I am posting this letter to lactnet by request from Mary Rose Tully,
Chair of HMBANA.
Darlene Breed, BSN, RN, IBCLC
Milk Bank & Breastfeeding Center
Worcester, MA (USA)
--------- Begin forwarded message ----------
From: "Mary R. Tully" <[log in to unmask]>
To: "Breed, Darlene" <[log in to unmask]>
Cc: [log in to unmask]
Subject: response to Mitchell
Date: Thu, 28 Oct 1999 23:37:58 -0400 (EDT)
Message-ID: <[log in to unmask]>
Darlene,
Here's the letter for you to post on Lactnet.
Anne P. Mitchell, Esq.
<[log in to unmask]>
Dear Anne,
The correspondence regarding your web page milk exchange has been
forwarded
to me. I can certainly understand your desire to help mothers provide
human
milk for their babies - I have spend the last 22 years of my professional
life doing just that. However, since the days when I started in the field
and when you were active in milk banking previously, milk banking has
become
more complicated. For one thing, viruses such as CMV, HIV and HTLV are
found
in breast milk. As Chair of the Human Milk Banking Association of North
America (HMBANA), which represents all of the donor human milk banks in
the US, Canada and Mexico, I would like to clarify several issues which
have
been raised in the discussion on Lactnet.
First, Lois Williams-Arnold was a founding member of HMBANA, but her
private
consulting business, the National Commission on Human Milk Banking,
speaks
only for itself, and does not represent any donor human milk banks. So
Lois's letter does not represent a big Goliath trying to "muscle" anyone
out
of the milk banking arena. The concerns she expressed reflect her genuine
concerns for the safety of donor milk.
No milk bank would be in operation if there were not a fundamental belief
by
many health care professionals in the optimal nutrition offered by human
milk for human infants. Likewise, we all know there are instances when a
mother cannot provide her own milk for her infant, and that our role is
to
fill that need.
However, human milk is a tissue. It contains living cells from the mother
who produces it, and while these can protect the infant from external
exposure to most bacteria, viruses and other infection causing agents,
it
can also support the growth and viability of viruses and bacteria, and
unfortunately it can, in the right circumstances, also infect the infant
with some of them. Therefore, donor milk is now seen as more than just
food. It is considered donor tissue, and needs to be treated as such to
protect the recipients. Although the laws and regulations concerning the
handling of donor milk are not consistent, most heath care professionals
and
regulatory bodies see breast milk as a donor tissue and therefore
regulate
it as such.
HMBANA and its member banks' primary concern is for the recipients and
the
donors and their infants. The demonstrated risks of acquiring HIV and
other
viral and bacterial infections from breast milk make it no longer
acceptable
or responsible to conduct informal milk sharing. Furthermore, the typical
recipient is usually already medically vulnerable and may be
immunologically
compromised. Donor milk is usually considered as a treatment because of
the
rich array of nutritional and immunologic components it can offer. To run
the risk of introducing pathogens from unprocessed milk, or drugs
(including
mega vitamins) the donor may have taken, to this type of patient is of
great
concern. We know both from clinical experience and from bench research
that,
except in rare cases, processed donor milk provides the therapeutic
benefits
of human milk without the potential risk of exposure to pathogens in the
milk, and therefore should be used. Also, borrowing on the experience and
skill of another tissue banking system, the Red Cross, milk banks ask
about
medications and drugs in several ways to both the potential donor and her
physician, to assure minimal chance of a donor's forgetting to mention a
medication. Then the milk is pooled to dilute the effect of a single
donor
on a batch of milk.
Since the typical donor is a very generous and caring mother who must
always
keep the care of her own child paramount, but may feel pressure to give
more
to a recipient and less to her own child, she is protected by the
anonymity
of the donor milk bank system. The anonymity and centralized nature of
the
milk banking system allows her to be generous with her milk as long as
she
can produce in excess of her own child's needs without feeling pressure
to
produce for someone else's schedule at all times.
One of HMBANA's guidelines is that all milk is donated and no payment is
made, which removes any incentive or pressure to short-change the donor's
own child, or to adulterate the milk in order to supply more volume. With
an
exchange such as you have proposed that could be a potential risk. Also,
our donors' physicians and the physicians for their infants are all aware
that they are donating and that they can contact us with any concerns.
Secondarily, HMBANA is concerned about the professional reputation of
donor
milk banking which is only slowly gaining recognition and credibility
within
the medical profession. It has taken a long time for donor milk banking
even
to be invited to the table with other tissue and organ banks to discuss
the
concerns for safety and how best to meet them. If all sources of donor
human
milk do not have safety and quality control assurances in place, it is
difficult for physicians to consider donor milk a viable treatment
option,
regardless of the wonderful medical success it may have in some cases.
The
Guidelines for Establishment and Operation of a Donor Human Milk Bank
were
initially developed by milk bank coordinators and medical directors with
significant input from our Advisory Panel and representatives of the
American Academy of Pediatrics, the FDA, and the CDC, both because they
were able to offer expertise and guidance with regulatory bodies, but
also
they are experienced in assuring a safe product with maximum nutritional
and
therapeutic value. Their oversight is not punitive, but protects the
consumer.
All of the milk banks are located in health care systems which are
not-for-profit, or organized as not-for-profits. We do not sell the milk,
but do charge a processing fee of about $2.50 per ounce, which we know
does
not fully cover the cost. No member bank turns away recipients in
medical
need because of inability to pay, and most of us have not raised our
processing fees since the early 1990s, although our operating costs
continue
to escalate. There is not big money in donor milk banking, but the
processing fee is critical to supporting the service, just as other
tissue
and organ banks must charge a fee to cover the cost of screening and
processing.
Member banks in HMBANA are all delighted to help other facilities open
new
banks. Many of us have assisted the Austin milk bank over the last two
years, and are now working with another hospital in the Midwest which is
proposing to open a bank.
Certainly your enthusiasm for milk banking has not diminished over the
years, and we milk bank coordinators really value your enthusiastic
support.
One thing you might consider is using your web site to refer potential
donors and recipients to the milk bank nearest them (HMBANA is an all
volunteer organization, and we are still working on getting our permanent
web site fully up and running). Most of us are always looking for new
donors (as you recall, babies grow up and moms move on to other things).
If you would like to discuss this further, please feel free to contact me
by
e-mail or by phone.
Mary Rose
Mary Rose Tully, MPH, IBCLC
Chair, HMBANA
Coordinator of the Lactation Center and Milk Bank
WakeMed
Raleigh, NC
(919) 350-8599
CC: Kenneth Dominguez, MD, Centers for Disease Control
Clint Venable, California Department of Health
Lois D. Williams-Arnold
Lactnet
Mary Rose Tully, MPH, IBCLC
Conference Program Planner
ILCA
1122 Vic Charles Dr.
Raleigh, NC 27606
(919) 851-8816 (home)
(919) 852-0985 fax
Coordinator of the Lacation Center
& Mothers Milk Bank at WakeMed
(919) 350-8599
(919) 350-8923 fax
--------- End forwarded message ----------
___________________________________________________________________
Get the Internet just the way you want it.
Free software, free e-mail, and free Internet access for a month!
Try Juno Web: http://dl.www.juno.com/dynoget/tagj.
***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|
