Liver transplantation in Jehovah’s witnesses: 13 consecutive cases at a single Institution

Abstract

Jehovah's Witnesses represent a tremendous clinical challenge when indicated to liver transplantation because they refuse blood transfusion on religious grounds and the procedure is historically associated with potential massive peri-operative blood loss. We developed a peri-operative management pathway with strategies toward a transfusion-free environment in the respect of the patients’ religious beliefs. Briefly, our peri-operative multimodal strategy to liver transplantation in Jehovah's Witnesses includes a pre-operative red cell mass optimization package and the intra-operative use of normovolemic haemodilution, veno-venous bypass and low central venous pressure. In a 9-year period, 13 Jehovah’s Witness patients received liver transplantation at our centre representing the largest LT program from deceased donors in JW patients that has been reported so far. No patient received blood bank products but 3 had fibrinogen concentrate and one tranexamic acid to correct ongoing hyper-fibrinolysis. There were 4 cases of acute kidney injury (one required extracorporeal renal replacement treatment) and one patient needed vasoactive medications to support blood pressure for the first 2 postoperative days. Two patients underwent re-laparotomy. Finally, of the 13 recipients, 12 were alive at the 1 year follow-up interview and 1 died due to septic complications. Our experience confirms that liver transplantation in selected Jehovah's Witnesses patients can be feasible and safe provided that it is carried out at a very experienced centre and according to a multidisciplinary approach

Patient blood management when blood is not an option: a report of two cases

“…PBM has been developed to treat patients with evidence-based and multidimensional approaches. Many experiences of treatment without transfusion, including cardiac surgery (16,17), liver transplantation (7,11) and lung transplantation (18), have accumulated through treatment of JW patients, and concept such as PBM and "bloodless medicine and surgery" have been spreading around the world. Blood transfusion is still one of the best treatments if used appropriately, but is no longer the only treatment option for some patients.…”

“…These efforts in developing bloodless treatment options have resulted in patient blood management (PBM). Fortunately, many countries, including the USA, European nations, Australia, Japan and Korea, have reported significant results with bloodless treatments (5)(6)(7)(8)(9)(10)(11)(12). Here, we report the treatment of two JW patients without blood transfusion, and discuss strategies for reducing blood transfusions and how to manage JW patients.…”