks India follows the “Closed bag” collection method for harvesting cord blood stem cells which greatly reduces the possibility of contamination of cord blood. The company provides a facility of collection from all major cities in India. Cryobanks has a team of medical professionals who have been extensively trained, certified and educated in cord blood processing and Quality Assurance processes at Cryobanks International, Inc., U.S.A.
About RJ Group
The RJ Corp is Rs. 3000 crore diversified conglomerate with interests in Beverages, Fast Foods, Dairy products, Retail, Real Estate, Housing, and Healthcare & Education, in India and overseas. Started in 1991, the RJ Corp is headed by Mr. R. K. Jaipuria. The Group's vision - to excel in everything we touch and handle - is visible in their many charitable and pioneering initiatives, The RJ Corp has a tie-up with Pepsi Foods Limited to manufacture and market Pepsi brand of beverages in geographically pre-defined territories. It is a successful franchisee/joint venture partner for brands such as Pizza Hut, Kentucky Fried Chicken, Costa Coffee, and Disney Artist, amongst others. It has real estate interests in Gurgaon and Agra where developed Park View City and Sunrise Greens, respectively. It is diversified into education by opening its Schools in Gurgaon and Jaipur under the management of Delhi Public School Society. Recently the group has entered into a long-term joint venture agreement with InBev (Euronext: INB) to start operation in Indian beer market.
Vision
“To excel in everything we touch and handle” is visible in their many charitable and pioneering initiatives, under the supervision of Mrs. Dhara Jaipuria. All to meet the genuine needs of the community and society
Objective
To be the largest inventory holder of cord blood stem cells in India for both family storage & public donation Have a total of seven cord blood banks all over India to have stem cell inventory, covering maximum ethnicities in India. Be part of stem cell research initiative of India by becoming major source of all types of stem cells to various research institutions with in the country
People Behind
Mr. Ravi Kant Jaipuria Mrs. Dhara Jaipuria Dr Naresh Trehan
Dr. C.V.Nerikar Dr Mrinalini Chaturvedi
Area’s of Operations
Cryobanks India operates/offers the service in:
Pan India Sri Lanka Bangladesh Nepal UAE
ABOUT CRYOBANKS INTERNATIONAL, INC.:
Founded in 1993, Cryobanks International, Inc., a pioneer in the collection, isolation, and storage technologies for cord blood stem cells, is located in Altamonte Springs, Florida, a suburb of Orlando. Cryobanks International, initially formed as a semen bank and a clinical and andrology laboratory, expanded its scope of business into the field of cord blood banking in mid-1995. The company is focused on providing high-quality umbilical cord blood stem cell processing and storage for both private family use and public donation purposes.
Company Mission
To become the largest provider of cord blood stem cells for transplant and research purposes in the world.
CRYOBANKS INTERNATIONAL INDIA PVT.LTD.
Gurgaon Office: 129, Pace City-I, Sector-37,Gurgaon
Toll Free: 1-800-102-2796 (AirTel Only)
Telephone: 91-124-4265030-34
Mumbai Office: Ground Floor,Bhima Building,
Sir Pochkhanwala Road,
Worli, Mumbai-400030
Telephone: 91-22-32649398
Website: www.cryobanksindia.com
E-mail : [email protected]
ORGANIZATION CHART
R. J Group
CRYOBANKS INT. (I) LTD.
R K Jaipuriya
Dhara Jaipuriya
CEO (Dr. Nerikar)
Marketing(Mr. A. Mehra)
HR(Mr. Sumit)
Finance(Mr. S Sharma)
Zonal Head
RSM
ASM
Regional Exe.
Sr. Relationship Exe.
Relationship Exe.
BENEFITS GIVEN BY COMPANY
This world-class facility provides complete, in house processing and storage technology,
licensed by Cryobanks International, Inc., USA
“Closed Bag” collection method for harvesting Cord Blood Stem Cells immensely reduces the
possibility of contamination of cord blood.
National Coverage- Facility of collection is being provided from all major cities/ towns in India.
Our team of medical professionals have been extensively trained, certified and educated in
Cord Blood processing and Quality Assurance at Cryobanks International., USA.
All equipments is backed by 24 hr UPS and Generations, in case of power failure.
Flexible payment plans that makes Stem Cells banking the birth right of every one.
The facility is equipped with a Central Monitoring systems 24 X 7 to ensure a controlled
environment as required for Current Good manufacturing Practices and Current Good
Laboratory Practices.
THEORETICAL ASPECT OF FIELD RESEARCH
PRODUCT PROFILE
INTRODUCTION
What is Cord blood?
Umbilical Cord Blood Banking
Umbilical Cord Blood Collection
Cord Blood Transplantation
Ethical Issues
Treatable Diseases
Cord Blood Banking in India –the road ahead…
Introduction to SAPLAP Framework
Market Potential and Demand Dynamics
Since 1988 it has been shown that the haematopoietic stem cells present in the blood of the umbilical cord can be used for allogeneic transplantation in a number of genetic diseases, blood malignancies and immune deficiencies, for example leukemia. After transplantation, the haematopoietic stem cells can repopulate the bone marrow of the patient, providing a source of blood cells. It currently constitutes an increasingly used alternative to bone marrow transplantation.
In order to have cord blood cells available for transplantation a number of banks were created worldwide. These banks are run by either hospitals or non-profit organizations that collect the samples from donors and provide them when the cells are needed for transplantation.
Recently, private firms have been offering to future parents the conservation of blood from the umbilical cord of newborn children for one’s own use or for the use of close relatives. Different types of cord blood banks can be distinguished: private or public, for-profit or non-profit.
In this opinion, the Group considered: 1. public (non-profit) banks that store cord blood cells from donors and provide them when transplantation is prescribed to an unrelated patient and
2.Private banks that offer a commercial service to parents in order to preserve the cells to be used for their child or children in the future.
Definitions
a) cord blood : residual placental blood collected from the cord of the newborn;
b) stem cells : cells that can both replicate and also differentiate into several types of cells .
c) progenitor stem cells : cells whose terminal progeny consist of a single cell type only .
d) haematopoietic stem cells: those cells that give rise to cells present in blood ;
e) pluripotent : capable of giving rise to all cell types in the body ;
f) HLA (Human Leukocytic Antigen) types : are determined by proteins present on the surface of leukocytes that allow the cells from the individual to be recognized. Identical or similar HLA types are necessary for successful transplantation.
g) autologous transplantation : refers to the transplantation to a patient of his/her own cells ;
h) allogeneic transplantation : refers to the transplantation of cells from a donor to another person.
What is cord blood?
Cord blood is the baby’s blood that remains in the placenta and cord after birth. After the baby is born, the blood in the placenta and cord is no longer needed and is usually disposed of carefully.
Cord blood contains many different types of cells including very small numbers of a particular type of cell, known as stem cells. These cells are the building blocks of all the other cells in the body. Different parts of the body are made up of different types of cells: the heart is made up of heart cells, the liver is made up of liver cells, and blood is made up of blood cells, and so on. Stem cells can grow into these different kinds of cells in the body.
Characteristics of cord blood
Umbilical cord blood was found to be rich not only in normal blood cells but also in haematopoietic stem cells. These stem cells are found only in insignificant numbers in normal adult peripheral blood. After transplantation, the haematopoietic stem cells can repopulate the bone marrow of the patient, providing a source of blood cells.
An important characteristic of cord blood cells is their immunological immaturity. Therefore, haematopoietic stem cells from cord blood are less likely to induce immunological reactions when transplanted than haematopoietic stem cells from bone marrow. Furthermore, in laboratory experiments it has been shown that cord blood stem cells can differentiate into a number of different cell types, which could give rise to future potential new therapeutic uses.
Umbilical Cord Blood Banking
Constantly growing attempts are being made to spread awareness of the phenomenon of umbilical blood (stem cell) banking that has, to put it very mildly, created a sensation in the scientific community. There is no doubt that we are on the edge of a major stem cell breakthrough and that these cells which were earlier predicted to provide effective low cost treatment for diabetes, some form of blindness, heart attack, stroke, spinal cord damage, and many other health problems are finally on their way to achieving their potential. Research being carried out on stem cells for the past few years, has been aimed at their use in the repair of injuries to the heart muscle, restoring of dopaminergic neurons in patients with Parkinson’s disease, and reduction or eradication of the clinical symptoms thereby. These cells are being used to try and improve the outcome of cancer patients, to improve learning and memory functions in patients with cognitive disorders and Alzheimer’s disease, and for improving visual acuity by repairing damaged retina. There has been a completely new wave of research trials involving umbilical stem cell research that has swept through the nation.
In India, there are approximately 72000 births daily, which results in discarding 72000 umbilical cords a day. The storage of stem cell rich blood derived from these umbilical cords can prove to be the best possible insurance against life threatening diseases. In brief, the procedure of the umbilical cord blood banking, involves the cutting and clamping of the umbilical cord. A specialized blood bag is then bar-coded for collection of cord blood. For the collection step, the needle of the blood bag is inserted into the umbilical vein and the bag is held at a lower level in order to allow the blood to drain into the bag. Stem cells are then harvested from the cord blood and stored in cryo-vials at -1960 C in liquid nitrogen. Molecular tests are conducted for tissue (HLA) typing. The first treatment using umbilical cells derived from cord blood was that of Fanconi’s anemia by Dr. Elaine Gluckmen in 1998, in Paris. Umbilical cord research was initiated at the Cancer Research Institute, Tata Memorial Center, Mumbai in 1990 with National Center
for cell Science, Pune as the co-investigator. The research shows that cord blood derived stem cells were comparable to bone marrow in terms of number and quality. The technology of umbilical cord blood collection, enrichment of stem cells, and their cryopreservation was transferd to Armed Forced Medical Collage, Pune and the Tata Memorial Hospital in Mumbai. However, these institutions did not get any support from government of India to set up a stem cell bank. The first private cord stem cell bank was established in 2002. The Ministry of Health has approved a Grant of Rs 5 crores to upgrade its stem cell research at the Mumbai based Natioal Institute for Research in Reproductive Health under the Indian Council of Medical Research (ICMR).
The Ministry of Health is working on a memorandum of understanding with California based private Korean research company Histostem that wants to setup four umbilical cord blood banks in India as part of what it believes to be the largest umbilical cord blood banking in the world. Histostem claims to have initiated clinical trials for stem cell therapeutic application in the area of strokes, liver cirrhosis, diabetes, Berger’s disease, osteoporosis, spinal cord injuries, hypertension, and vascular necrosis. The company said that they would be obliged to only conduct research while its application would be carried out at the two leading institutes–All India institute of Medical Sciences, Delhi and Post Graduate Institute at Chandigarh. Histostem and Apollo Hospitals have also agreed to setup a Histostem Cell Therapy Center for which the Apollo Hospital will provide the cord blood from the births at the hospital. New private cord blood banks are being establised all over India in an attempt to use their knowledge, research and storage facility to benefit the Indian pollution. What seemed like a dream few years back is now becoming reality.
The use of umbilical stem cells for therapeutic purposes can ensure lower treatment costs and longer lives. Some may say the cost of umbilical cord blood storage which is approximately Rs 35,000 for 21 years in a considerable amount, but comparing it with the benefits of the child’s and ones own future will help one put things in perspective.
Public vs. Private Cord Blood Banking
Researchers now urge parents to store or donate the Umbilical Cord Blood to specialized “Cord Blood Banks”. These can be either public or private institutions.
Private Cord Blood Banks
This system is run by individuals or private organizations. The organization will store the Cord Blood irrespective of medical reasons. There are charges for collection and storage. The arguments against private cord blood banking are –
1. If the child has inherited blood disease, the Cord Blood would be affected too. It would be useless to have it stored in that case.
2. Doctors also prefer, in cases of children with leukemia, to have the Cord Blood of a healthy donor.
3. Private banking does not allow for choosing from an array of donors. It can only hold an individual’s Cord Blood for their personal or immediate family’s needs.
The advantage of this system is that blood from a healthy child with no inherited diseases can be maintained as insurance, in case a family member or the child itself should need it in the future.
Public Cord Blood Banks
This system is usually government run. There are generally no charges for collection and storage. Parents are encouraged to donate Cord Blood to Public Banks. The reasons are –
1. The chances of needing the Cord Blood are rare for a child in a family without history of disease.
2. By donating the Cord Blood, parents contribute to an already growing reserve. This way, another person from anywhere in the world may find a match in the donated blood.
3. Often, a person may not find a match among relatives for a marrow transplant. With a stem cell transplant being a viable option, a Public Cord
4. Blood Bank would ensure a chance for the most appropriate cord blood unit even from several unrelated donors.
The disadvantage of this system is that it is not always guaranteed that the donor will receive Cord Blood should he or she need it. It may have been donated. However, matches may be found from among many other donated samples. The match referred to is required between the donor’s and recipient’s HLA antigens. The closer the match is, the better is the body’s chance of accepting the new stem cell. The first ever Cord Blood Bank in the world was started in New York’s Milstein National Cord Blood Center. It is a Public Cord Blood Bank.
Cord blood banks can be primarily divided into public and private banks. While public banks accept eligible donations to be used for anyone in need; private banks allow families to preserve their blood for their own use for a fee ($800-$2000). The basic differences between a public and a private cord blood bank have been enumerated in Table.
Table: Types of cord blood banks
Public banks Private banks
Use not restricted. For use of the family
No remuneration collected Facility paid for by the family
Usage subject to availability Availability guaranteed
The medical community strongly supports public cord blood banking as it widens the compass of beneficiaries from medical advances. However, since the estimated probability of a need for cord blood stem cells within a family is 1/1500, private cord blood banking is generally not recommended. Globally, out of 100 cord blood stem cell banks, 75 are public banks.
Advantages of Umbilical Cord Blood cells
Studies suggest that stem cells from cord blood offer some important advantages over those retrieved from bone marrow. For one thing, stem cells from cord blood are much easier to get because they are readily obtained from the placenta at the time of delivery. Harvesting stem cells from bone marrow requires a surgical procedure, usually under general anesthesia, that can cause post-operative pain and poses a small risk to the donor.
A broader range of recipients may benefit from cord blood stem cells. These can be stored and transplanted back into the donor, to a family member or to an unrelated recipient. For a bone marrow transplant to succeed there must be a nearly perfect match of certain tissue proteins between the donor and the recipient. When stem cells from cord blood are used, the donor cells appear more likely to “take” or engraft, even when there are partial tissue mismatches.
A potentially fatal complication called graft versus host disease (GVHD), in which donor cells can attack the recipient’s tissues, appears to occur less frequently with cord blood than with bone marrow. This may be because cord blood has a muted immune system and certain cells, usually active in an immune reaction, are not yet educated to attack the recipient. A 2000 study found that children who received a cord blood transplant from a closely matched sibling were 59 percent less likely to develop GVHD than children who received a bone marrow transplant from a closely matched sibling.
The use of cord blood may make blood stem cell transplants available more quickly for people who need them. About 30,000 individuals each year are diagnosed with conditions that could be treated with a bone marrow transplant. Approximately 25 percent of these individuals have a relative who is an appropriate tissue match. While suitable donors can be located for many through national bone marrow registries, the process can take months. Donors can be located within 4 months for about 50 percent of patients. It often is more difficult to find a bone marrow match for members of non-white ethnic and racial groups; transplants from cord blood may make timely treatment available for more of these individuals. Banked stem cells from cord blood can be more readily available, and this can be especially crucial for patients with severe cases of leukemia, anemia or immune deficiency who would, otherwise, die before a match can be found.
Cord blood also is less likely to contain certain infectious agents, like some viruses, that can pose a risk to transplant recipients.
In addition, some studies suggest that cord blood may have a greater ability to generate new blood cells than bone marrow. Ounce for ounce, there are nearly 10 times as many blood-producing cells in cord blood. This fact suggests that a smaller number of cord blood cells are needed for a successful transplantation.
In addition, cord blood stem cells offer some exciting possibilities for gene therapy for certain genetic diseases, especially those involving the immune system. Donald Kohn, MD, and colleagues at the Children’s Hospital of the University of Southern California in Los Angeles and the University of California in San Francisco, made the first attempt at gene therapy with cord blood in 1993 in three children suffering from adenosine deaminase (ADA) deficiency, a potentially fatal defect that cripples the immune system. The children, who also receive additional drug treatment, appear healthy to date, even though their blood now carries only a small amount of the gene introduced into their stem cells.
UMBILICAL CORD BLOOD COLLECTION
In summary, while available evidence regarding the optimal method for cord blood collection is inconclusive, in utero collection may increase the yield of cord blood unit volume and nucleated cell count. From the perspective of perinatal care providers, cord blood collection before placental delivery appears to offer advantages in terms of time, space, and staffing requirements. The potential risks to mother and newborn, time demands on the obstetrical team, and possible requirements for modification of normal delivery routines associated with cord blood collection need to be clarified. In addition, the liability of care providers, should the cord blood unit be inadequate, contaminated, or mislabelled, should be assessed. In order to optimize cord blood retrieval without compromising perinatal care, standardized cord blood collection, labelling, and shipping instructions must be provided to obstetricians, family practitioners, midwives, and birth unit staff.
Banking Issue
Storage
Cord blood is cryopreserved in the liquid phase of liquid nitrogen using the techniques described by Rubinstein et al. With current technology, it remains uncertain how long umbilical cord blood will remain viable after cryopreservation. Published data by Broxmeyer et al. suggest that cord blood can be stored frozen for 10 to 15 years with highly efficient recovery of viable and functional stem cells needed for successful transplantation. Most cord blood units that have been used clinically have been cryopreserved for 6 years or less. Final proof of the engrafting capability of cord blood stored for long periods of time must await clinical results demonstrating long-term successful engraftment. Cord blood banks use a variety of processing and storage techniques, with each option offering advantages and disadvantages.
When UCB is received at a processing facility, the unit and accompanying paperwork are
inspected and reviewed. The product is then reduced of the red cell and/or plasma components in
preparation for cryopreservation (freezing). Procedures and methods for this part of the process
vary. It is very important for facilities to validate the procedures used. Validation provides data to
demonstrate the procedure works consistently and effectively at each facility. Generally, there are
three processing methods utilized in the field. Some programs use a density gradient solution to
separate the different cell layers based on the principle of gravity. Though this method results in
overall cell loss, it results in a more pure population of the layer that includes the stem cells - the
mononuclear cell population of the white blood cells - and contains only a few red blood cells.
Another widely employed method uses a starch solution to facilitate the depletion of red blood
cells. These procedures are performed because the red blood cells do not contribute any therapeutic
benefit in a transplant and lyses, or rupture, upon thawing and are generally not desirable for the
patient to receive. Other processing facilities reduce the volume of the product by depleting the
liquid portion or plasma. Both processes result in a smaller volume for freezing while still
recovering the stem cells. The process of plasma depletion minimizes stem cell loss but results in a
larger volume for cryopreservation and storage and contains more red blood cells. Red blood cells
are lysed during cryopreservation, and subsequent thawing and the cell particles and their contents
remain in the product for infusion. A freezing solution, usually containing dimethyl sulfoxide
(DMSO), is added to the product, which is then frozen at a controlled rate to slowly freeze the cells
without damaging them. DMSO is a cryoprotectant that helps protect the cells during this process
and when stored at cold temperatures.
The product is then cooled before placing into the storage freezer to avoid the shock and
subsequent damage of immediate transfer into liquid nitrogen. Cooling at a controlled rate had
been shown to result in better viability (more live cells) when thawed. Controlled rate freezing
involves the use of equipment, including a computer, to freeze cells at an ideal, set rate for the
cooling process. Alternative methods may be used for freezing that do not include a controlled rate
freezer. In these cases, facilities should have validated their procedure to demonstrate the
procedure results in a viable product upon thawing. In general, methods used in clinical
laboratories involve bringing the cells to -80 C or colder prior to transfer into a storage tank. The
storage tank contains racks or boxes into which the labeled, frozen product is placed. Nitrogen in
its liquid state is at -196 C (-320 F) and is used to keep the product frozen. The cord blood storage
facility should have a system to monitor the temperature and to alert staff in the event of a failure
so that products may be transferred to another tank if necessary.
When a patient is identified for transplant, the selected product is shipped to the transplant facility and eventually thawed for infusion into the patient. Some transplant centers wash UCB products and others do not. Washing removes the lysed red blood cells but also results in some overall cell loss in the product. The lysed red blood cells may or may not have an adverse effect on the patient, and the decision whether to wash or not may be based on the processing facility’s recommendations, the patient age and condition, and transplant center’s practices.
Cord Blood Transplantation
The transplantation of hematopoietic stem cells (HSC) is commonly used to treat malignant and nonmalignant disorders, such as acute and chronic leukemias, lymphomas, solid tumours, immune deficiencies, inborn errors of metabolism, and genetic diseases.1 Stem cells may be obtained from the patient (autologous) or from related or unrelated (allogeneic) donors. Although bone marrow or peripheral stem cell transplantation from a human leukocyte antigen (HLA)-matched sibling is preferred, only 25% of patients will have an HLA-matched sibling available. Alternative sources of stem cells include bone marrow and peripheral blood progenitor cells from unrelated donors and umbilical cord blood (UCB). Umbilical cord blood is an excellent source of highly proliferative stem cells capable of completely reconstituting the hematopoietic system.2 Practical advantages of cord1 blood include a lower risk and severity of graft-versus-host disease (GVHD) in HLA-matched and -unmatched recipients, ease of collection without discomfort or risk to the donor, and prompt availability as a frozen graft.
With growing experience and encouraging results over the past decade, cord blood banks have been established globally to supply hematopoietic stem cells from related and unrelated donors. The worldwide inventory of more than 145 000 cord blood donations has provided transplants to more than 3000 recipients, mainly in unrelated pediatric patients for hematologic conditions. In addition, an ever increasing number of private cord blood banks encourage women to store umbilical cord blood for potential future use by their children or themselves. Increasing public, media, and commercial interest in cord blood banking has resulted in an increased demand for information, counseling, and cord blood collection from Canadian childbearing women.
A recent Canadian survey of pregnant women revealed that 70% of 443 women interviewed felt that their knowledge of cord blood banking was poor to very poor. Most respondents (68%) wanted to receive information about umbilical cord blood transplantation from their prenatal care provider or at prenatal classes. Given the growing demand for information and services related to cord blood banking, it is imperative that perinatal care providers keep abreast of the scientific, clinical, and ethical implications of UCB banking. The quality of evidence and classification of recommendations have been adapted from the Report of the Canadian Task Force on the Periodic Health Exam.
Clinical Evidences
HLA-matched bone marrow transplantation from related and unrelated donors is an accepted treatment for conditions requiring bone marrow reconstitution. Only 25% of patients requiring hematopoietic stem cell transplantation have an HLA identical sibling. Although 76% of preliminary allogeneic searches yield a prospective donor, the time from initiating a search to transplantation is generally 4 months or more. Transplantation of HLA-mismatched bone marrow stem cells is associated with significantly reduced engraftment rates, severe graft-versus-host disease, increased infectious morbidity, and decreased survival.
For patients without an HLA-identical sibling or matched unrelated donors, umbilical cord blood provides an attractive alternative. Umbilical cord blood has been used clinically for transplantation therapy in children and adults with a wide variety of malignant and nonmalignant diseases. Most of the published series are compilations of transplant results from numerous institutions where procedural methods, including preparative regimens and graft-versus-host disease prophylaxis schedules, were inconsistent. Although these reports have yielded important preliminary information, available evidence is retrospective, uncontrolled, and anecdotal.
Clinical Properties of Cord Blood Stem Cells
Preclinical in vitro studies demonstrated the proliferative superiority of primitive cord blood hematopoietic cells, compared with the bone marrow. The high proliferative capacity of bone marrow repopulating cells in umbilical cord blood has been confirmed in clinical transplants. A 100 mL unit of cord blood contains one-tenth the number of nucleated and progenitor cells present in 1000 mL of marrow, but because they proliferate rapidly, the stem cells in a single unit of umbilical cord blood can reconstitute the entire hematopoietic system. The likelihood of acute
and chronic graft-versus-host disease with umbilical cord blood transplants is significantly reduced, compared with bone marrow transplants. This phenomenon is believed to be secondary to the decreased number and alloreactivity of umbilical blood lymphocytes, particularly T cells. As a result, there is increased likelihood of successful engraftment of cord blood transplants, despite HLA mismatches at 1 or more loci. For recipients with leukemia, the decreased immunoreactivity of umbilical cord blood stem cells may result in reduced graft-versus-leukemia effect, which may increase rates of disease relapse in UCB recipients. Factors which influence disease relapse in such patients include age of recipient, malignant risk group, and biology of disease.
The median time to neutrophil and platelet recovery after umbilical blood transplantation is longer than that expected after bone marrow or adult peripheral blood stem cell transplants. The delay in immune reconstitution following cord blood transplantation increases the risk of infection and transplant-related mortality and morbidity. Nevertheless, overall survival in pediatric cord blood transplant recipients is comparable with that observed following unrelated donor bone marrow transplants. The total nucleated cell count of the umbilical cord blood transplant relative to recipient size is the most important factor influencing successful engraftment and survival. Particularly poor results are seen with cord blood transplantation when the nucleated cell dose is less than 1.5 x 107/kg.The effect of HLA incompatibility on the success of cord blood transplantation is less clear, but some investigators have observed an association between the degree of HLA mismatch and the probability of engraftment and GVHD.
Limitations of Umbilical Cord Blood Transplantations
Despite the potential advantages, umbilical cord blood transplantation has a number of potential limitations. The quantity and quality of a single umbilical cord blood unit may not be sufficient to engraft larger children and adults reliably. The optimal volume required for safe and successful umbilical cord blood transplantation is unknown. This is a major limiting factor to more widespread use of cord blood, particularly in adults. The limited hematopoietic cell dose in individual cord blood donations has emerged as the most significant disadvantage of umbilical cord blood as a source of hematopoietic stem cells for clinical transplantation. There is also the potential for transfer of genetically abnormal cells. In addition, clinical results show that the frequency and rate of myeloid and platelet engraftment are slower than that observed with comparably matched bone marrow, leading to the possibility of increased rates of engraftment failure and transplant-related mortality. In contrast to bone marrow or peripheral blood progenitor cell transplantation, where it is possible to seek subsequent donations if needed, the unrelated cord blood donor cannot offer a second donation in the event of marrow failure or relapse of the disease. Finally, cord blood collection, storage, and transplantation raises numerous financial, ethical,and regulatory issues for health care providers and society.
Ethical Issue
There are many unresolved ethical issues related to the clinical and experimental
Use of umbilical cord blood. These issues include determination of ethical procedures for donor recruitment and informed consent for cord blood donation to public banks, to private banks, and for research. Legal and ethical issues related to privacy, confidentiality, and ownership of cord blood units is complex and controversial. Whether cord blood donor information should be linked to individual cord blood units and whether donors should be notified of infection or genetic abnormalities remains controversial. Finally, there is considerable debate regarding the ethics of commercial cord blood banking, particularly related to the availability of this potentially valuable resource for clinical use and research.
Donor Recruitment
Expectant parents want to do what’s best for their child and are therefore susceptible to promotion and advertising regarding the potential benefits of umbilical cord blood banking. Private banks market cord blood collection as “biological insurance” and suggest benefits of cord blood collection and storage that lack scientific support. Commercial banks use various media, including the Internet, direct mailings, and videotapes, which include dramatic, impassioned language describing cord blood transplantation outcomes as “lifesaving” or “miraculous.” Public cord blood banks encourage pregnant women to consider cord blood donation for altruistic motives. To ensure equitable recruitment, families and care providers must be provided with accurate, unbiased information about the potential benefits and risks of cord blood banking. Messages that provoke parental guilt for not choosing to bank cord blood should be discouraged, so that parents have autonomy in their decision making about cord blood banking. In addition, coercive strategies should not be employed to recruit cord blood donors from ethnic minorities.
Informed Consent
Since newborn infants cannot consent to the collection, testing, donation, and long-term storage of their cord blood, parents must make these decisions on their behalf. It is generally agreed that cord blood collected for transplantation is not waste material and that informed consent is required because of the sensitivity of medical information that must be obtained to ensure the safety of potential recipients. Prenatal, intrapartum, and after-collection consent policies and practices have been developed and implemented by cord blood banks and professional organizations to accommodate the diverse procedural, logistic, and financial
priorities of public and private cord bloodbanks. For mothers to give informed consent, they must be provided with information about the procedures that are followed for collection, processing, testing, storing, and use of the umbilical cord blood. They should know what measures will be taken to ensure that personal and medical information will be kept confidential. They must also be counselled about disclosure of abnormal test results and the importance of contacting the storage facility in the event their child develops a serious illness. If the cord blood is to be stored by a private bank, issues of ownership, dispositional authority, and cost should be clearly defined.
The consent process is difficult, if not impossible, to achieve during labour, when women are distracted by the physical and emotional stress of the intrapartum experience. Postponing the consent procedure until after cord blood collection improves efficiency and reduces recruitment costs, with no additional burden on perinatal care providers; however, umbilical cord blood is collected without the parents’ knowledge or explicit consent. The Working Group on Ethical Issues in Umbilical Cord Blood Banking and the American Academy of Pediatrics consider intrapartum and after-collection consent unethical and recommend that written informed consent be obtained during prenatal care, before the onset of labour, followed by confirmation of consent after delivery.
Privacy and Confidentiality
There is considerable debate as to whether public cord blood units should remain traceable to the donor. Advocates of maintaining linkage between cord blood units and infant donors point out that such linkage allows donors and recipients to be informed of positive test results and receive appropriate referral and treatment. It also allows donors and recipients to be informed of the results of new screening tests conducted at a later date. Linked donors may also provide informed consent for cord blood testing, which was not anticipated at the time of collection.
Unfortunately, the autonomy of linked donors may be compromised if personal and (or) medical information is disclosed to insurance companies, schools, or employers. There may also be serious repercussions related to identification of severe congenital diseases for which there is no cure, such as HIV infection. The donor’s identity should be protected from the recipient, since the recipient may wish to contact the donor for additional stem cells in the future. To avoid adverse consequences of linkage, donor privacy and the confidentiality of test results must be carefully protected.
Commercial Cord Blood Banking
Private companies view umbilical cord blood as a potential source of profit through storage fees and development of future therapies. Despite the lack of scientific evidence to support cord blood storage for autologous use, the number of private cord blood banks in Canada continues to grow, particularly in metropolitan Toronto and Vancouver, where new parents are susceptible to the marketing strategies of commercial banks. Directed cord blood donations for autologous or family member use are unavailable for public donation or research; this limits the supply of cord blood donations in Canada to the ACBB, which is inadequately funded to meet the cord blood transplantation needs of the population. Since hematopoietic stem cells from umbilical cord blood have greater potential as a collective asset than as an individual asset, eligible pregnant women should be encouraged to consider public cord blood donation by their prenatal care providers.
TREATABLE DISEASES
Cancers: Many cancers including: Acute and Chronic Myelogenous Leukemia, Acute Lymphoblastic Leukemia
Blood Disorders: Thalessemia, Sickle Cell Disease, Fanconi's Anemia
Immuno Deficiencies: Kostmann Syndrome, Omenn's Syndrome
Musculoskeletal Connective Tissue Disorders: Osteopetrosis
Metabolic/Storage Disorders: Hunter's Disease, Leukodystophies
Complete list of Treatable Diseases with Stem Cell Transplant
ACQ Idiopathic Siderblastic Anemia
Acute Biphenotypic Leukemia Acute Myelofibrosis Acute Myelofibrosis Acute Myelogenous Leukemia (AML) Acute Undifferentiated Leukemia Adrenoleukodystrophy Advanced Chronic Lymphocytic Leukemia (CLL)
Agnogenic Myeloid Metaplasia(myelofibrosis) Amegakaryocytosis / Congenital Thrombocytopenia Amegakaryocytic thrombocytopenia Aplastic Anemia (Severe) Ataxia-Telangiectasia Bare Lymphocyte Syndrome Beta Thalassemia Major Blackfan-Diamond anemia Breast Cancer Burkitt's Lymphoma Cartilage-Hair Hypoplasia Chediak-Higashi Syndrome Chronic Granulomatous Disease Chronic Myelogenous Leukemia (CML) Chronic Myelomonocytic Leukemia (CMML) Common Variable Immunodeficiency DiGeorge Syndrome Dyskeratosis congenital Essential Thrombocythemia Evans syndrome Ewing Sarcoma Familial Erythrophagocytic Lymphohistiocytosis Fanconi Anemia Gaucher's Disease Glanzmann Thrombasthenia Gunther disease Hemophagocytosis Histiocytosis-X Hodgkin's Disease Hunter's Syndrome (MPS-II) Hurler's Syndrome (MPS-IH) Juvenile Chronic Myelogenous Leukemia (JCML) Juvenile Myelomonocytic Leukemia (JMML) Kostmann's Syndrome Krabbe Disease Langerthans cell histiocytosis Lesch-Nyhan Syndrome Leukocyte Adhesion Deficiency Liposarcoma Maroteaux-Lamy Syndrome (MPS-VI) Metachromatic Leukodystrophy Morquio Syndrome (MPS-IV) Mucolipidosis II (I-cell Disease) Multiple Myeloma Myelofibrosis Myeloid Metaplasia Myelodysplastic Syndrome
Chronic Myelomonocytic Leukemia Neutrophil Actin deficiency Neuroblastoma Niemann-Pick Disease Non-Hodgkin's Lymphoma Omenn's Syndrome Osteopetrosis Paroxysmal Nocturnal Hemoglobinuria (PNH) Pancytopenia Plasma Cell Leukemia Polycythemia Vera Prolymphocytic Leukemia Pure Red Cell Aplasia Refractory Anemia (RA) Refractory Anemia wih Excess Blasts (RAEB/RAEB-T) Refractory Anemia w/ Ringed Sideroblasts (RARS) Renal Cell Carcinoma
FUTURE POTENTIAL
Scientists are predicting that in the near future the collection of cord blood at birth will be nearly as common as birth itself. More than the existing uses of cord blood stem cells, research indicates that these stem cells someday may be used to treat numerous other diseases including;
• Alzheimer's Disease
• Cartilage Regeneration
• Diabetes
• Heart Disease
• Liver Disease
• Multiple Sclerosis
Major Players in Cord blood Banking in India
Figure: Cord Blood Banking In India- A SAPLAP Analysis
ACTORS• Cord Blood BanksIndian – Relicord, Life CellForeign – Histostem• Government bodies laying downRegulations ICMR, DBT,
DGCI
SITUATION• Cord Blood Banking is in its nascent stage Very few private players• No public cord blood banks yet in India.• Cord Blood Banking tying up with
PROCESS• Collection of cord blood is a once in a lifetime opportunity.• Preservation is achieved by storing with liquid nitrogen at -196 °C• The concept of biological insurance was introduced by Cord Blood Banking.• Matching is an important aspect before usage.
The major players of cord blood banking in India are Relicord , Lifecell,
Cryobanks and Histostem.
Histostem Co. Ltd., is a South Korean, US based Biotechnology Company that is developing the latest human cell based therapy. It is a pioneer in cell based therapy. The main divisions of Histostem are cell therapy research, public cord blood bank for transplantation, and family cord blood bank. It is in the process of investing $20milion to establish the world’s largest cord blood bank ,providing stem cells for transplant surgeons globally.
The leading Indian player in cord blood banking and cell research is Chennai based LifeCell. Establish with initial investment of Rs. 140 million, LifeCell has a lab and state of art storage facility near Chennai. The world class infrastructure, which has accreditation from American Association of Blood Banks, help LifeCell provide seamless service from the collection of cord blood to harvesting, testing and finally storage. With 20 regional centers LifeCell has been able to harvest 10,000 units of stem cells.
The third important player is Relicord- which is Reliance Life Sciences Stem Cell Banking services has established south Asia’s first most advanced and completely automated stem cell enriched umbilical cord blood repository. This is the first cord blood repository in the world to be accorded a license by an official regulatory authority, Food and Drug Administration (FDA), Government of India.
DATA ANALYSIS AND INTERPRETATION
Approach to clients
Total
No. of Hospital covered 80
No. of Gyn/Obs. covered 94
Doctors welcome to Stem cell banking (%) 85%
Total
No. of Hospital got permission for OPD 75
No. of patients interact during OPD 510
Avg. no. of patients interact during OPD/day 13.5
OBSERVATION AND ANALYSIS
1]
No. of deliveries per month No. of Doctors
000-010 22
011-20 46
021-30 18
031-40 08
Analysis: The graph shows the number of doctors and no. of deliveries per month they carry in their clinic/hospital.
2] Doctors having more than 20 deliveries per month i.e. potential Doctors
More than 20 26
Less than 20 68
No. of Doctors
05
101520253035404550
00-10 011-20 21-30 31-40 41-50
No. of Doctors
Doctors categarization
28%
72%
More than 20
Less than 20
Analysis: The chart shows there are 26 doctors i.e. 28 % doctors having more than 20 deliveries per month.
3] Average no. of patients
Service class 60 %
Business class 20 %
Poor socio-economic class 15 %
Others 5 %
Analysis: Above chart shows the average no. of patients coming to the doctors from different classes. It shows that 60% are from service class, 20% are from business class, 15% patients are from socioeconomic class and others 5%. Thus the percentage of affordable patients is 65%.
Average no. of patients
60%20%
15% 5%
Service class
Business class
Poor socio-economic class
Others
4] Doctors having service+ business class patients more than 70% together
More than 70% 24
Less than 70% 70
doctors having class of ffordable patients
26%
74%
More than 70%
Less than 70%
Analysis: the above chart shows that there are 26% doctors having service+ business class patients more than 70%.Thus there are almost one-fourth of the doctors having class of affordable patients.
5] Doctors having facilities like ante natal classes/stress management classes.
no. of AN/ SM classes 3
Drs. having AN/ SM class facilities 10
Drs. not having AN/ SM class facilities 81
AN/ SM class facility
310
81
no. of AN/ SM classes Drs. having AN/ SM class facilities
Drs. not having AN/ SM class facilities
Analysis: The above chart shows there are 10 doctors having the facilities like ante natal classes, stress management classes etc.
6] No. of doctors educating patients on latest developments in healthcare
Often 15
Never 69
Occasionally 10
No. of doctors educating patients on latest developments in healthcare
16%
73%
11%
Often Never Occasionally
Analysis: The above graph shows there are 16% patients doctors who educate their patients often on latest developments in the field of healthcare, 73 % doctors never educate their patients while 11% doctors which occasionally educate their patients.
7] Doctors’ opinion about stem cells
Favorable 64
Not favorable 20
Not sure 10
Doctors’ opinion about stem cells
68%
21%
11%
Favorable
Not favorable
Not sure
Analysis: the above graph shows there are 68% doctors in favour of stem cell banking ,21% doctors against stem cell banking while 11% doctors having no firm opinion about the concept.
8] Average no. of patients asking about latest developments in the healthcare
Asking 15
Not asking 85
patients asking about latest developments
20%
80%
Asking
Not asking
Analysis: The graph shows there are 20 % patients on an average who ask the doctors on latest developments in healthcare.
9] Doctors point of view- Best way of promotion
ways of promotion %
participation of companies 23
one to one interaction with patients 60
making leaflets, brochures in the clinics 12
Seminars, workshops, etc 5
0
10
20
30
40
50
60
participationof companies
one to oneinteraction
with patients
makingleaflets,
brochures inthe clinics
Seminars,workshops,
etc
The Best way of promotion
Analysis: the above graph shoes that 12 % doctors think that distributing leaflets, brochures etc. would work for giving more information to the patients on stem cell technology.
10] Competitor Analyses:
Stem cell banks %
life cell 60
Reliance 40
Stem one 25
Other 10
Doctors visited by competitor stem cell banks
44%
30%
19%
7%
life cell Reliance Stem one other
11] Market Share:
Stem cell banks %
Life cell 60
Reliance 10
Cryobanks 20
Others 10
0
10
20
30
40
50
60
life cell Cryobanks Reliance others
Market Share
life cell
Cryobanks
Reliance
others
12] Doctors not visited by any company
Visited 46
Not visited 48
Doctors not visited by any company
49%
51%
Visited
Not visited
Analysis: The above graph shows that 51% doctors have not been visited by any company yet.
13] Doctors thinking stem cell banking is costly
Yes 78
No 16
Doctors thinking stem cell banking is costly
No17%
Yes83%
Yes No
Analysis: The above graph shows that 46% doctors think that stem cell banking is costly.
14] Patients’ awareness about stem cells
Awareness %
Aware 20
Not aware 80
Awareness about stem cell
20%
80%
Aw are Not aw are
Sample Size = 1030 patients
Analysis: The above graph shows that 20% patients are aware about stem cells while 80% patients are not aware.
16] Patients interested in knowing more about stem cells
Interested 76
Not interested 24
Patients interested in knowing more about stem cells
76%
24%
Interested Not interested
Analysis: The above graph shows that 76% are interested in knowing more about stem cells while 24% patients are not interested.
FINDINGS
According to most of the gynaecologists the concept has a great potential in the future.
Most Doctors think the stem cell banking is too costly to accept for many patients.
Almost all patients think the concept is beneficial but too costly.
Almost all patients are interested in knowing more about stem cells.
Few doctors were skeptical about the concept due to limited no. of stem cell therapies in
India.
Large percentage of patients is well acquainted with the stem cell banking.
Competitors have a deep reach to the market.
Many potential doctors have not yet been targeted by company.
There is no proper communication with the doctors as well as patients by the company.
SUGGESTIONS & RECOMMENDATION
Aggressive marketing is necessary as concept is new so market can be captured with fast rate
and brand has to be established.
As many potential doctors have not yet been reached by any company, this will be the good
opportunity for the company to reach to these doctors so company will face little competition
As more patients are reluctant to pay the existing price for the company’s services better
payment options for the patients should be provided.
Company should use promotional mix effectively to reach to the doctors as well as patients
as competitors have deep reach to the market.
As many doctors are skeptical about the applications of the stem cell technology the related
materials particularly about the stem cell therapies should be provide to the doctors as well
as their doubts should be cleared by organizing workshops or special seminars.
Proper information about the stem cell banking should be given to the patients through
one to one interaction, providing leaflets, brochures etc. as almost all patients are willing
to know more of the concept as well as more advertising of the concept is necessary.
Appendix I
1. Questionnaire for the doctors Maternity to Motherhood
1. Name : ____________________ Occupation : _______________________2. Spouse’s Name : _____________Spouse’s Occupation: _________________3. Mobile / Landline No. : ___________________________________________4. email Address : __________________________________________________5. Expected Date of Delivery : ________________________________________6.
1. What makes you come to this clinic?
1) Proximity to home2) Affordability3) Doctor’s experience and good nature4) Family doctor
Any other
2. How do you plan your day during your pregnancy? Self/ Spouse or Family Support__________________________________________________________
3. Are you happy with the facilities available at the clinic?
a. Staff Behavior Yes/ Nob. Wash Room/ Waiting Area Yes/ Noc. OPD timingse. Any Suggestions to make the services at your doctor’s clinic better
1. Awareness Program 2. Ante natal Classes 3. Facilities
4. Others ____________________________________________________
4. From where do you get your medical / diagnostic test done? ______________________________________________
5. Do you Exercise regularly? Yes / No
6. Do you attend any Anti-Natal/ Stress Management Class.? Yes / No
8. Are you aware about stem cells? Yes / No
9. Did you know that the stem cells found in the umbilical cord can be used to protect your child or your family against 75 life threatening diseases? Yes / No
10. Would you like to know more about stem cells? Yes/No
Signature & Date:
2. Feedback forms : for Doctors
Your Clinical Practice
Name: _________________________________________________________________
Qualification: __________________________________________________________
Clinic/ Hospital Name & Address: ________________________________________________________________________
_______________________________________________________
Mobile / Phone No. ______________________________________________________
Email Address: ______________________________________________________
How long have you been in practice? ___________ No. of Deliveries/month ___________
What do you like best about your job? ________________________________________________________________________
What other hospitals are you associated with? ____________________________________
What sort of Ante Natal/expectant patients do you generally get?
Service Class Business Class Poor Socio- Economic Others
%age
What are the facilities available with your Clinic/Hospital?
a.________________________ b.___________________________
c.________________________ d.___________________________
If you're unavailable for delivery, is there a backup? Yes/No
Who's the backup physician; does he/she meet the patients during their pregnancy? ________________________________________________________________________
Do you run/ have facility of any Ante-Natal / Stress management Classes? Yes/No
________________________________________________________________________
How are between visit questions handled? Do you return calls or with the nurse or receptionist call the expecting mothers back? ______________________________________
Do you or your colleague educate your patients on the new developments like stem cells, non invasive treatments etc. _____________________________________________________
What is your opinion about cord blood stem cells as this is a much debated topic today?
________________________________________________________________________
Do you think activities CMEs, workshop for Drs. at regular intervals would help? No/Yes (at what time intervals) _________________________________________________________
What is the %age of patients coming to you with queries on umbilical cord blood stem cells banking, new facilities Etc?
And what do they generally ask? How do you educate them? _______________________________________________________________________
_______________________________________________________________________
Which activity would you recommend for the awareness among the general mass?
Participation of Companies in Camps conducted by you? One to One interaction with families on your recommendation/feedback? In Clinic/OPD (leaflets, brochures/interaction with patients) activity?
Have you ever been approached for by any of the organizations/ Institutes for stem cell Banking? No/ Yes (which______________________________________________
Are private postpartum rooms available if desired? What's the extra charge? ________________________________________________________________What's the visitation policy? Are there specified visiting hours?________________________________________________________________________
Would you like to recommend any of your colleagues who agrees with the concept of cord blood stem cells or would be interested in knowing the same?
________________________________________________________________________
Any Suggestions you would like to give?
_____________________________________________________________________________
Signature with Stamp:
Date:
Appendix II
List of doctors covered by us:
Sr. No. DOCTOR NAME & ADDRESS TRADE / HOSP.
1 Dr. Pradip Pawar Vidula Hospital
2 Dr. Suvarna pawar Vidula Hospital
3 Dr. Ranjit Mehta Mehta hospital
4 Dr. Priyali Mehta hospital
5 Dr. Nivedita pawar Nivedita Hospital
6 Dr. Vijalaxmi Ganorkar Ganorkar Hospital
7 Dr. Neha & Nitin Lad Navjeevan Hospital
8 Dr. Reeta Patil Navjeevan Hospital
9 Dr. Nalini Bagul Bagul Hospital
10 Dr. Kanchan desle Malti Hospital
11 Dr. Vijaya Sule Kulkarni Hospital
12 Dr. Ravindra Shivde Shivde Hospital
13 Dr. Anita Patil Shreeya Hospital
14 Dr. Sachin Gawle Gawle Hospital
15 Dr. Neeta Gawle Gawle Hospital
16 Dr. R T Desle Sparsh hospital
17 Dr.Pooja Vadgorkar Vijay nursing home
18 Dr.Shailaja Bedmutha Chaitanya Nursing home
19 Dr.Sujata kulkarni Seeta Nursing home
20 Dr. Sujata Bachav Tulsi hospital
21 Dr.Rajendra khairnar jyoti clinic hospital
22 Dr.Varsha Baste Baste maternity hospital
23 Dr.ujwala Bhambri ujwala hospital
24 Dr.Sanjay kadam city care hospital
25 Dr.Abhay Sukhatme abhay hospital
26 Dr.Shaila p Gondhale Gondhale hospital
27 Dr.Yeshwant Mane Atharva hospital
28 Dr. Archana Khairnar Aditya Hospital
29 Dr. Raviraj khairnar Aditya Hospital
30 Dr. Varsha Lahad Prayag Hospital
31 Dr. Manisha Surjuse Surjuse Nursing Home
32 Dr. Preeti Avhad Avhad Maternity Home
33 Shraddha rajesh valvekar Shraddha clinic
34 Dr. Ashwini Pekhle Shraddha Hospital
35 Dr. Padmaja Joshi Shri Guruji Rugnalaya
36 Dr. Chandrakant Sanklecha Sanklecha Hospital
37 Dr. Bhausaheb More Sri Samarth Super Speciality Hospital
38 Dr. Anand Tambat Vignhar hospital
39 Dr. Prerana Shinde Chetana Hospital
40 Dr. Guari Karandikar Karandikar Hospital
41 Dr. Shekhar Amle shoam Hospital
42 Dr. Aruna vankhede Vankhede Hospital
43 Dr.Pardeshi C.R. Pradesi Clinic
44 Dr. Madhuri Kailas Boraste Matoshri clinic
45 Dr. Gosavi S.M. Gosavi Hospital
46 Dr.Priya Modak Akanksha Hospital
47 Dr.Jayshree T Suryawanshi Vishvagandha Ayurvedic Hospital
48 Dr.Bhadane pankaj krishan Hospital
49 Dr.Sangita Gandhi S Mehta hospital
50 Dr.Prerama Kiran Shinde Chetana Hospital
51 Dr.Umesh Marathe Life Care Hospital
52 Dr.Archana Jadhav Deep Nirmal Hospital
53 Dr.Aarti Kulkarni Aarti Kulkarni Hospital
54 Dr.Archana Patil T New Satyam Hospital
55 Dr.Jagdish Suwalal Malpani Malpani hospital
56 Dr.Nilima Kulkarni Seva hospital
57 Dr.Vishram Diwan Diwan Clinic
58 Dr.Nalini Shardul Shardul Hospital
59 Dr.Upadhye Aparna S Upadhye Hospital
60 Dr.Smita Amit Sope Yashshree Clinic
61 Dr.S.B.Yeuge(Gundre) Shri Balaji Hospital
62 Dr.Ranjit Anil Thatte ShreeRamClinic
63 Dr. Kanchan Wanere Vimal Hospital
64 Dr. Jaywant aher Shatabdi Hospital
65 Dr. Charushila bele Bele Hospital
66 Dr. Kalpna sankelcha Saubhagya Hospital
67 Dr. Satish Paprikar Paprikar Hospital
68 Dr. Vasant Darade Mauli Hospital, bhandup
69 Dr. Ashwini Ghaisas Nirmala clinic
70 Dr. Sarika Partani Sadguru Hospital
71 Dr. Sameer Pawar AKPI, CBS
72 Dr. Anita Parikh Shurti polyclinic, ashokstambha
73 Dr. Ratnaparkhi Ratnaprkhi Hospital, dwarka
74 Dr. Smita dahekar Dahekhar maternity home
75 Dr. Kothadiya Bhupendra Kothadiya polyclinic, Sharanpur rd
76 Dr. Kamkhedkar Nalini Ashirwad Hospital
77 Dr. Pravina Pawar AKPI, Cidco
78 Dr. Vasanthi Parikh Shreeji Hospital, canada corner
79 Dr. Sucharita Patil Jivan jyoti Hospital, Satpur
80 Dr. Mrs. Kiran Rajole Rajebadur Hospital, Shalimar
81 Dr. Arti parikh Rajebadur Hospital, Shalimar
82 Dr. Prashant Purandare Suvichar Hsp. Pvt. Ltd, Nsk Rd
83 Dr. Arti Andhale Suvichar Hsp. Pvt. Ltd, Nsk Rd
84 Dr. Babita Chauhan wockhardt hospital, Dwarka
85 Dr. Sanjeev Torane wockhardt hospital, Dwarka
86 Dr. Saudamini Naik Life Line Hospital, Nsk Rd
87 Dr. Nilima Kulkarni Life Line Hospital, Nsk Rd
88 Dr. Mrs. Vaidya Civil Hospital, CBS
89 Dr. Gore V Civil Hospital, CBS
90 Dr. Pramod Patil Maher Hospital, satpur
91 Dr. Ajit Patil Sudarshan hospital, Old Agra rd
92 Dr. kiran Patole Trupti Maternity Hospital
93 Dr. Neeraja kanikar Kanikar Maternity hsp., Khutwadnagar
94 Dr. Vikranti More More Hospital, dwarka
Bibliography:
www.cryobanksindia.com
J Obstet Gynecol India Vol. 55, No. 6 : November/December 2005, Pg 502-504
Societyof Obstetricians andGynaecologistsofCanada(SOGC) CLINICAL PRACTICE GUIDELINES,
No. 156 March 2005
Cord Blood Banking –Opening New Vistas for Medical Tourism Industry in India By Saboohi
Nasim, and Kiran. K. Momaya
Royal College of Obstetricians and Gynaecologists, Cord blood banking: information for
parents Published August 2006 by the RCOG Due to be reviewed in 2008
Umbilical cord cell banking: a surprisingly controversial issue By Dr Jennifer Gunning Cardiff
Law School
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