Jehovah's Witnesses and Heart Surgery

One patient population always requires meticulous planning prior to cardiac surgery.  It is estimated that there are approximately 8 million Jehovah’s Witnesses worldwide, with a 2.5Million in the United States. These are Christian people who have a unique interpretation of the Bible regarding celebrations, service to humanity, and, most important to me, a refusal to accept blood transfusions.

It is worth understanding where this belief is rooted, so I spoke to a few former patients as well as the Elders in a nearby Kingdom Hall. As it turns out, there are a few passages in the Old Testament, (Genesis 9:4 and Leviticus 17:10.), where God commanded His people not to eat human blood.  This topic resurfaced, later in the New Testament ( Acts 15:28, 29), when the governing body of the early Church instructed Christians to “keep abstaining . . . from blood.”

What about the medical use of blood? Believers in Jehovah apply the passages in the Bible to mean that the transfusion of whole blood or any of its main components​—red cells, white cells, platelets, and plasma, violate the Scriptures. However, there are some medical procedures areas that are in a grey zone. For example, some procedures involve the use of fractions of one of the main components of blood. Other procedures involve the use of a person’s own blood, back (an example is a cell-saver suction device, or storing one’s own blood prior to surgery and re-transfusing.  When weighing these options, patients must make a personal decision.

I have always embraced religious freedom, and do not discriminate against this belief in patient selection…except if I am convinced that the operation is impossible without transfusion (I am Catholic and believe that Thou Shall Not Kill). 

There are several techniques to improve success, that we implement in all patients in our center for bloodless surgery.  These include boosting the patients own blood volume pre-operatively with Iron and Procrit.  We do not give any excess intravenous fluids during or after surgery.  The procedure is performed under normal temperature without any cooling.  The technique is meticulous to avoid any bleeding.  The care is conserved by only staff members that understand the value of maintaining proper blood volume.  When all stakeholders are engaged, I believe that most cardiac surgeries can be safely performed without any risk of transfusion.  Obviously, there are procedures that carry and extremely high risk of bleeding.  In those circumstances, it is necessary to have an informed conversation with the patient, the family, and the patient’s representatives, to craft a proper decision.