Will my surgeon honor my belief on Blood Transfusion if I’m a Jehovah’s Witness?
At Memorial Plastic Surgery, we strictly respect all of our patients’ religious beliefs But Jehovah’s Witnesses do pose a particular issue in the surgical community, especially when it comes to their beliefs regarding blood transfusion Why Because they often refuse to take any and all... | Read More
At Memorial Plastic Surgery, we strictly respect all of our patients’ religious beliefs. But Jehovah’s Witnesses do pose a particular issue in the surgical community, especially when it comes to their beliefs regarding blood transfusion.
Why? Because they often refuse to take any and all blood transfusions. As it is a common companion process in surgical procedures, especially cosmetic surgery, this bears further discussion.
If your question is about blood transfusions since you’re a Jehovah’s Witness, and are looking for a doctor that will honor your religious convictions, then I can assure you that we will definitely respect that.
As you read through this post that hopefully answers your most common questions and address the concerns of other patients who may have differing beliefs, we’ll also tackle the alternatives and pre-operative preparations of the bloodless surgery we’ll tailor-fit for you, so you’re armed with what you need to know and how we’ll go about it.
A Religious Issue, Not A Medical One
At its most basic, Jehovah’s Witnesses will not take whole blood or its major components. This includes red cells, white cells, platelets, and plasma—including fresh, frozen plasma.
The rejection of blood transfusions has caused an ethical dilemma throughout the medical community, especially regarding the patient’s freedom to accept or to reject medical treatment in a scenario where it might possibly save his life. This has caused the popular notion that Jehovah’s Witnesses have antiquated views and practices regarding medical science, even an outright “anti-medical” stance.
This is far from the truth since it’s not a medical issue but rather a religious one. In fact, not only do Jehovah’s Witnesses value life and medical science, they want the best medical care that will be allowed within their beliefs.
Still, their non-negotiable position against allogeneic blood transfusions was a point of contention for decades, until a sea-change in perspective came. Doctors eventually came around to viewing that Jehovah’s Witnesses must be cared for in the same way as other religious needs and their constraints. The Jehovah’s Witnesses’ needs must be considered, presented with alternatives to navigate around it, all the while honoring the medical oath to treat the patient holistically.
The Belief Against Transfusions
There are currently more than 7.5 million Jehovah’s Witnesses globally, with 1.2 million in the U.S as of 2018. Nearly every year, the International Jehovah’s Witnesses Convention is held for three days at the NRG Stadium in Houston, attracting approximately 50,000 devotees.
In 1945, The Watchtower (the governing body of the Jehovah’s Witnesses) mandated what’s called “The Blood Ban.” This ban had its origins on the strict and literal interpretation of a few passages in the New World Translation of the Bible. They include the commandments to abstain from blood like the passages in Leviticus 17:10, Deuteronomy 12:23, and Acts 15:28-29.
For example, in Genesis 9:4, it states that “Everything that lives and moves will be food for you. Just as I gave you the green plants, I now give you everything. However, you must not eat meat that has its lifeblood still in it.”
Since Jehovah’s Witnesses view blood as representing life, they avoid taking blood in obedience to God. To give this further clarification, for a Witness, getting a blood transfusion is almost on par with cheating on your spouse. Viewed in that light, the sin of an extramarital affair is certainly something that may cut you off from the rest of the community and even deny you the promised resurrection.
According to the CDC, around 5 million Americans receive blood transfusions every year, so a Jehovah’s Witnesses’ choice to have blood-free surgery always poses some legal, ethical, and medical challenges for their surgeon and his team.
Fortunately, many Jehovah’s Witnesses carry what’s called an Advance Directive, a document that prohibits blood transfusion. This is usually accompanied by a detailed Health Care Advance Directive, or a Living Will, that we will need to process along with your other preparatory documents for any procedure at Memorial Plastic Surgery.
We’ll also encourage you to present the Medical Power of Attorney that meets the legal criteria for the State of Texas. Make sure that you outline your medical products, medical procedures, as well as end-of-life decisions and any health care agents you may already have.
It’s understood that whole blood, packed red cells, and even plasma are all off-limits. So the history of the medical community’s response has been of great interest in the development of what’s now called “bloodless medicine.”
Bloodless Medicine & Surgery
The need for bloodless procedures among Jehovah’s Witnesses has led to the development of many techniques that have now become standard medical practice.
Programs in bloodless medicine that previously only catered to Jehovah’s Witnesses have since blossomed at dozens of U.S. hospitals. The development of this kind of blood conservative medicine has its origins in many preparatory small precautions; a coordinated effort by practitioners to enact pharmacological blood-saving techniques, many of which begin well prior to surgery.
A sterling example is that of Dr. Patricia Ford at Pennsylvania Hospital, who spearheaded their bloodless medicine program in 1998. By aggressively boosting red-blood-cell counts in advance of transplants and other ancillary methods, Ford was able to perform more than 130 stem-cell transplants on Jehovah’s Witnesses with a mortality rate of 6%. Ford cited zero deaths in either her Witness or non-Witness patients for stem-cell transplants since 2010.
In one groundbreaking case published in the ”Annals of Plastic Surgery” back in September 2000, a report was made on the case of bilateral breast reconstruction in a Jehovah’s Witness patient with saline-filled implants that was complicated by postoperative hematoma. The complication was averted by some of the blood products stated in the next section.
According to the American Red Cross, from 2008 to 2011, because of the advances with these practices, transfusion numbers in the U.S. decreased by more than 11%. What doctors have found out is that transfusion is one procedure that has been all too wildly accepted as a “more is always better!” approach. It is a procedure that is all too often abused in the surgical theater. Not to say that transfusions are useless, far from it, but doctors have discovered that they’re not nearly as useful as they used to believe.
Advances in alternatives to transfusion are practices that have been so successful and life-saving that even the American Association of Blood Banks has started advocating for blood-saving techniques. So much so that they’ve even started sponsoring seminars and conferences to spread the gospel of bloodless medicine.
Alternatives to Transfusion
Many of the lessons and techniques doctors developed when working with Jehovah’s Witnesses have begun to benefit patients of other religions. Bloodless medicine has become a key part of showing how often patients can be successfully treated through complex surgical and medical procedures without blood transfusions.
In general, blood conservation medicine includes the use of alternative drugs and techniques that are prepared in a way that there will be no need for a transfusion with someone else’s blood. Here are some of the techniques we can use to minimize blood loss, including some of the blood products that you may choose from should the need arise.
Donation of your own blood
We’ll need you to donate several units of your own blood before we go into surgery, but this will depend on the procedure. This is in case a transfusion is needed during the operation.
In bloodless medicine, the controlled lowering of the body temperature to 30-32°C can decrease metabolic oxygen consumption and therefore result in less bleeding during a procedure. We will use controlled cooling by decreasing ambient room temperature, decreasing the temperature of any intravenous fluids, or using a cooling blanket.
Cell salvage machines can take blood from the patient and process it in a machine that “cleans” the blood. By re-introducing it into the patient’s system, if and when more blood is needed, there is effectively no need for another person’s blood for transfusion. Bear in mind that the Cell Salvage machine’s tubes are simply an extension of your body, and your blood never really leaves your system.
We can decrease blood loss through vasoconstriction agents or through cell-stimulating agents like Antifibrinolytics, Aprotinin, Desmopressin, or Erythropoietin.
Blood plasma fractions are basically the reinfusion of a patient’s own blood. But I can understand how this may lead to an issue that falls in the “no blood transfusion” area since RBC alternative products like blood fractions are more or less a kind of chemically diluted blood—something that in medical terms is called “spun down.”
The problems associated with how to safely store blood has allowed researchers to produce major groups of red cell substitutes (perfluorocarbons and Hb solutions). This means a range of blood fractions and blood products might be hemoglobin-based blood substitutes, interferons, interleukins, albumin, globulin, or fibrinogen. Those cells might be red, white, platelet, or plasma when they’ve become a blood fraction.
These blood products may need further discussion during your consultation. Since it’s been previously established that fractions are left up to the individual choice of each Jehovah’s Witness, you’ll need to make a conscientious decision where you fall on this spectrum after it’s explained to you in detail.
While some doctors previously believed that the religious objection of Jehovah’s Witnesses to blood transfusion was synonymous with the refusal of care, it’s my stance that getting the best-informed treatment and procedure isn’t just your right but my obligation as a surgeon. Every case is different and I believe that together we can formulate a treatment plan that’s not just safe and effective, but respects your religious beliefs.
Always remember to only consult with a board-certified plastic surgeon to ensure that their training, expertise, and experience can be brought to bear for your care and protection.
Come in for a consultation and we can find a way to achieve your aesthetic goals together.
*This blog is created and maintained for informational purposes only. The images present may not accurately reflect actual cases per individual. Individual cases are unique, and the descriptions and solutions will vary per patient.