Donor milk banks: service operation

Introduction

Research has consistently shown that breast milk is the best nourishment for babies and that it is highly beneficial to their health in the short, medium and long term. Women are recommended to breastfeed their baby exclusively for 6 months and continue to breastfeed after 6 months as part of a balanced diet (see the latest NHS advice on breastfeeding).

If, after discussion with experienced staff, a mother is unable to express sufficient milk or does not wish to express milk for a baby unable to feed at the breast, donor breast milk can be used.

In this guideline, donor breast milk is defined as breast milk expressed by a mother that is then processed by a donor milk bank for use by a recipient that is not the mother's own baby. Payment for the donated milk is not given.

A Health Technology Assessment (HTA) report entitled 'Breastfeeding promotion for infants in neonatal units: a systematic review and economic analysis' was published in 2009. This report used systematic review methodology and health economic modelling to assess which interventions, including the availability of donor breast milk, effectively promote the initiation and duration of breastfeeding in neonatal, special and intensive care settings. The authors noted that in the UK, donor breast milk is neither widely nor readily available in the majority of units; this was reflected through modelling the use of donor breast milk by availability, not need. They concluded that if mechanisms by which donor milk is provided were improved, donor milk would become cost effective compared with using formula. This was based on a significant improvement in the operation of milk banking, and suggested models include setting up a national donor milk banking system similar to that for blood (Renfrew et al. 2009).

Although this guideline does not make recommendations on the configuration of services, it does make recommendations on the safe and effective operation of donor milk services.

Throughout development, the safety of donor breast milk was considered to be the aim of the guideline and recommendations were made to minimise the risk to recipients of donor milk. Maximising safety comes at a cost and recommendations were made to observe the best possible safety standards without exceeding opportunity costs acceptable to society.