Cardiac Surgery in Jehovah's Witness Patients: Experience of a Brazilian Tertiary Hospital

Valle, Felipe Homem; Júnior, Fernando Pivatto; Gomes, Bruna Sessim; Freitas, Tanara Martins de; Giaretta, Vanessa; Gus, Miguel

doi:10.21470/1678-9741-2017-0012

Cited by 7 publications

(50 citation statements)

References 11 publications

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“…The study noted that there were no clinically significant differences in outcomes measured between the two cohorts, demonstrating the positive impact of EPO for patients refusing transfusion and hence supports its use for Witness patients. 8 Eleven comparative studies discussing outcomes between Witnesses and non-Witnesses were found 2,16,21,[45][46][47][48][49][50][51][52] (Table 2) and these often gave agents to increase the preoperative Hb. This varied between studies and makes comparison more challenging.…”

Section: Pre-operativementioning

confidence: 99%

“…This varied between studies and makes comparison more challenging. Six of the studies reported preoperative Hb levels, [45][46][47][48]51,52 with three of these showing higher levels for the Witness group (Witness vs non-Witness: 13.7 vs 12.8 g/dL, p = 0.01; 45 13.9 vs 12.3 g/dL, p < 0.0001; 47 13.6 vs 12.9 g/ dL, p = 0.01 48 ). Similar preoperative haemoglobin levels were reported in Witness only studies (12.1 ± 1.3, 53 13.91, 8 14.1 31 and 14.5 g/dL 54 ).…”

Section: Pre-operativementioning

confidence: 99%

“…Mechanical ventilation is one such example of these measures, however, it has been noted in the literature that this is not a measure undertaken by all clinicians, as no difference was found in ventilation times in seven comparative studies between Witnesses vs controls ( Table 2). 2,45,[48][49][50][51][52] Six of the 11 comparative studies in Table 2 which reported the outcome of blood loss did so differently, making direct comparison difficult. 2,21,48,[50][51][52] However, within the studies themselves, two found that the Witness group experienced significantly less postoperative blood loss compared to the non-Witness control (Witness vs non-Witness: 466.8 vs 843 mL, p = 0.0001; 45 312 ± 141 vs 721 ± 619 mL, p < 0.05 50 ).…”

Section: Post-operativementioning

confidence: 99%

“…In-hospital mortality figures were given for 10 out of the 11 comparative studies found. 2,16,21,[45][46][47][48][49][50][51][52] None stated a significant difference in mortality rates between Witnesses and non-Witnesses. Witness inhospital mortality rate in the comparative studies varied between 0% and 18.8%.…”

Section: Mortalitymentioning

confidence: 99%

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Outcomes of cardiac surgery in Jehovah’s Witness patients: A review

et al. 2020

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Objective: To review current literature evidence on outcomes of cardiac surgery in Jehovah’s Witness patients. Methods: A comprehensive electronic literature search was done from 2010 to 20th August 2020 identifying articles that discussed optimisation/outcomes of cardiac surgery in Jehovah’s Witness either as a solo cohort or as comparative to non-Jehovah’s Witnesses. No limit was placed on place of publication and the evidence has been summarised in a narrative manner within the manuscript. Results: The outcomes of cardiac surgery in Jehovah’s Witness patients has been described, and also compared, to non-Witness patients within a number of case reports, case series and comparative cohort studies. Many of these studies note no significant differences between outcomes of the two groups for a number of variables, including mortality. Pre-, intra and post-operative optimisation of the patients by a multidisciplinary team is important to achieve good outcomes. Conclusion: The use of a bloodless protocol for Jehovah’s Witnesses does not appear to significantly impact upon clinical outcomes when compared to non-Witness patients, and it has even been suggested that a bloodless approach could provide advantages to all patients undergoing cardiac surgery. Larger cohorts and research across multiple centres into the long term outcomes of these patients is required.

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Section: Pre-operativementioning

confidence: 99%

Section: Pre-operativementioning

confidence: 99%

Section: Post-operativementioning

confidence: 99%

Section: Mortalitymentioning

confidence: 99%

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Outcomes of cardiac surgery in Jehovah’s Witness patients: A review

et al. 2020

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“…Regarding this issue, several trials have been reported, which although limited in size present valuable data. [22][23][24][25] Furthermore, many programs have revised cut-off for prescribing transfusion, based upon recommendations made by scientific societies and regulatory bodies, and meta-analyses of clinical trials. Nonetheless, it may happen that bloodless resuscitation does not suffice; in a recent survey, an Australian group have reported that 34 members of Jehovah's Witnesses suffering from major trauma bleeding, in which 3 had to undergo transfusion.…”

Section: Understanding the Refusal Of Blood Transfusion From The Jehomentioning

confidence: 99%

Transfusion and refusal: trials and tribulations

Garraud¹,

Tissot²

2018

IJCTM

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Transfusion is special, not only because it is a life-saving therapy from caring siblings and, more commonly, anonymous benevolent donors, but also because blood is nontrivial, symbolic, and carries ancestral fears. Blood is generally offered and should be accepted by the beneficiaries, meaning that the question should be addressed to them. Most often, the question is not whether they accept the donated blood, but whether they accept the minimal risk associated with it. This is a different matter, and it can be questioned whether both the questions are actually put to the respondent, that is, the patient needing the transfusion, to present better what transfusion is and what the benefit/risk ratio is. Since acceptance is an issue, refusal is the flipside. Some patients, including those with religious faiths (such as Jehovah's Witnesses), refuse blood transfusion; they also refuse bloodshed on the battlefield. It is a situation that represents a high medical and psychological burden for healthcare practitioners. Practitioners have, however, strived to respect the beliefs of Jehovah's Witnesses and have helped advance bloodless medical and surgical interventions that have benefited all those involved. This paper attempts to clarify some of the issues pertaining to blood refusal by groups of believers such as Jehovah's Witnesses and takes the opportunity to clarify certain blood acceptance issues with regard to its opposite, blood refusal, and decision-making process.

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Our experience of lung resection in patients who decline blood transfusion for religious reasons

Takagi

Muto

Yamaguchi

et al. 2021

Gen Thorac Cardiovasc Surg

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Objective Surgical treatment for patients who refuse blood transfusion due to religious beliefs is an important issue related to medical safety. Few reports have examined pulmonary surgery for these patients, and we analyzed clinical characteristics in such cases. Methods Ten Jehovah’s Witness (JW) patients with lung tumor resection who declined blood transfusion for religious reasons between December 2013 and February 2020 at the Fukushima Medical University Hospital were included. Median total intraoperative blood loss was 17.5 mL (range 5–150 mL). Fibrin glue was used intraoperatively for 8 patients. Final pathological examination revealed pulmonary adenocarcinoma in 9 cases and metastasis of bladder cancer in 1 case. In 8 patients with pulmonary adenocarcinoma examined for epidermal growth factor receptor (EGFR) gene mutation, 6 cases showed mutation. No patients had serious complications, but 1 patient displayed temporary anemia due to postoperative hemorrhagic gastrointestinal ulcer. Result and conclusions Our findings confirm that pulmonary resection is feasible and safe for JW patients if performed by experienced medical staff. However, awareness of complications associated with perioperative bleeding is important. Each JW patient should be interviewed individually and every available perioperative option aimed at blood-sparing management, including use of blood coagulation factors and fibrinogen concentrates, should be carefully discussed and clarified. In this study, the EGFR gene mutation rate was higher than usual for cases of lung adenocarcinoma. Further studies are necessary to assess clinical features in JW patients with lung cancer.

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Cardiac Surgery in Jehovah's Witness Patients: Experience of a Brazilian Tertiary Hospital

Cited by 7 publications

References 11 publications

Outcomes of cardiac surgery in Jehovah’s Witness patients: A review

Outcomes of cardiac surgery in Jehovah’s Witness patients: A review

Transfusion and refusal: trials and tribulations

Our experience of lung resection in patients who decline blood transfusion for religious reasons

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