Donor human milk in
North America:
Donor human milk (DHM) is
breastmilk that has been donated to a
milk bank for use by a
baby other than one’s own. In North America there are currently only 7 dispensing milk banks. All follow the standards set by the
North American Milk Banking Association.
The
donor mother is screened, by
questionnaire to herself and her doctor and by
blood tests to ensure she is not at risk for or carrying
viruses known to be spread via
breastmilk. It is also assured that her milk supply is adequate to meet the needs of her own child first. Donors are
volunteers but are usually supplied with a good
breast pump; milk storage supplies costs and shipping costs are borne by the milk bank.
The donor mother freezes her pumped milk and delivers or ships it on
dry ice to the
milk bank.
Milk from several (5 – 6 is typical) donors is thawed, pooled, repackaged in glass bottles (typically 3 or 4 ounces – sometimes less) and
pasteurized using one of 2 methods. One is a slightly higher temperature for a slightly shorter time; the other is a slightly lower temperature for a slightly longer time. Both methods are known by research to kill bacteria and viruses but to leave as many
immune factors intact and the nutritional qualtiy as high as possible.
Quality assurance is measured by temperature monitoring during the pasteurization and storage processes and by bacterial cultures of the processed milk.
After being pasteurized, the milk is re-frozen with an
expiration date and a
lot number.
DHM is distributed with a medical
prescription only and needs are prioritized.
DHM can be of 4 types:
Premature milk (pumped in the first 30 days after the birth of a premature infant)
Early premature milk (as above but in first 7 to 10 days)
Full term milk (pumped after the birth of a full term infant)
Early full term milk (as above but in first 7 to 10 days)
These classifications are important because the amounts of certain portions of the milk vary according to the gestation of the infant and the time since birth.
DHM is used for infants and some older children or adults with special needs.
Prematurity, intolerances of other foods,
immunologic deficiencies,
digestive disorders, and certain
cancers and
organ transplants are some of the reasons for using HDM. It would be great if all babies whose mothers are unable to breastfeed could have DHM but supply and cost usually preclude its use by well infants. Some adopted babies are given DHM when available and if the parents can afford it.
Insurance covers the cost of DHM sporadically at best. The cost is currently (May, ’02) $3.25 an ounce including shipping or $2.75 to $3.00 an ounce plus shipping at the three milk banks I checked. Shipping is expensive ($70 for 150 ounces) because it must be done overnight and special packaging with dry ice and coolers are required. Liquid, glass and dry ice are also heavy by nature.
The cost of DHM is directly related to the costs of running a milk bank. The donor is not paid and the milk banks are non-profit organizations that typically also have fund raising efforts to help with costs. Milk is not denied to a sick baby because of an inability to pay.
The
World Health Organization places DHM 3rd in the ranking of foods most suitable for human
infants.
First is the mother’s milk, direct from the breast.
Second is the mother’s own milk; pumped and fed by another method.
Third is DHM.
Forth is commercial infant
formula.
Casual sharing of breastmilk can be dangerous. Viral infections caused by both devastating viruses like
HIV and more benign viruses like
cytomegalovirus (CMV) can be spread via breastmilk. CMV is only benign in a mother's own breastmilk. If an infant was not exposed in utero to mom's CMV and therefore has no antibody protection from it and then acquires CMV via another mom's breastmilk (or other route)it can be deadly.
No infant is known to have acquired any disease via banked donor human milk.