Jehovah's Witnesses and cardiac surgery: a single institution's experience

Abstract

Background Based on biblical doctrines, patients of the Jehovah's Witness faith refuse allogeneic blood transfusion. Cardiac surgery carries a high risk of blood transfusion, but has been performed in Jehovah's Witnesses for many years. The literature contains information on the outcomes of this cohort, but does not detail the perioperative care of these patients. This article describes a single institution's experience in perioperative care of Jehovah's Witnesses undergoing cardiac surgery. Study Design and Methods A chart review of adult Jehovah's Witness patients undergoing cardiac surgery at Duke University between January 2005 and June 2012 was completed. Institutional protocols regarding preoperative erythropoietin (EPO) therapy and intraoperative isovolemic hemodilution are detailed. Patient demographics and use of various blood conservation techniques are described. Hemoglobin (Hb) at various points throughout the perioperative management, hospital length of stay, and mortality are reviewed as indicators of outcome. Results Forty‐five Jehovah's Witness patients underwent cardiac surgery at Duke University Medical Center. Preoperative EPO increased the mean Hb by 1.2 g/dL before surgery. Intraoperative normovolemic hemodilution was used in 37 patients with intraoperative mean nadir Hb of 10.3 g/dL. Antifibrinolytics and desmopressin were commonly used as coagulation adjuncts. Mean cardiopulmonary bypass time was 137 minutes, with mean nadir temperature of 30.5°C. The mean length of hospital stay was 6.2 days, with mean intensive care unit stay of 1.7 days. This cohort had zero 90‐day mortality in the perioperative period. Conclusions This case series demonstrates that bloodless cardiac surgery can be performed in select patients refusing allogeneic blood transfusion.

Bloodless medicine: what to do when you can't transfuse

“…[1][2][3] In fact, several academic health centers are establishing "Bloodless Medicine & Surgery Programs" that specialize in treating patients who do not accept allogeneic blood transfusions (ABTs). [4][5][6][7][8][9][10][11][12][13][14][15][16] A multidisciplinary approach is frequently required to optimize clinical outcomes for these patients, particularly in the setting of multiple comorbidities or high-risk surgical procedures.…”

“…[4][5][6][7][8][9][10][11][12][13][14][15][16] Based on religious beliefs, these individuals do not accept blood products considered to be "primary components," which includes RBCs, WBCs, platelets, or plasma. 4 In addition, JW patients do not typically accept autologous blood donated preoperatively, although most will accept autologous blood that is considered to be physically contiguous with one's body.…”

“…[4][5][6][7][8][9][10][11][12][13][14][15][16][17] Moreover, there are no standard, established guidelines to manage cytopenias in these patients, nor are there many studies to inform optimal treatment approaches. Here, we outline prior studies on bloodless management and discuss the approaches used at our institution to care for patients who refuse transfusions (hereafter referred to as "bloodless patients").…”

“…We close with suggestions for further studies to guide management of bloodless patients. Because recent evidence suggests that bloodless patients do as well, if not better than other patients, [4][5][6][7][8][9][10][11][12][13][14][15][16] advances in bloodless medicine are likely to benefit all patients with anemia. Given the significant expense associated with transfusion therapy,…”

Surgeon’s dilemma: should I save patient’s life at any cost?

“…Based on biblical doctrines, patients of the JW faith refuse allogeneic blood transfusion [4]. Jehovah's Witnesses take this to mean that blood that has left a body should not be transferred to others, neither via the mouth nor via blood-vessels.…”