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Who we turn away.
This page is a 7-minute read. The video covers who the treatment isn't for, the conditions a good clinic declines, and why an honest no comes from a physician, not an email. Keep scrolling for the full version.
Most stem-cell pages list indications. We also list non-indications.
The standard format for a clinic site is to list "conditions we treat." That list is always longer than it should be, because every condition added to it produces another inquiry, and most inquiries convert at some non-zero rate. The omitted list, the not-treated list, is the one that matters more. It's the list that tells you whether a clinic is making clinical judgments or marketing judgments.
This page is the not-treated list. It has three parts: hard exclusions where we decline absolutely, conditions we don't treat regardless of how the inquiry is framed, and a yellow-zone where the decision depends on specifics. A meaningful share of people who reach our intake fall into one of the categories below. The decline is delivered by a physician on a call, not by an email; the reasons are stated; we send the records back.
A meaningful share of intake
A meaningful number of people who complete records review are declined or routed elsewhere.
A physician, by phone
Declines are clinical decisions, not emails from a coordinator. The reasoning is delivered live.
Sometimes yes
A "not now" decline (active infection, recent surgery) can become a "yes later." A categorical no is final.
Eight categorical no's.
The conditions below are absolute exclusions for our program. They are not "we'd prefer not to"; they are "we will not." Each is grounded in real safety concerns, either the cells themselves carry risk in that physiology, or the underlying condition makes the procedure unsafe in a way no protocol modification fixes.
Active or recent malignancy
Any active cancer, or one in remission for under 24 months. We will not run cell therapy alongside an active cancer. Five-year remission threshold for some indications.
Pregnancy or breastfeeding
No data exists on MSC transfer in pregnancy or via breast milk. We will not be the clinic that generates that data. Six-month interval after weaning.
Unmanaged active infection
Untreated infection of any kind, including sepsis, untreated HIV, active TB, or unresolved abscess. Treatable and reversible: when the infection is resolved, intake reopens. Not now ≠ never.
End-stage organ failure
Decompensated cirrhosis, ESRD on dialysis, NYHA class IV heart failure. The infusion itself is safe; the post-procedure recovery is not. You should not travel for this procedure.
Severe immunosuppression
Patients on high-dose chemotherapy, recent organ transplant on heavy immunosuppression, or untreated primary immunodeficiency. The procedure risk profile shifts in ways we don't accept.
Active substance dependence
Active untreated alcohol or opioid use disorder. Not a moral judgment; a clinical one. The post-treatment protocol requires reliable cooperation, and active dependence makes that unreliable. Treatment-engaged, reversible.
Inability to consent
Patients who cannot meaningfully consent (severe dementia, severe psychiatric incapacity) and whose family is seeking treatment for them. The patient has to want this, in a way they can describe.
Anticoagulation that cannot pause
Patients on lifelong anticoagulation who cannot safely hold the medication for the procedure window. Cardiology consult sometimes resolves this; sometimes not. Decision is the cardiologist's, not ours.
Four conditions that get marketed and we don't accept.
The list below is not a judgment on whether MSCs could someday help these conditions. The biology is genuinely interesting in several of them, and active research is ongoing. The judgment is whether the evidence today supports charging a five-figure out-of-pocket sum to offer it. For these four conditions, it does not.
We publish the not-treated list. Most clinics publish only the yes list, and call us back the next year asking why we don't.
For any condition on the second list, we are happy to point patients toward NIH's ClinicalTrials.gov for any active, IND-cleared studies in their indication. That referral is free and unconditional.
Seven genuinely-it-depends situations.
The yellow zone is where the clinical judgment actually happens. These aren't auto-declines; they're conditions where specifics flip the decision. The factors that tilt the call appear on the right.
Where the answer is "tell us more."
Tilts toward no:Active flare; no rheumatologist of record; expectation that MSCs replace biologic therapy.
Tilts toward no:Primary progressive MS; recent relapse within 90 days; off-DMT against medical advice.
Tilts toward no:Long-standing disease with zero C-peptide; pediatric patients (refer to trial); expectation of cure.
Tilts toward no:Symptoms under 6 months (let recovery run); no objective markers; expectation of single-infusion cure.
Tilts toward no:Late-stage with loss of capacity to consent; family hope alone as the indication; expectation of reversal or cure.
Tilts toward no:Late-stage with significant loss; expectation of a cure or of halting progression; no specialist of record.
Tilts toward no:Expectation of a cure or developmental reversal; no objective markers; hope alone as the indication.
The conversation, in three real shapes.
Below are three composites of how the decline call actually goes. They aren't transcripts; they are typical phrasings, anonymized. The point is to show that the language is direct, the reasoning is specific, and the door is not always closed.
Three calls. Three different "no's."
We can't take you forward right now. The reason is the breast cancer treatment 14 months ago. We don't treat anyone in remission under 24 months, because the data on MSC interaction with residual tumor cells isn't where it needs to be for us to be confident. I know that's not the answer you were hoping for. The right answer for you is to revisit this in 10 months, and we'll do a full re-review then.
I can't recommend our IV program for spinal cord injury. The trials that matter here use implantation-based protocols, not a systemic infusion, so offering it would imply more than the evidence supports. What I'd point you to instead is the active, IND-cleared studies on ClinicalTrials.gov for your specific injury. If you'd like, I can email you the links.
I'd like to do this for you, but the relapse six weeks ago changes the timing. I want to wait until you've been clinically stable for at least 90 days from that event and your neurologist signs off. Realistically, that's a 60-day delay from where we are today. Let's put a hold on the slot, get a note from your neurologist, and revisit at the end of November.
The shapes above are intentionally different. The first is final. The second is a referral elsewhere. The third is a delay. None of them are an email; all three are physician phone calls. That is a deliberate choice. Declines deserve the same time investment as approvals.
Three reasons this page exists.
Why the not-treated list is public.
- It saves your time before our consult. If you have an active malignancy under 24 months, you don't need to fill out a form to learn we can't help you right now. The whole page exists so you can self-screen before paying any attention to anything else.
- It is a competitive disclosure, intentionally. Several clinics in this market will treat conditions on the not-treated list. Publishing ours tells you what we think about that market, without us having to say it about any specific competitor.
- It is a public commitment. Putting the list on the website means we cannot quietly drift on it when a tempting case comes in. The not-treated list is what we are willing to be held accountable to in writing.
Three categories of "no." One delivered by phone.
Eight hard exclusions, four conditions we don't treat, seven yellow-zone case-by-case calls. A meaningful share of intake meets one of these gates. Declines are delivered by a physician on a call, with reasoning. Sometimes the answer is "not now" rather than "never", and when it is, we say which.