Wanted: Human Milk Donors

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​Andrew Parsons, Harvard Medical Student

Imagine dropping by the grocery store to buy some milk – but alongside cow’s milk you see human milk from donors too. The cow’s milk costs about $3 per gallon, and there are mountains upon mountains of containers on the shelves. The human donor milk costs more than $500 per gallon and shelves are nearly empty. While dramatized here, this is the situation some neonatal intensive care units (NICUs) and families encounter trying to feed their tiniest babies.

Premature baby in a NICU with an oxygen device to support breathing
and a nasogastric tube to supply nutrition
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Breastmilk has numerous advantages over formula with respect to newborn health. In newborns weighing below 1500 grams, these health benefits are especially important – for example, resulting in lower incidence of a dangerous gut infection called necrotizing enterocolitis (NEC). Sometimes new parents are unable to produce enough breastmilk to feed their babies in this category. This is where donor human milk comes in. Donor human milk is simply breastmilk that people can volunteer to donate.

People who would like to donate begin the process by contacting a milk bank accredited with the Human Milk Banking Association of North America. There is no compensation for donation. Milk donors undergo preliminary screening to ensure adequate health – including bloodwork for conditions like HIV/AIDS. All donor milk undergoes pasteurization to minimize any risk of infection. This process may decrease certain contents like immunoglobulins, but many nutrients remain abundant.
 
Because donor human milk is not in infinite supply, NICUs use criteria to determine which babies are eligible. For example, criteria at Beth Israel Deaconess Medical Center include 1) born at less than 30 weeks gestation, 2) birth weight less than 1500 grams, 3) babies whose siblings are receiving donor milk, or 4) babies re-initiating feedings after illnesses like NEC. Milk from an infant’s parents is always prioritized above donor human milk.
 
The reasons that people choose to become donors are diverse. In one study of such donors, some cited altruism, oversupply of breastmilk, encouragement from health providers, and grief after a perinatal loss as factors in this decision-making process. Barriers to donation included screening (for example, time spent on back-and-forth and bloodwork), general logistics (for example, the cost of milk freezer bags, inconvenient drop-off depot locations, lack of childcare during drop-off time), donation rules (some milk banks require a 150 ounce donation minimum), and lack of awareness.
 
Unfortunately, many NICUs must continue to ration human donor milk because of limited supply. Reducing the above barriers – by encouraging OB/GYN counseling around human milk donation, raising awareness in the community, easing screening hurdles, and creating unique solutions for logistics issues – may help improve this shortage. This could increase the number of vulnerable babies who benefit from breastmilk’s protective effects.

About the Author:

​Andrew is a 4th-year student at Harvard Medical School. This summer he will start residency in pediatrics at Boston Children’s Hospital / Boston Medical Center. His hobbies include tennis, hiking, language-learning, stand-up / improv comedy, and going to the beach.