Our Sibling Connection Program

ViaCord's Newborn Stem Cell Donor Program

What is the Sibling Connection Program?

Helping those who need it most.

This Sibling Connection program provides ViaCord's high-quality cord blood collection, processing, and lifetime storage (78 years) at no cost to expecting parents who have a child that meets the enrollment requirements of the program. 

The Sibling Connection program may be available to any expectant family with a child who has an established diagnosis that is currently treatable with a sibling cord blood transplant.

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Download Our Brochure in English
 
Download Our Brochure in Spanish

Who Is Eligible for The Sibling Connection Program?

Eligible Criteria:

✔    The baby whose cord blood will be stored must be a full sibling (same biological parents) of the child in need. 

✔    The child in need must have one of the diseases that are currently treatable with sibling cord blood in transplant (see the list of eligible diagnoses below).


What Is The Process?

Next steps for parents-to-be interested in the Sibling Connection program

1.    Talk to your child's physician about the Sibling Connection program to find out if it's right for you.

2.    Call our Sibling Connection program specialists at 866-861-8435 

3.    Complete required forms - see below.

4.    Upon approval, a ViaCord collection kit will be sent to your home and a letter will be sent to the delivery medical professional with cord blood collection training materials. 

5.    Bring your ViaCord collection kit to the hospital on the day of delivery. 

IMPORTANT TIPS: Let your doctor know that you're collecting the cord blood and your intention to potentially use it for another child.  Remind the doctor to thoroughly clean the cord and collect as much cord blood as possible.


Required Forms for Enrollment

The below forms must be completed and returned to ViaCord prior to enrollment.

To complete the ViaCord Sibling Connection Enrollment process please see below. Completed forms are required by parent(s) and the doctor caring for the sibling with the qualifying condition.

PARENT REQUIRED FORMS
Parent(s) must complete three forms for enrollment: 1) Health History Questionnaire  2) Service Agreement and 3) Maternal Testing Informed Consent. The Mother's Health History Questionnaire is required should you need to use your newborn's stem cells in the future. Please download the required forms in your preferred language below:

1) Health History Questionnaire

English:         Mother  (Required),  Father  (Required for New York state residents only)

Spanish:        Mother  (Required),  Father  (Required for New York state residents only)


2) Service Agreement 

English:        Service Agreement  (Required)

Spanish:       Service Agreement  (Required)


3) Maternal Testing Informed Consent 

English:        Informed Consent  (Required)

Spanish:       Informed Consent  (Required)


DOCTOR REQUIRED FORMS
The appropriate Medical Referral Form must be completed by the doctor caring for the sibling with the qualifying condition (the newborn must be a full sibling). Find and download the appropriate medical referral form from the Eligible Diagnoses list below. 

The simplest way to return your completed forms is to e-mail them to siblingconnection@viacord.com. You can also fax them toll-free to 1-781-240-8427


Eligible Diagnoses for ViaCord's Sibling Connection Program

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CLICK HERE TO DOWNLOAD MEDICAL REFERRAL FORM

Acute lymphoblastic leukemia (ALL)
Acute myeloid leukemia (AML)
Burkitt's lymphoma Chronic myeloid leukemia (CML)
Chronic myelomonocytic leukemia (CMML)
Hodgkin's lymphoma
Juvenile myelomonocytic leukemia (JMML)
Lymphomatoid granulomatosis
Myelofibrosis
Myelodysplastic syndrome (MDS)
Non-Hodgkin's lymphoma

 


Bone Marrow Failure Syndromes

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Amegakaryocytic thrombocytopenia
Autoimmune neutropenia (severe)
Congenital dyserythropoietic anemia
Congenital sideroblastic anemia
Diamond-Blackfan anemia
Dyskeratosis congenita
Evan's syndrome
Fanconi anemia
Glanzmann's disease
Kostmann's syndrome (Severe Congenital Neutropenia)
Severe aplastic anemia
Shwachman syndrome
Thrombocytopenia with absent radius (TAR syndrome)

 


Blood Disorders

CLICK ON THE BLOOD DISORDER BELOW TO DOWNLOAD THE MEDICAL REFERRAL FORM

Sickle-cell anemia (hemoglobin SS)
Sickle βo Thalassemia α-thalassemia major (hydrops fetalis)
β-thalassemia major (Cooley's anemia)
β-thalassemia intermedia
E-βo thalassemia
E-β+ thalassemia


Metabolic Disorders 

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Adrenoleukodystrophy
Alpha mannosidosis
Fucosidosis
Gaucher's disease (infantile)
Gunther disease (congenital erythropoitic porphyria)
Hermansky-Pudlak syndrome
Hurler syndrome
Hurler-Scheie syndrome
Hunter syndrome
Krabbe disease (globoid cell leukodystrophy)
Lesch-Nyhan disease
Maroteaux-Lamy syndrome
Metachromatic leukodystrophy
Mucolipidosis Type II, III
Niemann Pick Syndrome, type A and B
Sandhoff Syndrome
Sanfilippo syndrome
Sly syndrome
Tay-Sachs Disease
Wolman Syndrome


Immunodeficiencies

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Adenosine deaminase deficiency
Ataxia telangiectasia
Chronic granulomatous disease
Complete IFN-γ Receptor 2 Deficiency
DiGeorge syndrome
IKK gamma deficiency
Immune dysregulation polyendocrineopathy
Leukocyte adhesion deficiency
LRBA deficiency
Myelokathexis X-linked immunodeficiency
Omenn's syndrome
Reticular dysplasia
Severe combined immunodeficiency
Thymic dysplasia
Wiskott-Aldrich syndrome
X-linked agammaglobulinemia
X-linked lymphoproliferative disease
X-linked Mucolipidosis, Type II


Other Conditions

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Juvenile Dermatomyositis 
Osteopetrosis
Langerhans cell histiocytosis
Hemophagocytic lymphohistiocytosis