Liver transplant in Jehovah's Witnesses patients

Abstract

The Jehovah's Witness religion is a Christian movement, founded in the USA in the 1870s, with 6 million members worldwide (150,000 in the UK). Members of this faith have strong beliefs based upon passages from the Bible that are interpreted as prohibiting the 'consumption' of blood. Their beliefs prevent them from accepting transfusion of whole blood or its primary components. They also believe that blood that has been removed from the body is 'unclean' and should be disposed of. The use of procedures that involve the removal and storage of their own blood is often unacceptable. Biological hemostats, including collagen and cellulose pads (Kaltostat) and fibrin glues and sealants (Tisseal), aid coagulation and reduce blood loss. Strategies have been described to reduce the number of red cells lost during hemorrhage by the nonlinear reduction in packed cell volume achieved by hemodilution. With the cell-saver technique, shed blood is suctioned from the wound, centrifuged, washed, mixed with an additive/anticoagulant solution and then reinfused as required. Many coagulation factors are available as recombinant products, including factors VIII, IX and VIIa. In summary, major surgery can be performed safely in the Jehovah's Witness who refuses blood transfusion by utilizing preoperative and intraoperative techniques that decrease surgical blood loss, decrease oxygen consumption, and increase oxygen delivery. Even if significant intraoperative blood loss occurs, successful postoperative management is possible by utilizing techniques that minimize oxygen consumption and maximize oxygen delivery.