Transfusion issues in a child of Jehovah's Witness parents: A neurosurgical case report

Abstract

Jehovah's Witness (JW) is a religious Christian group whose members believe blood transfusion to be unholy and do not accept blood or its components, even if refusal of transfusion may prove to be life threatening. This belief is extended by them to their offspring too, despite the children being unaware of the implications of their parents' stand. A conflict arises between the parents' firm position against transfusion and the responsibility of the treating doctors towards the safety of these children. It raises several ethical and medico-legal issues, besides requiring a modified treatment plan. While there are well-defined practice guidelines and legal directives on this subject in the west, there is a paucity of similar literature in many other countries including India leading to major transfusion related conflicts. The perioperative protocol for the surgical management of a JW patient is directed towards achieving bloodless surgery. An anemic child of JW parents underwent excision of an intracranial third ventricular mass without blood transfusion at our hospital. We present here our experience in managing this case using blood-saving surgical and anesthetic methods including a meticulous surgical technique and acute hypervolemic hemodilution.