Why Moms Can and Do Donate to Human Milk Banks

Diane L. Spatz, PhD, RN-BC

Disclosures

August 12, 2016

In October 2015, The Children's Hospital of Philadelphia (CHOP) opened the 18th milk bank in the United States under the umbrella of the Human Milk Banking Association of North America (HMBANA). In 2016, to date the CHOP Mothers' Milk Bank has pasteurized and dispensed more than 13,000 ounces of milk.

Pasteurized donor milk is available from both nonprofit and for-profit organizations in the United States. Nonprofit milk banks are part of the HMBANA network and have a shared set of standardized milk-banking practices. HMBANA has an interdisciplinary board, with representatives from HMBANA milk banks as well as external board members from a variety of professions.

Milk Bank Donors

Why do mothers with extra milk donate to a human milk bank? Optimistic and altruistic motives are the primary reasons for donation to an HMBANA milk bank.

Mothers may find themselves with too much milk that they would rather not discard, and by donating their milk they are giving a tangible gift that they know will benefit other infants. They have seen the benefits of providing their milk to their own children. Mothers who are familiar with the needs of HMBANA milk banks and the infants they serve are motivated to donate their extra milk and report positive emotions and a willingness to donate again if given the opportunity. Healthcare providers can influence a mother by recommending donation of her excess milk to a HMBANA milk bank.

Some bereaved mothers also choose to become donors to HMBANA milk banks. Some mothers know during pregnancy that their infants have a fatal diagnosis, and others have infants who die after a long hospitalization. Bereaved mothers report that by donating their milk, they give meaning to their child's life. They report that donating their milk helps in the grieving and healing process and may help them achieve a sense of closure.

The HMBANA Milk Banking Process

Mothers who wish to donate milk must go through a rigorous screening process. The first step is a verbal health screening. The mother then completes a lifestyle questionnaire related to her health, her infant's health, and her lifestyle and dietary practices, as well as an extensive health history. A healthcare provider must complete a screening form for the mother, reporting her health status and laboratory testing from pregnancy. In addition, the infant's healthcare provider must complete a form stating that the infant is in good health, is growing well, and is breastfeeding well.

A milk bank coordinator then reviews all of these materials and verbally confirms the information with the potential donor, who gives written consent to be a donor. At this point, donors undergo serologic testing for HIV, HTLV1, HTLV2, hepatitis A, hepatitis B, and syphilis. The cost of the laboratory testing ($200-$300) is paid by the milk bank.

Once a mother has passed all screening and her blood work is negative, she is approved to be a donor. Mothers can make a one-time donation or be repeat donors. If a mother continues to be a regular donor, the milk bank staff will follow-up regularly to ensure the mother has had no changes in her lifestyle or health.

Milk is transported to HMBANA milk banks using a variety of methods (in person drop-off, courier service, milk depots in the community, and shipping). Raw milk is stored frozen until ready to be prepared for pasteurization. Raw milk is thawed, pooled, poured, and then pasteurized, and cultured after pasteurization to ensure that there is no bacteriologic growth. After pasteurization, the milk is stored frozen. Once the milk culture comes back negative, milk can be dispensed to donor recipients.

In the United States, most HMBANA milk is donated to hospitals with neonatal intensive care units. Pasteurized donor human milk is mostly used for preterm infants or other vulnerable infants. However, some data support the use of donor milk for term infants or late preterm infants, if supplementation is required during the hospital stay. In the community setting, a prescription from a health professional is required for the milk bank to dispense pasteurized donor milk to a home.

Pasteurized donor milk from HMBANA is provided on a cost-recovery basis, causing the milk banks to charge a processing fee of $3.00-$5.00 per ounce. Insurance reimbursement varies from state to state, resulting in a cost to the hospitals or consumers.

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