The variation of acceptable blood products and procedures amongst Jehovah’s Witness patients: analysis of a hospital pre-transfusion discussion tool

Abstract

To the Editor, Jehovah’s Witness (JW) patients who may require blood transfusions during their treatment pose a unique set of challenges to health care practitioners. Until 2004, most JWs did not accept transfusion of blood or its major components. At this time, the Watchtower Society, the governing council of the Jehovah’s Witnesses, updated its stance on transfusion and rendered the administration of fractionated blood products acceptable. Nevertheless, an outright ban on all blood components continued, and the ultimate decision was left to the discretion of the individual. Today, there is substantial variation amongst JW patients regarding acceptable products and procedures. Following Sunnybrook Hospital Research Ethics Board approval, we reviewed our institutions’ JW blood transfusion discussion tool (Figure; available as electronic supplementary material) to help us quantify this variability and prevent unintended inadvertent transfusions. The data gathered since the introduction of this discussion tool in early 2011 (Table) include information regarding 25 JW patients. Ten (40%) patients amongst our cohort were male. Only one patient (4%) agreed to receive packed red blood cells and platelets, and only two (8%) patients agreed to receive plasma. These results are not surprising given the continual ban on blood components. Then again, more than half of the JWs (52%) accepted some kind of fractionated product. Fifty-six percent agreed to fibrin sealants, and an even greater proportion accepted erythropoietin (76%) and recombinant clotting factors (88%). When asked about types of transfusion procedures, five (20%) JW patients agreed to utilize preoperative autologous blood donation (PAD), which contradicts the previous notion that PAD was not acceptable. Almost 80% of the JWs agreed to be involved in acute normovolemic hemodilution, cardiopulmonary bypass, hemodialysis, or plasmapheresis, if required. All respondents agreed to utilize intraoperative cell salvage, which strengthens the previous notion that JWs are more willing to accept procedures that have continuous extracorporeal circuits. Analysis by sex revealed that females accepted fractionated blood products only 36% of the time, whereas males accepted these products an average of 80% of the time (P = 0.04). Only three individuals of the patients screened received blood products, and one of them received only a fractionated product. Two of these individuals were transfused blood components on an emergent basis (prior to identifying their JW status and completing the screening form). After the initial event, both of these individuals indicated on the screening form that the products they received were not acceptable. An inadvertent transfusion in a JW patient, although lifesaving, can lead to major negative social ramifications for the individual involved, including religious ostracization. In our view, it is crucial that physicians present and explain all blood transfusion options to JW patients before a transfusion is necessary. This approach involves proper documentation at preoperative assessment prior to surgical admission and a systemic process to initiate discussions Electronic supplementary material The online version of this article (doi:10.1007/s12630-012-9784-7) contains supplementary material, which is available to authorized users.