Summer Internship Report

A MARKET STUDY ON THE AWARENESS OF STEM CELL BANKING TECHNOLOGY IN KERALA FOR

CRYOBANKS INTERNATIONAL INDIA PVT LTD

By

ARAVIND RAJANA0102209104

MBA- Marketing & Sales (2009-2011)

Under the Supervision ofMs.TEENA BAGGA

Senior LectureDepartment of Information Technology

In Partial Fulfilment of Award of Master of Business AdministrationAMITY BUSINESS SCHOOL

AMITY UNIVERSITY UTTAR PRADESHSECTOR 125, NOIDA - 201303, UTTAR PRADESH, INDIA

2010

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AMITY UNIVERSITY UTTAR PRADESHAMITY BUSINESS SCHOOL

DECLARATION

I, Aravind Rajan student of Masters of Business Administration from Amity Business School,

Amity University Uttar Pradesh hereby declare that I have completed Summer Internship on

“A MARKET STUDY ON THE AWARENESS OF STEM CELL BANKING

TECHNOLOGY IN KERALA FOR CRYOBANKS INTERNATIONAL INDIA PVT LTD”

as part of the course requirement.

I further declare that the information presented in this project is true and original to the best

of my knowledge.

Date: 08/07/2010 ARAVIND RAJANEnrol. No: A0102209104

MBA- Marketing & Sales (2009-2011)Place: Noida Amity Business School

Amity UniversityNoida, UP

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Attach certificate from the organization.

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AMITY UNIVERSITY UTTAR PRADESH

AMITY BUSINESS SCHOOL

CERTIFICATE

I hereby certify that ARAVIND RAJAN students of Masters of Business Administration at

Amity Business School, Amity University Uttar Pradesh has completed Summer Internship

on “A MARKET STUDY ON THE AWARENESS OF STEM CELL BANKING

TECHNOLOGY IN KERALA FOR CRYOBANKS INTERNATIONAL INDIA PVT LTD”,

under my guidance.

Ms. TEENA BAGGA

Senior Lecturer

Department of Information Technology

Date: Amity Business School, Amity University

Noida, UP

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Acknowledgement

First off all I would like to present this piece of work to our guiding light Dr.Sanjay

Srivastava, Head and Additional Director General, Amity Business School, who has been

inspiration to me throughout the academic year.

The successful completion of this project would not have been possible without help and

assistance that was received from various directions.

I would like to thank Ms.Teena Bagga, Senior Lecturer, Department of IT, Amity Business

School who has directed me to choose such an interesting topic to do research upon and also

for letting me submit a project on the same. I would also like to thank ma’am for providing

me with assistance and guidance throughout the project.

I would like to extend my gratitude to Mr. Rajesh, Head of Cryobanks Trivandrum, Kerala

and Mr.Arun, Regional Manager, Cryobanks International India Pvt Ltd, Kerala and other

employees of all departments at CRYOBANKS INTERNATIONAL INDIA PVT Ltd who

provided me with all facilities without which the compilation of the entire project would have

been impossible. I would be failing in my duty if I do not thank Dr.Vaijayanthi Manilal,

HOD Gynecology and Obstetrics, SK Hospital, Trivandrum, Kerala and my parents who

provided me with enough facilities to do research on the topic for hours at an end. They have

unfailingly supported my efforts at completion of the project.

ARAVIND RAJAN

Enrollment No: A0102209104

MBA-Marketing & Sales (2009-2011)

Amity Business School, Noida, UP

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CONTENTS

Declaration

Certificate from Industry Guide

Certificate from Faculty Guide

Acknowledgement

Sl. No. CHAPTER NAME PAGE NO.1 INDUSTRY PROFILE 72 LITERATURE REVIEW 123 COMPANY PROFILE 174 RESEARCH OBJECTIVES

& SCOPE23

5 RESEARCH DESIGN & METHODOLOGY

25

6 DATA ANALYSIS & INTERPRETATION

28

7 FINDINGS, SUGGESTIONS, CONLUSION

37

References

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CHAPTER 1

INDUSTRY PROFILE

Cord Blood Banking in India-An Overview

Cord Blood –i.e the blood that remains in the umbilical cord after a baby is born-represents a

new and the richest source of stem cells-which is the origin of the body’s immune & blood

system. With rising interest in stem cell based therapy, the scope of cord blood bank is

becoming more of a cell pharmac. In order to understand the importance and potential of

Cord Blood Banking, it is imperative to explore further the emerging applications of stem

cells.

1.1 Stem Cells-Emerging Applications

Stem cells are basically the primal cells found in the multi cellular organisms. It has the

remarkable potential to develop into many different cell types in the body, serving as a sort of

repair system for the body. They are actually master cells because they give rise to all tissues,

organs and system in the body. The stem cells ability to differentiate or change into other

types of cells in the body is a new discovery that holds tremendous potential for treating and

curing some of the most common diseases such as heart diseases, cancer etc.(Wikipedia.org)

There are basically three sources of stem cells; bone marrow, embryonic cells and cord

blood. A bone marrow based surgical treatment is mostly stringent and is a difficult process

as it requires accurate and correct match which is often too tedious. On the other hand the

treatment based on embryonic cells involves a lot of controversies as it requires the culture of

embryo or waste fetus. The third and the richest source of stem cells is the cord blood.

Umbilical cord blood contains inexhaustible, non-controversial sources of stem cells for

therapy. Stem cell therapy in the coming decades may provide solutions to incurable ailments

and severe injuries. Diseases like leukemia, metabolic disorders and immune deficiencies etc

have been successfully treated with umbilical cord blood transplantation. Further stem cell

breakthrough is expected to promote effective low cost treatment for diseases like diabetes,

stroke, spinal cord damage etc. The Indian Council of Medical Research has estimated that

some 50 million patients with heart disease, 5 million with Parkinson’s disease and 5 million

with Alzheimer’s disease in India are ‘potential beneficiaries’ of stem cell therapy. First-

generation therapy is already being offered in South Korea for spinal injuries .Some of the

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current and emerging applications of cord blood based stem cells have been listed in Table-1,

below.

Table 1-Applications of Stem CellsCurrent Applications of Stem Cells/Cordblood

Emerging Stem Cell /Cord bloodApplications

Acute LeukemiasChronic LeukemiasThalassemiaFanconi’s AnemiaSickle Cell AnemiaHodgkin’s LymphomaNon-Hodgkin’s LymphomaMultiple MyelomaOthers

Cardiac DiseaseDiabetesMultiple SclerosisMuscular DystrophyParkinson's DiseaseSpinal Cord InjuryStrokeAlzheimer's DiseaseLupus,Rheumatoid Arthritis

Source: Wikipedia.org

1.2 Cord Blood-the richest source of Stem Cells

Cord blood is the blood that remains in the baby’s umbilical cord after it has been cut and is a

rich source of stem cells. Earlier treated as a waste to be discarded after birth, cord blood is

now considered a precious resource. Although the first cord blood transplant was performed

by Gluckman in 1988, the concept of banking cord blood was pioneered by Dr. Pablo

Rubinstein , who was awarded grant by the National Institute of Health to set up the first

National Cord Blood Banking Program at the New York Blood Centre.(National Institute of

Health, USA). Back home in India, umbilical cord research started in 1990 at Cancer

Research Institute, Mumbai, but did not receive any support from the government to set up a

stem cell bank. The first private stem cell bank in India, however, was set up in 2002.

1.3 Cord Blood Banking- the Process

A cord blood bank is place that stores umbilical cord blood for future use. Cord blood

banking basically involves three steps: collection, processing and storage. Cord blood

collection is a simple, safe and painless procedure that usually takes less than 5 minutes and

can be performed just after child birth in which the cord is clamped and cut and the blood is

drawn from the umbilical cord in a specialized bar coded bag. These collections are further

harvested for stem cells, which are then stored in cryo-vials at -196 degrees celsius in liquid

nitrogen.

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1.4 Public Vs. Private Cord Blood Banking

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-2.

Table 2- Types of cord blood banks

Public banks Private banks

Use not restricted. No remuneration collected Usage subject to availability

For use of the family Facility paid for by the family 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.

1.5 Major Players in Cord blood Banking in India

The major players of cord blood banking in India are Relicord,Lifecell,Cryobanks

International Ltd 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 Hindu, July 12, 2005)

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

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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.

Cryobanks International India a JV between Cryobanks International USA and RJ

Corp founded in 2006. Cryobanks International is a leader in the collection,

processing and banking of umbilical cord blood stem cells. 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 15000 samples of stem cells till date .

Another 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.

1.6 Cord Blood Banking in India –the road ahead…

High birth rate and lack of any stringent government regulations are the factors favoring the

development of cord blood banking in India. With approximately 72000 births daily,

resulting in discarding of 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. The Ministry of Health has approved a Grant of Rs.5 crores to upgrade

its stem cell research at the Mumbai based National Institute for Research in Reproductive

Health under the Indian Council of Medical Research (ICMR). New private cord blood banks

are being established all over India in an attempt to use their knowledge, research and storage

facility to benefit the Indian population. What seemed like a dream few years back is now

becoming a reality. The use of umbilical stem cells for therapeutic purposes can ensure lower

treatment costs and longer lives. India is poised to be the largest source for umbilical cord

blood in the world. It's no surprise then that leading stem cell banking companies are keenly

eyeing India. The investments are considerable and mostly run into millions of dollars.

Analysts estimate that Indian stem cell banks, which are currently at Rs 100 crore, would

generate Rs 2,700 crore in revenues by 2012, accounting for 17 per cent of the world market.

Companies with foreign funding are entering the market and are planning to capture at least

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21 per cent of the total market. As of now, there are more than six players in this five-year-

old market. Most of these cord blood banking companies are having an overseas parent

company which is responsible for the initial investment.

CHAPTER 2

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LITERATURE REVIEW

The Indian State of Kerala with a per capita income of around 1% of that of the wealthiest

countries, has achieved good health comparable to theirs. Kerala is having the highest

number of health care institutions as per the 1991 census. About 26% of total health care

institutions in India are located in Kerala. Mortality indicators show that health status of

Kerala is far advanced and higher than the all India average and is even comparable with

developed countries. This outstanding progress of health status is achieved through

widespread growth of the three systems of medicine in public, private, co-operative sectors

combined with people's health awareness. The basic health indicators of Kerala and India are

given in Table below. For example the infant mortality rate for Kerala in 2000 was 14/1000

live births compared with 23/1000 for India. Life expectancy at birth was 76 years for women

and 71 for men in Kerala; for India these figures were 64 and 63 respectively. The most

important reasons for this good health in Kerala are probably the following: its high level of

female literacy (87%); access to health care (e.g. 97% institutional deliveries); a good public

distribution system (PDS), which provides essential food items at subsidized rates (the

system covers 96% of the population); political commitment (40% of the state budget went to

the social sector till recently – 15% to health, and 25% to education); good communication

and transport (newspapers, telephones, rural roads); land reforms (land distributed to the

poorest and the landless) which helped reducing inequality in land and income; and Christian

missionaries who started schools and hospitals, mostly in rural areas. Overall, the

achievements of Kerala seem to result from a relatively fair distribution of wealth and

resources across nearly the entire population of the state.

The urgent need for public delivery of health care services is increasingly being recognized

and has drawn considerable attention in recent years. Kerala’s remarkable achievements in

health care were to a large extent based on its vast network of public health institutions which

enabled her to earn the fame of ‘Kerala Model of Health’ worth emulating even by advanced

countries. The hall mark of this model was the low cost of health care, universal accessibility

and availability to the poor sections of the society. This health model was made possible by

many socio-economic conditions, important among which was the high female literacy rate in

the state. Apart from these, the extensive network of medical care institutions in modern

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medicine, homeopathy and ISM has also made this possible. Despite all these, Kerala faces

some major problems in the health sector at the beginning of the 21st century. Difficult access to

health care owing to high out of pocket health care expenditure has resulted in the impoverishment of

a sizeable segment of the population. Kerala’s total health care system spread across villages and

communities consists of institutions in Government sector, co-operative sector, and in private sector

with systems of treatment in allopathy, ayurveda, homeopathy, sidha, unani and naturopathy.

Table 3-Basic Health Indicators – Kerala & India

Sl. No. Health Indicators Kerala India

1 Birth rate (‘000

population)

14.7 23.1

2 Death rate (‘000

population)

6.8 7.4

3 Infant mortality rate

(‘000population)

13 55

4 Child mortality rate

(‘000 population)

3 17

5 Maternal mortality

rate (per lakh live

birth)

110 301

6 Total fertility rate

(children per women)

1.7 2.9

7 Couple protection

rate (in percent)

48.28 (2009) 46.6 (2005)

8 Life at birth Male 71.3 62.3

Life at birth Female 76.3 63.9

TOTAL 73.8 63.1

Source: Directorate of Health Service (DHS)

Table 4- Treatment Expenditure in Kerala (in Rs)

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Sl. No. Population

Group

Morbidity

Rate

Expense for

one time

Percapita

Treatment

Expenditure

% of total

family

expense

1 Extremely

Poor

85.1 701.9 1552.9 31.7%

2 Poor 82.1 613.5 1309.7 18.1%

3 Lower

Middle Class

78.1 886.9 1801.0 13.0%

4 Upper

Middle Class

73.9 1686.1 3238.5 10.4%

Total 79.2 830.7 1722 13.9%

Source: Kerala Padanam, Kerala Sasthra Sahithya Parishad, 2004

Morbidity rate has decreased from 85.1 in 1000 in extremely poor group to 73.9 in upper

middle class. Though it shows that morbidity rate has decreased, treatment expenditure has

increased. Percapita treatment expenditure has increased from Rs89 in 1987 to Rs1722 in

2004. This can be treated has a huge increase while taking inflation into consideration. The

changes in technology and treatment methods, increased use of laboratory tests and scans,

and rise in price of medicines could be some of the reasons for this. There has been not much

change in the first three income groups. Whereas treatment expenditure for the fourth group

of people stands high when compared with other three showing that advanced technology and

methods of treatment can be availed only by people of high income.

Table 5- Treatment Expense Percapita in Kerala (in Rs)

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Sl. No. Item Extremely

Poor

Poor Lower

Middle

Class

Upper

Middle

Class

Total

1 Medicines 714.5 527.4 578.8 1196.4 622.5

2 Hospital

Fee

192.0 172.7 164.6 252.9 175.3

3 Lab 76.8 128.6 160.6 717.3 181.5

4 Others 569.6 481.0 897.0 1071.9 742.7

Source: Kerala Padanam, Kerala Sasthra Sahithya Parishad, 2004

Treatment expenditure and other expenditures like medicines are an important factor. There

is a greater difference between people belonging to different income group. While people

belonging to upper middle class avail routine check-ups and conducts tests & scans

unnecessarily, people belonging to lower income are not even able to avail necessary tests.

Table 6- Treatment Area (in %)

Sl. No. Income Group Government Private Self/Others

1 Extremely Poor 50.8 44.6 4.3

2 Poor 38.3 59.0 2.4

3 Lower Middle

Class

23.0 73.6 3.0

4 Upper Middle

Class

9.2 84.9 3.3

Total 31.6 64.4 4.1

Source: Kerala Padanam, Kerala Sasthra Sahithya Parishad, 2004

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More than 80% of people belonging to upper middle class depend solely on Private hospitals

for treatments and only half of the extremely poor category of people depends on

Government hospitals and PHCs for treatment. The perceived quality of care seems to play

an important role in the choice of the provider, irrespective of household income. As the

quality of public service is perceived to be poor, people increasingly seek private care. The

cost implications of this are serious, with the poorer segments of the population devoting a

sizable proportion of their income to health care.

Low mortality, high morbidity, and high utilization of private care summarize the story of

health care in Kerala. The use of private care, with the associated out-of-pocket expenditure,

is a heavy burden on the poorer segments of the population. As in the other states of India,

only a small proportion of Kerala's population is gainfully employed in the organized sector

with some financial protection against the cost of ill health. The large unorganized sector—

farming, household manufacturing, and services—provides no financial protection against the

cost of illness, leading to high levels of financial distress and dragging down productive

investment and income generation. Furthermore, the lack of access to health care belies

Kerala's image of providing good health at low cost.

CHAPTER 3

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COMPANY PROFILE

Cryobanks International India a JV between Cryobanks International USA and RJ Corp

founded in 2006. Cryobanks International is a leader in the collection, processing and

banking of umbilical cord blood stem cells. Cryobanks International provides a Private Cord

Blood Storage Program for expecting families that wish to privately store their baby's

precious stem cells and a Public Cord Blood Donation Program for those who prefer to

donate. 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. 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.

Other facilities of the group are in Greece, India and Thailand.

RJ Corp is a well diversified Indian MNC, with business interests in soft beverages,

breweries, real estate, hospitality, healthcare, education, dairy, food service and retail, with an

annual turnover of over 15 billion rupees. The first signs of economic liberalization signalled

the entry of Pepsi into India in 1991 and with it started the journey of partnering Pepsi in their

beverages business in India. In 1993 Devyani Beverages Ltd was set up to take the Pepsi

bottling operations forward. Currently there are 9 bottling plants operating across the

country.   The current capacity is 35 million cases per annum during the peak season. In 1995

Varun Beverages was created and Devyani Beverages was merged with it in October 2004.

Devyani International Limited is the food service/retail arm of the group and is uniquely

placed with a portfolio of 3 international brands in the quick service restaurant space. (Pizza

Hut, Costa Coffee, KFC)

Group’s foray into the healthcare business started in 2005 with a tie up with Cryobanks in the

US for the storage of stem cells. The business has mushroomed and is on the verge of

explosive growth. The year 1992 heralded our appearance in the ice cream industry with

Gaylord. After being a key supplier to HLL in India for many years, in 2003 we launched

Cream bell ice creams with Candida of France in 2003. With a manufacturing facility in

Baddi to start with, we are now on threshold of starting another unit in Panda district in Goa.

  

Group has been associated with education. It strongly believes that investment in quality care

and education for young minds is essential for the future growth and development of our

country. The group’s foray into Secondary & pre-school education is in line with educational

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projects of the group. The Group has entered into a joint venture partnership with Modern

Montessori International (MMI) Singapore, to open pre-school educational institutions across

the country and franchise agreement with DPS at Gurgaon and Jaipur.

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 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 15000 samples of stem cells till date .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.

Cryobank has a bank in Gurgaon with a network of 200 thalassaemia patients and nearly

3,000 medical practitioners. The company is setting up cord blood banks in Chennai,

Mumbai, Bangalore, Kolkata and Hyderabad. It is also setting up collection and counselling

facilities in cities like Coimbatore, Erode, Madurai, Vellore and Pondicherry. Cryobank also

provides a public banking facility, which means that parents can place the umbilical cord of a

newborn for public use. There are 2.5 million registered deliveries in India every year. “This

means potentially, these many donors every year,” Nerikar said. Once the sample is HLA

typed, it is in a registry. It can be accessed by anyone who needs the cord cell type and can

revolutionise thalassaemia and leukaemia therapy.

3.1. 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.

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3.2. 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.

3.3. Cryobank advantage over other banking companies

Cryobanks International India is the first “ State of the Art” cord blood stem cell bank

to be set up in India.

They have set up a 14,000 square feet, state-of-the-art stem cell processing and

banking facility in Gurgaon, Haryana. 

This brand new 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 greatly reduces

the possibility of contamination of cord blood. 

National coverage - Facility of collection is being provided from all major cities in

India. 

Certified team of medical professionals have been extensively trained and educated in

cord blood processing and Quality Assurance at Cryobanks International, Inc.,

U.S.A. 

The storage facility is an earth quake resistant building i.e. it is a concrete structure. 

All equipment is backed up for 24 hours with UPS and Generators, in case of a power

failure. 

Adequate fire fighting measures such as automatic sprinklers and alarm systems are

present throughout the building.

Laboratory operating 24 x 7. 

Flexible payment plans that offer hope for your family 

The facility is been fitted with a Central Monitoring system which monitors the

temperature, humidity and pressure, 24*7 to ensure a controlled environment as

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required for Current Good Manufacturing Practices and Current Good Laboratory

Practices

3.4. Processes

The company has an established sales force wherein trained medical representatives who visit

the prospective client's home and explain the concept, collection and processing, and provide

confidence on the storage facilities.

Cryobank follows Processes in accordance with international standards and has ensured that

thye follow the best practices in every step of the way. Cryobank gives presentation to clients

interested in stem cell banking at any time of their convenience. The following are the

various processes involved:-

3.4.1. The Registration Process: Simple procedure where one is required to complete

and sign an enrollment form that includes mother-to-be's health history form and a client

agreement form. Once the paperwork and payments are done, Cryobank send a cord

blood collection kit that is be used to collect the umbilical cord blood after the delivery of

your baby.

3.4.2. Pre-Collection: The registered client will get a specialized cord blood collection

kit which contains everything their doctor needs, including instructions, to collect the

cord blood. Most doctors do not have a problem performing this simple procedure.

However, it is essential that the client discuss their decision to bank their baby's cord

blood and check with the doctor prior to collection whether they will perform the

procedure. All that the client need to do after this is to make a call to let Cryobank know

that the client is about to deliver the baby. They will immediately dispatch a courier to

the hospital who will then pick up the cord blood once it is collected, packed and ready to

be shipped.

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3.4.3. Collection Process: The doctor in charge performs the collection process. The

collection of the cord blood is done immediately after the baby is born when the

umbilical cord is clamped and cut to stop the outflow of the blood present in the cord. As

collection can be performed in-utero or ex-utero, this choice is left to the doctor who is

the best judge of the situation. Depending on whether the birth is a vaginal delivery or a

caesarean section, the doctor can make a decision on collecting before or after the

delivery of the placenta. The collection of the cord blood is a simple and short procedure

that does not take more than 10 minutes. After the baby is born, the doctor will clean and

sterilize the umbilical cord with the iodine and alcohol swabs provided in our kit. Once

cleaned, the sterile needle, with one end attached to the blood collection bag, is inserted

into the maternal side of the cord. The blood is allowed to flow by gravity into the bag.

This usually takes 3-5 minutes and when there is no more blood left, the needle is taken

out and reinserted into the umbilical cord, closer to the placenta. This allows some

remaining blood to be collected, thus increasing the total volume of blood collected.

After collection of the blood, the needle and connecting tube is cut and removed, and the

tubing emerging from the bag is stripped, clamped and knotted twice. The blood bag is

carefully placed in a plastic bag and the bag sealed. The cord blood bag is packed in

between the two gel packs which are placed on either side of the bag to maintain the

temperature. The bag is then sealed in the box provided in the kit and a customer

information card is filled out and placed along with the box in a kit container, which is

then handed over to the courier.

3.4.4. Shipping of Cord Blood: When the client register with Cryobank, the help in

arranging for a suitable courier who will transport the cord blood to them, safely. The

best suitable logistics plan is offered to the customers and Cryobank bear the courier

charges. Once customer leaves for the hospital, they should call Cryobank so that they

are able contact the courier on customer’s behalf. The courier collects and safely

transports the cord blood to the lab .

3.4.5. Processing Of Cord Blood: As soon as Cryobank receives the cord blood, they’ll

inform parents of the safe arrival of the sample. The maternal and cord blood sample is

tested for bacterial and viral infections when it arrives at the Cryobank India lab. This

testing is necessary to check the status of the sample and to see if any infection is present

in the blood. This is a mandatory requirement as per the cord blood banking regulations.

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3.4.6. Reporting Test Results: All the results of tests performed on maternal and cord

blood are documented and a report is prepared and sent to all our customers. If samples

test positive for any transfusion transmissible infections (TTIs), the parents are duly

informed. The cord blood may either have to be quarantined or discarded. In such cases

we discuss the issue with parents before any further steps are taken.

3.4.7. Storage of cord blood Stem Cells: If the cord blood is found fit for storage after

processing, they’ll store the cord blood in Cryo-bags by controlled rate freezers, cooled

by Liquid Nitrogen (which takes the temperature of the cord blood from 40 Celsius to -

196  Baby's cord blood sample is stored in a set that constitutes a 20ml main

3.5. EMI Payment schemes

The cost of harvesting, processing and storing stem cells is about Rs 35,000 ($850) but this is

too expensive for the common man. That is why stem cell bank Cryobank International offers

a first payment option of Rs 8,500 ($200) to store cord cells. The remainder is collected as

EMIs of Rs 3,000 ($75) and the EMI period can be stretched to 11 months or even 21

years. Such schemes have made it possible for people from low-income groups to access the

path-breaking technology. Those families that cannot raise the money at the time of birth can

bank the cord blood in the public domain and then arrange for it to be transferred for

exclusive use. Cryobank believes that very parent should have the right to bank, provided

they believe in it.

CHAPTER 4

RESEARCH OBJECTIVES AND SCOPE OF RESEARCH

PROJECT

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4.1. PRIMARY OBJECTIVE

To conduct a market research on the awareness of stem cell banking technology

among the Gynecology and Obstetrics out patients of various hospitals in

Trivandrum, Kerala.

4.2. SECONDARY OBJECTIVE

To collect data on the reason for the selection of clinic among Gynecology and

Obstetrics (ObGyn) out patients at various hospitals.

To know the satisfaction level of the Gynecology and Obstetrics out patients on the

various services provided by the clinic.

To know the reason for the unawareness of stem cell banking technology among the

Gynecology and Obstetrics out patients

4.3. SCOPE AND SIGNIFICANCE

Scope: The study is to understand the awareness of stem cell banking technology among the

Gynecology and Obstetrics out patients at hospitals and the various factors that results in the

unawareness of the technology. The study thus provides information on the preferences made

by the patients in choosing the clinic/hospital. Since stem cell banking technology is

considered as an expensive technology, income of the patients is also a critical factor in this.

Thus study helps to know which classes of customer choose which type of clinics, their

preferences and their awareness level on stem cell banking technology.

Significance: With more than 80,000 births a day or 26 million births a year, India is poised

to be the largest source for umbilical cord blood in the world. It's no surprise then that leading

stem cell banking companies are keenly eyeing India. The investments are considerable and

mostly run into millions of dollars. Analysts estimate that Indian stem cell banks, which are

currently at Rs 100 crore, would generate Rs 2,700 crore in revenues by 2012, accounting for

17 per cent of the world market. As of now, there are more than six players in this five-year-

old market. Most of these cord blood banking companies are having an overseas parent

company which is responsible for the initial investment.

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CHAPTER 5

RESEARCH METHODOLGY AND LIMITATION

5.1 RESEARCH PLAN

5.1.1 PRELIMINARY INVESTIGATION

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The study is conducted based on Questionnaire to collect the necessary data; the

questionnaire was distributed among the Gynecology and Obstetrics out patients at

various hospitals who are expectant mother.

5.1.2 TOOLS OF COLLECTION OF DATA

a. Primary data:

The tools used for collection of primary data were Questionnaire. The

questionnaire was provided by Cryobank for the collection of data. It

was constructed in a manner of getting maximum information from the

expectant mother and her family.

b. Secondary data:

The Secondary data mainly consists of data and information collected

from company records; company profiles offices records and also

discussion with employees of the organization

Internet

Brochures

5.2 SAMPLING PLAN

5.2.1 SAMPLING UNITS

The units chosen for the study as sample generally speaking are the Gynecology and

Obstetrics out patients at various hospitals who are expectant mother.

5.2.2 SAMPLING TECHNIQUES

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The technique employed for the sampling in this study is mainly the identification of

expectant mothers from the Gynecology and Obstetrics out patients at hospitals to whom

the instrument or tool can be distributed to collect the primary data.

5.2.3 RESEARCH INSTRUMENT

The research instrument used for the study was an open ended and well structured

questionnaire.

5.2.4 CONTACT METHOD

Communication with the patients and employees of Cryobank took place frequently.

Researchers were given opportunity to interact with the expectant mother and staffs of

Cryobank and the doctors of various hospitals where the survey was taken place to

discuss and get their responses informally.

5.3 SAMPLE SIZE

A sample of 130 expectant mothers was chosen. Questionnaires were distributed to

each out patient, inviting their suggestions.

5.4 DATA COLLECTION INSTRUMENT DEVELOPMENT

While preparing the questionnaire, the key factors that contribute towards the topic

have to be considered. This enables the construction of the questionnaire easier.

Before delivering the questionnaire, plotting or testing the questionnaire effectively is

very important. The reasons for this are:

To test how long it takes to complete

To check that the questions are not ambiguous

To check that the instructions are clear

To allow one to eliminate questions that do not yield usable data

Developing a checklist for the questionnaire can help spot any of the common mistakes that

apply to your questionnaire developed. Some of the important things to be kept in mind are:

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Avoid all leading questions

Make the questions as specific and simple as possible.

Make sure all questions are understandable to all the respondents.

Applicability of the questions to all the respondents

Make sure none of the questions are double-barreled

5.5 RESEARCH LIMITATION

Similar to the case of most research conducted, the research conducted for this project

had its own limitations. These limitations may have contributed to results and

suggestions which may have been different if some of them could have been avoided.

Most of the hospitals were reluctant to give permission to do such a survey as they

believed, this could result in violation of medical ethics. Mostly this was due to poor

awareness about the underlying issues.

Limited number of patients - the survey was done among 120 out patients. The reason

behind this being the unwillingness of patients to take part in the survey

Time – time was yet another limitation as such a survey and analysis cannot be done

within a short duration of two months

Less Educated people – Some of the patients who undergone the survey were less

educated. So it was very difficult to make them understand about the scientific details

on stem cell and stem cell banking technology.

CHAPTER 6

DATA ANALYSIS, INTERPRETATION AND

PRESENTATION

Table 7- MONTHLY INCOME OF THE SAMPLE POPULATION

Sl. No Monthly Income No. Of Respondents Percentage (%)

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1 Less than Rs20,000 43 37%

2 Rs20,000-Rs50,000 71 62%

3 Rs50,000-Rs80,000 1 1%

4 Rs80,000 and above 0 0%

Less than Rs.20,00037%

Rs.20,000-Rs.50,00062%

Rs.50,000-Rs.80,0001%

Monthly Income

In Kerala, normally people with a monthly income of less than 20,000 or 10,000 depends on

Government owned hospitals and health centres for treatment whereas a bit higher income

group depends on private clinics which are not too luxurious and costly.

When it comes to stem cell banking, on an average Rs70,000 has to be paid by the client for

the storage of umbilical cord for 21years. Though companies have come out with EMI

schemes of payment, each client has to pay an initial cost of Rs10,000- Rs25,000 which is 3 -

5 times higher than the average expenditure for a Childbirth incurred at a Government

hospital and twice the charge of a private clinic/hospital.

Table 8- SHOWING REASON FOR THE SELECTION OF CLINIC

Sl. No. Reason for selection

of Clinic

No. Of Respondents Percentage (%)

1 Proximity to home 75 36%

2 Affordability 35 17%

3 Experience & Good

Nature of Doctor

98 46%

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4 Family Doctor 3 1%

Proximity to home36%

Affordability17%

Experience & Good Na-ture of the

Doctor46%

Family Doctor1%

Reason for selection of clinic

Most people wish to visit clinic that are near to their place of stay. Experience and good

nature of doctor is also another reason for the selection of clinic. People with a monthly

income of less than 20,000 also take affordability into consideration while choosing the

clinic. They depend largely on Government owned hospitals and private hospitals which are

not too costly. Proximity and experience of the doctor plays a major role.

Thus it shows that if any medical concept has to be rolled out, the doctors have to be taken

into the loop. It is better to set up a marketing and sales force structure which is just like a

pharma company that gets in touch with the obstetrician, gynaecologist on regular basis and

have tie-ups with the hospitals and get pregnant patient population from them. Thus emphasis

should be more on doctors and hospitals to make people aware of stem cell banking.

Table 9- SHOWING REASONS FOR SELECTION OF CLINIC

Sl. No. Reasons for selection

of clinic

No. Of Respondents Percentage (%)

1 Proximity to home &

Experience and Good

Nature of Doctor

45 39%

2 Proximity, 16 14%

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Experience of Doctor

& Affordability

3 Affordability &

Experience of Doctor

17 15%

4 Proximity &

Affordability

6 5%

5 Experience and Good

Nature of Doctor

21 18%

6 Family Doctor 3 3%

7 Proximity to home 7 6%

8 Affordability 0 0%

Proximity to home & Ex-perience and Good Nature

of Doctor39%

Proximity, Experience of Doctor & Affordability

14%

Affordability & Experience of Doctor

15%

Proximity & Affordability5%

Experience and Good Na-ture of Doctor

18%

Family Doctor3%

Proximity to home6%

Table 10- SHOWING AWARENESS ON STEM CELL BANKING

Sl. No. Awareness on stem

cell banking

No. Of Respondents Percentage (%)

1 Yes, Aware 21 18%

2 No, Not Aware 94 82%

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Yes18%

No82%

Awareness on stem cell banking

Table 11- SHOWING RESPONDENTS WHO WOULD LIKE TO KNOW MORE

ABOUT STEM CELL BANKING

Sl. No. Like to know more

about stem cell

banking

No of Respondents Percentage (%)

1 Yes, I wish to know 30 26%

2 No, I don’t wish to 85 74%

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know

Yes26%

No74%

Like to know more about stem cell bank-ing

Lack of awareness among the people about the benefits that can be gained from the storage of

cord blood is a key reason for small customer base in Kerala. The study shows that when it

comes to preventive healthcare (“futuristic” healthcare), there is very little concern among the

people. Stem cell banking requires a customer base that has a high concern in preventive

healthcare. Technical and scientific nature of the process involved normally creates a

disinterest among the clients. They never show interest in such details.

Rarity of the diseases that Cord blood banking aspires to cure/treat is crucial. For example,

Cancers and other Genetic/Congenital diseases, though devastating for the family and the

patient, are very rare in incidence in the society at large. Hence the disinterest is somewhat

justified.

Table 12- Awareness about stem cell banking

Sl. No. Criteria No. Of.

Respondents

Percentage

(%)

1 Not aware of stem

cell banking & like

to know more

24 21%

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about it

2 Not aware of stem

cell banking &

don’t want to

know more about

it

71 62%

3 Aware of stem cell

banking & don’t

want to know

more about it 14

12%

4 Aware of stem cell

banking & like to

know more about

it

6 5%

Not aware of stem cell banking & like to know

more about it21%

Not aware of stem cell bank-ing & dont want to know

more about it62%

Aware of stem cell banking & dont want

to know more about it12%

Aware of stem cell banking & like to know more about it

5%

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0

20

40

60

80

Series1

Though stem cell banking technology is an ultimate preventive, it is considered as a luxury

because of high cost barrier. Thus a person who knows about the technology doesn’t show

any interest in it. People normally have a belief that the need for cord blood is not great and

their child—or other children—will hopefully never need a transplant with this lifesaving

blood. They also state that one in 1000 or 10,000 families that bank cord blood actually use

the blood at some date. Thus, just like any other insurance policy, the cord blood is there if it

is needed. 

less than Rs20,00013%

Rs20,000-Rs50,000

88%

Not aware of stem cell banking & like to know more about it- 24

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less than Rs20,000

52%

Rs20,000-Rs50,000

47%

Rs50,000-Rs80,0001%

Not aware of stem cell banking & dont want to know more about it- 71

less than Rs20,000

21%

Rs20,000-Rs50,000

79%

Aware of stem cell banking & dont want to know more about it -14

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less than Rs20,00017%

Rs20,000-Rs50,000

83%

Aware of stem cell banking & like to know more about it -6

CHAPTER 7

SUGGESTIONS, RECCOMENDATION AND CONCLUSION

7.1 FINDINGS

In Kerala, normally people with a monthly income of less than 20,000 or 10,000

depends on Government owned hospitals and health centres for treatment whereas a

bit higher income group depends on private clinics which are not too luxurious and

costly. When it comes to stem cell banking, on an average Rs70,000 has to be paid by

the client for the storage of umbilical cord for 21years. Though companies have come

out with EMI schemes of payment, each client has to pay an initial cost of Rs10,000-

Rs25,000 which is 3 - 5 times higher than the average expenditure for a Childbirth

incurred at a Government hospital and twice the charge of a private clinic/hospital.

36 | P a g e

Most people wish to visit clinic that are near to their place of stay. Experience and

good nature of doctor is also another reason for the selection of clinic. People with a

monthly income of less than 20,000 also take affordability into consideration while

choosing the clinic. They depend largely on Government owned hospitals and private

hospitals which are not too costly. Proximity and experience of the doctor plays a

major role.Thus it shows that if any medical concept has to be rolled out, the doctors

have to be taken into the loop. It is better to set up a marketing and sales force

structure which is just like a pharma company that gets in touch with the obstetrician,

gynaecologist on regular basis and have tie-ups with the hospitals and get pregnant

patient population from them. Thus emphasis should be more on doctors and hospitals

to make people aware of stem cell banking.

Lack of awareness among the people about the benefits that can be gained from the

storage of cord blood is a key reason for small customer base in Kerala. The study

shows that when it comes to preventive healthcare (“futuristic” healthcare), there is

very little concern among the people. Stem cell banking requires a customer base that

has a high concern in preventive healthcare. Technical and scientific nature of the

process involved normally creates a disinterest among the clients. They never show

interest in such details. Rarity of the diseases that Cord blood banking aspires to

cure/treat is crucial. For example, Cancers and other Genetic/Congenital diseases,

though devastating for the family and the patient, are very rare in incidence in the

society at large. Hence the disinterest is somewhat justified.

Though stem cell banking technology is an ultimate preventive, it is considered as a

luxury because of high cost barrier. Thus a person who knows about the technology

doesn’t show any interest in it. People normally have a belief that the need for cord

blood is not great and their child—or other children—will hopefully never need a

transplant with this lifesaving blood. They also state that one in 1000 or 10,000

families that bank cord blood actually use the blood at some date. Thus, just like any

other insurance policy, the cord blood is there if it is needed. 

7.2 RECCOMENDATIONS

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Cryobanks have already geared up to capitalize on the upcoming potential. The need of the

hour is to increase the number of repository of cord blood samples. To achieve this action

recommended may include the following:

Building awareness –establishing collection centers

Providing training for the specialized & contamination free collection process

Tie –up with hospitals engaged in cord blood based treatment: Cryobank at present

has tie-ups with selected number of hospitals in Kerala. These hospitals are mainly

chosen by people belonging to upper middle class and business class of the society.

Rather than concentrating only on a few segments of the society, they should target all

classes. This study on awareness of stem cell banking proved that most people visit

hospitals mainly because of two reasons: proximity to home and experience & good

nature of doctor. So they should target hospitals and doctors also.

Counselling, Meetings, Talks and Awareness Campaigns:

Conducting counselling and awareness campaign and talk shows at companies could

help to target more customers. IT and business parks like Technopark, Infoparks in

Kerala are a great source of young, talented and educated minds. People who get

benefitted through these talks and campaigns may contact Cryobank in future for

banking.

Seminar cum Dinner meetings for doctors.

Diversify into public cord blood banking

The Company needs to find people or specific groups that can really benefit from its

services, for example, families with many generations affected by genetic diseases

like Thalassemia, Muscular Dystrophies and various kinds of Leukaemias or people’s

Welfare initiatives and NGOs like the Multiple Sclerosis Society, or Cancer societies.

These can bring the target population closer to the services offered by CryoBank.

Persuading people who are directly or indirectly affected by the diseases is much

easier and fruitful than persuading people who only have a vague idea of how

38 | P a g e

impactful the disease can be. This is important considering the fact that all the

diseases where Cord blood banking has a role are very rare in incidence in the general

population.

Considering the special situation in Kerala, where the Government has initiated health

insurance/ health card schemes for the people with incurable genetic diseases like

haemophilia, thalassemia, sickle cell anaemia etc, the possibility of tie ups with the

Government need to be explored. This is especially important when it comes to the

Tribal populations that have a greater than average incidence of genetic diseases like

Thalassemia, Sickle cell Anaemia etc due to heavy inbreeding.

7.3 CONCLUSION

Despite medical expertise India’s global share in cord blood based surgical treatment is a

meagre 0.25 %.( 20 out of 8000 cord blood transplants). Major break through in stem cell

research promising low cost treatment is attracting foreign players in India. While

advancement in stem cell therapy would provide solutions to incurable and severe injuries, an

established cord blood banking sector in the country would widen the compass of

beneficiaries by making these affordable for the masses.

There is enormous potential for further growth in the cord blood banking sector in a well-

educated society like that of Kerala. However there is a need to devise specific measures for

making the concept aware among the public. Right awareness could be the first thing. Cord

blood banking when started in India was an expensive proposition. It is still considered that

only a particular group of the society can think and avail this technology. This involves a

thorough evaluative decision rather than a spontaneous one. There is also a huge shortage of

39 | P a g e

the right kind of people in Kerala. Since stem cell banking is a people-driven business, the

concept need to be understood by the people. Non availability of trained man power is also

there since the industry is very nascent. The technology requires huge funds. Further more,

researches are taking place across the globe. Once this technology gets outdated due to the

invention of some other cheap source of stem cells, it affects the entire industry in a bad way.

REFERENCES

Economic Review, Directorate of Health Services, Govt of Kerala, 2009

Kerala Padanam, Kerala Sasthra Sahithya Parishad, 2004

Cord Blood Banking- Opening New Vistas for Medical Tourism Industry in India, Saboohi Nasim and Kiran K Momaya

Websites:

www.wikepdia.org

www.cryobanksindia.com

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