Surgery Among jehovah's witnesses

With increasing demands for blood transfusions, the costs and shortages, clinically relevant risks and doubts on the efficacy, blood conservation is an important issues. Among the available methods cell salvage is of great importance as it has proven effective and safe. The high availability and cost efficacy allows fast processing of at least half of the lost red blood cells. The method has wide applications in cardiac and vascular surgery, in abdominal and transplantation surgery, in orthopedics and emergency medicine, in massive hemorrhage and for Jehovah's Witnesses, and by the use of blood irradiation also in cancer surgery...

BACKGROUND: Mortality increases as hemoglobin (Hb) levels fall. Among severely anemic patients, the clinical course, cause of death, and whether there are any warning signs before death are unknown. STUDY DESIGN AND METHODS: A retrospective cohort study was performed of surgical patients who refused red blood cell transfusions for religious reasons and died with a Hb concentration 6 g/dL or less. Mortality was defined as death that occurred during hospitalization...

BACKGROUND: Jehovah's Witnesses are widely known for their prohibition on the acceptance of blood transfusion. Such refusal serves as a potential obstacle to optimal therapeutic intervention among critically injured Jehovah's Witnesses. As such, care of these patients requires an aggressive and multidisciplinary approach to therapy. METHODS: A review of the pertinent English language literature. RESULTS: Jehovah's Witnesses exercise the right of any adult with capacity to refuse medical treatment and often carry advance directive cards indicating their incontrovertible refusal of blood...

Blood transfusions after cardiac surgery are very common, and the rates are highly variable among institutions. Transfusion carries the risk of infectious and noninfectious hazards and is often clinically unnecessary. This article discusses the history of bloodless cardiac surgery, the hazards of transfusion, the benefits of reducing or eliminating transfusion, and strategies to conserve blood. It also provides a list of resources for those who are interested in learning more about bloodless care.

OBJECTIVES: Aprotinin is a drug used to reduce bleeding in patients undergoing cardiothoracic surgery with cardiopulmonary bypass. A recent cohort evaluation found elevated risks of renal, cardiovascular, and cerebrovascular events when aprotinin was used. We sought to determine the impact of aprotinin on safety variables among patients receiving cardiothoracic surgery with cardiopulmonary bypass from a single US hospital that reserves aprotinin for complex surgeries and Jehovah's Witnesses and does not utilize celite-based activated clotting time determinations...

In a retrospective study at a university hospital, the perioperative morbidity associated with elective total abdominal hysterectomy in 23 Jehovah's Witnesses was compared with that of 46 non-Witness controls. The mean operative blood loss was significantly less, the procedure was lengthier and the average postoperative hospital stay was longer in the study than in the control group. Febrile morbidity was insignificantly more frequent among the study group (OR: 2.05, CI: 0.61-6.88) and there was no significant difference between the overall morbidity experienced by patients in both groups (study: 43...

The origin of bloodless medicine was probably generated due to the religious impediment of Jehovah's witnesses. In 1988 in Brooklyn New York, U.S., a hospital information center was created help Jehovah's witnesses 24 h/7 days a week. There are 109 branches of these centers in 230 countries throughout the world. Some Jehovah's witnesses may accept blood derivatives such as immunoglobulin, interferons, topical hemostatic cements, or auto-transfusion techniques. At present, there are a substantial number of bloodless surgery procedures including cardiac and orthopedic procedures, and there are 75 hospitals functioning in the U...

Indisputably, liver transplantation is among the most technically challenging operations in current practice and is compounded by significant coagulopathy and portal hypertension. Recombinant human coagulation factor VIIa (rFVIIa) is a new product that was initially described to treat bleeding in hemophilia patients. We present in this paper 10 liver transplants in Jehovah's Witness patients using this novel product at University of Southern California-University Hospital. The subject population included nine males and one female with an average age of 50 years...

A retrospective study was done of 73 consecutive Jehovah's Witness children less than 2 years of age who were operated on for lesions of the heart and major vessels. The series was divided into three groups: (1) neonates less than 31 days old, (2) children between 31 days and 2 years, and (3) children requiring cardiopulmonary bypass. The overall mortality rate for the series was 12.3% (9/73). Only three of the nine deaths were complicated by blood loss and anemia. The mortality rate for Group I was 18.2% (2/11)...

Open surgical repair is the standard treatment for a ruptured infrarenal abdominal aortic aneurysm (rAAA). This approach is associated with mortality rates of up to 70%, with significant surgery-related morbidity among survivors. In selected patients, endoluminal repair (ER) of an rAAA under local anesthesia may allow emergent aneurysm repair with reduced perioperative stress, ideally resulting in improved outcomes. The authors report their initial experience using a commercially available bifurcated endoluminal stent-graft to treat patients with rAAA under local anesthesia...

Ideas about bloodless surgery are changing. It now is more than transfusion-free surgery for Jehovah's Witnesses. Technological advances and concerns about the safety and availability of blood have led to interest in bloodless surgery among non-Witnesses. Perioperative nurses need to be aware of bloodless surgery technology, which typically incorporates the use of recombinant human erythropoietin and special surgical techniques and equipment. They must have a proper attitude toward blood conservation and respect patient autonomy...

Since 1968, following Cooley's and Zubiate's group presentation, our team has been using extracorporeal circulation (ECC) with hemodilution without use of blood for priming of the circuit. Progressively this technique, that was only reserved to the Jehovah's Witnesses, became routine. Whereas in 1980, 30% of the patients operated by our group had not received any blood products during their stay in hospital, in the last few years, 1987-95, more than 80% of the patients could benefit from this technique. So, out of 15,573 cardiac surgeries under ECC performed between 1972 and 97, 14,798 (95%) were done in auto-perfusion, and 314 to Jehovah's Witnesses...

Patients who are members of Jehovah's Witnesses refuse blood transfusion, even when the indication for giving blood is vital. This is a matter of controversy both in the clinical situation and in the medical literature and the press. All 430 members of the Norwegian Association of Anaesthesiology were sent a questionnaire requesting the guidelines issued by their hospitals, and their personal, professional opinion when dealing with this group of patients under life-threatening conditions caused by loss of blood...

Patients undergoing cardiovascular surgery are among the top users of homologous blood transfusion (HBT). Awareness of the risks of disease transmission and immune system modulation from HBT has prompted us to find alternatives such as autologous predonation (APD) and intraoperative autotransfusion (IAT). However, these latter options are not appropriate for all patients. We reviewed our experience with 59 Jehovah's Witness patients who underwent 63 elective cardiovascular procedures without either HBT or APD to determine the safety of operation without these modalities and to develop revised maximum surgical blood-ordering schedule guidelines for cardiovascular surgery...

The hemodilution technique for cardiopulmonary bypass using blood substitutes for priming has permitted open heart operations in Jehovah's Witnesses who refuse to accept blood, and has reduced the need for massive blood transfusion in certain procedures including aortocoronary bypass. A series of 46 Jehovah's Witness patients underwent aortocoronary bypass procedures. Of these, two patients died, representing a mortality of 4.3 per cent. Neither patient's death was related to lack of blood transfusions. The hospital stay and recovery time of all the other patients was not affected by failure to transfuse blood...

Jehovah's Witnesses who require operation represent a challenge to the physician because of the patients' refusal to accept blood transfusion. We report a 20-year experience with a consecutive series of 542 Jehovah's Witness patients ranging in age from 1 day to 89 years who underwent operation. Early mortality (within 30 days after operation) was 9.4%. In 362 patients requiring temporary cardiopulmonary bypass, early mortality was 10.7%. Mortality was 13.5% among 126 patients who had single- or double-valve replacement...