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Wed 1 Aug 2007 12:00 AM

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Striking a cord

Cord blood presents a valuable resource for the medical sector and as such requires an efficient but delicate logistics operation to match. Darryn Keast, regional director of Future Health, highlights the cares and concerns involved in transporting lifeblood across the globe.

Currently 75 different medical conditions can be treated using umbilical stem cells, a figure that many researchers believe could increase ten fold in the next 10 to 15 years. Interest in the concept is unsurprisingly growing fast and with it brings increased pressure on the transportation sector to provide services to the increasing number of storage banks spouting worldwide.

Due to the relatively youthful existence of cord blood expertise, storage centres often take an international approach, with stem cells arriving from all angles of the globe. This is very much the case with UK based, Future Health, whose presence in the Middle East since 2003 has relied upon the logistics sector to cater for the journey of each sample.

"We offer expecting parents the opportunity to collect the umbilical stem cells of their just born child and therefore harnessing possible future benefits. Once collected, the cells are sent directly to our regional hub in Nottingham through our global and local provider DHL," says Darryn Keast, regional director, Future Health.

"Normally the umbilical cord is discarded after birth, but by preserving the stem cells there is remarkable potential to develop it into other types of cells and tissue. Currently stem cells can be stored in cyrogenic freezers for at least 20 years," he remarks.

Future Health first entered the Middle East market in Saudi Arabia, targeting the wider possibilities of a larger population and growing accustomed to the challenges presented by the region. Since then it has spread to the rest of the Middle East through an office in Jordan and a new regional head office in Dubai. The bigger picture is more impressive, with Future Health providing to customers as distant as the Far East and America. With such lengths involved to transport samples, the question must be asked, what is the advantage of sending stem cells abroad for storage?

"There are direct storage facilities for cord blood in the Middle East, but our key advantage is offering a British accredited service. An economy of scale must be applied - our laboratory and storage facilities are state of the art, costing millions of dollars, so opening one here would not be cost effective," responds Keast.

"With facilities certified as A class, we possess the same level of sterility as pharmaceutical companies, preventing the chances of infection to the stem. This accreditation allows us to follow the highest standards of European guidelines, giving peace of mind to customers, doctors and everyone else involved," he finishes.

Justifying the distance involved, there is nevertheless a great responsibility placed on a delivery service to match aspirations both short and long term. Since its incorporation in 2002, Future Health has partnered with DHL to manage its delivery services worldwide. A renowned logistics heavyweight, the two have established a partnership built around the specifications of the cord blood, a learning curve that continues as the medical importance of stem cells becomes progressively clearer.

To understand DHL's involvement, it must be first made clear what happens following a birth and the conditions required for preserving the subsequent umbilical cord.

The blood produced by the umbilical cord appears after birth for less than ten minutes, in which time the doctor is instructed to take the sample and place it in the vacuumed packaging. Only if the mother is at potential risk is the procedure abandoned.

Instructions for the sample come complete in the Future Health kit distributed to customers. In the form of a simple cardboard box, three layers of insulation constitute the environment in which the stem cell travel. Placed in a high density plastic container, foam surrounds the object for protection during transportation and, perhaps more importantly, allows temperature control. "The sample must be kept at room temperature throughout movement time. A gel ice block is inserted to prevent the temperature rising above 26o C which is monitored by a data logger," says Keast.

Whilst maintaining room temperature may not be a menacing task Europe side, the heat in the Middle East, particularly during summertime, means extra precaution is very much a requirement. "The only real issue is taking the box to the DHL office from a hospital in the Middle East where the contrast between room temperature and outside is immense," portrays Keast.
Keeping the box room temperature requires no additional refrigeration from DHL neither in vehicle or office, the real challenge, however, lies in meeting the tough time constrictions. Future Health works towards an absolute maximum 72 hour transportation timeline, but estimates 98% of samples reach Nottingham headquarters within 36 hours. In this time frame, the sample must be collected from hospital, taken to the nearest DHL warehouse for automated tracking implementation and moved to the central DHL warehouse before air shipment.

Compliant to IATA regulations, specifically packaging instruction 650, the box is again stored in room temperature away from the belly of an aircraft where it is more prone to freeze. Last year Future Health changed from accreditation by the British Department of Health to the broader licencing regulations of the Human Tissue Authority (HTA), which receives its directives from the European Union. Additionally, DHL placed the packaging through its own rigorous testing, a symbol of the close bond between the two companies.

"To improve our process, DHL earlier this year tested our kits in their testing labs in Belgium. This included drop tests on the combination packaging and internal pressure control on secondary packaging used in combination packaging. This means the kit is accredited by both the European Union and DHL," exclaims Keast.

Another benefit highlighted by Keast is DHL's tracking system, an essential component considering the timescale and importance of the box in question. "When you are placed in a situation of high volume shipments, you must rely on your partners for support in terms of tracking and correct issuing on routes," says Keast.

"In this case, a pro forma invoice is required to send the sample into the UK. As you may imagine, during the initial birth process, fathers can get excited and on occasion can forget to hand over certain invoices to DHL. If the shipment leaves without the document and we realise it is missing, DHL is able to place the invoice through the computer system, therefore allowing it to pass through customs the other side," he exemplifies.

Able to follow the samples route via a personal account accessible on the internet using an airway bill number, a peace of mind is offered to Future Health, which only processes stem cells with 99% viability. Through a combination of the accreditation process and the data logger placed inside, it is possible to monitor precisely if anything was to go wrong during movement. A rarity, the sample is ultimately processed in the Nottingham facility before final stored in the vapour phase of liquid nitrogen at a temperature of -196oC.

Yet, what if this was not the final movement of a sample and it was indeed required for transplant purposes? Firstly the issue of the Middle East is currently irrelevant due to the unavailability of transplant facilities in the region. However, in the case of such an event in Europe, DHL is equally equipped and aware of procedures to ship the stem cells in cryo containers to reach a requested institute.

With a global network to match Future Health's lack of international boundaries, the business relationship is one that is longstanding and looks set to continue. "We continuously meet to discuss improvements to the process, and in the case of error, try to identify and find a remedy," says Keast.

"We see interest in the cord blood concept growing in Europe and the Middle East similar to its penetration in the US market where it has quadrupled in the last four years. We are certain DHL will not have any problems matching our aspirations," he smiles.

The DHL perspective

Cord blood and other blood rated organisations is growing business for DHL Middle East and one the courier service hopes to build on. "We have been involved in the transportation of blood for more than 36 months now and its what I would term a developing segment of the business. It is early days yet and we have experienced a significant learning curve," says Dirk van Doorn, express manager, DHL Middle East.

In comparison to the US and Europe, a distinct lack of rules and regulations follows the blood transportation sector in the region, an aspect DHL has acknowledged and tried to reform. "The European Union implements clear directives on carrying such items, in terms of what you need to do and where you to be doing it. We were asked to help draw up similar guidelines for procedures in the Middle East for government officials, so using advice from network colleagues in other continents we submitted standards for review and approval," notes van Doorn.

Categorised by the International Air Transport Association (IATA) as dangerous goods, the delivery of blood requires a level of understanding from all DHL quarters.

"The exportation of blood requires a statement from the ministry of health specifying its nature. It is our responsibility to educate the customer on minimum requirements before engaging in business and in this case we require the statement, a physical location to collect and deliver from, and specific guidelines on temperature variables. In our operations department we have ‘product champions' who have been briefed and trained in the transportation of a product, which are referred to when a delivery is placed," highlights van Doorn.

Future thoughts and improvements for the transportation leave Van Doorn pondering. "There is certainly room for improvement, only realistically achieved through conjunction of the industry, relative government bodies and other stake holders. The formation of some basic standards would be useful and I believe the whole administrative and bureaucratic process behind the scene could be made more accessible for both service provider and end customer."

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