Bloodless Medicine

About four million patients are given blood transfusions each year in the U.S., but the Jehovah's Witness religion does not permit its one million U.S. followers to receive blood, even their own. Adult Witnesses are commonly allowed to refuse transfusions, even if they die as a result, but children are sometimes transfused by court order. 

Ruling out transfusions presents a problem during surgery, since the procedure can result in considerable loss of blood. However, in an attempt to honor the wishes of Jehovah's Witness followers, some doctors will go ahead with surgery despite the additional risk. 

Experience from operating on Jehovah's Witnesses over the years has shown that patients can get by with lower blood levels during surgery than previously thought. This fact, as well as the fear of transmission of AIDS, hepatitis and other diseases through transfusions, has resulted in a marked shift toward using less blood in medical practice. Now, some doctors even specialize in what is called "bloodless medicine", and the approach is offered by seventy-six hospitals nationwide. 

Cutting down on transfusions has been made possible by a variety of new advances, such as: minimally invasive surgery using small incisions; machines that gather spilled blood, clean it, and return blood cells to the patient; and harmonic scalpels that use ultrasonic vibrations to seal incisions as they are cut. In addition, doctors are now willing to let hemaglobin levels fall much lower. Pre-operative procedure has also changed. To minimize blood loss, less blood is used for lab tests in patients scheduled for operations. With these various practices, most types of surgeries, including coronary bypasses, can now be safely done without transfusions. 

In those cases where transfusions are needed, the risks of withholding them include severe weakness, organ problems associated with anemia, and possibly bleeding to death. But transfusions also carry their own risk. Studies show that they may weaken the patient's immune system, resulting in a two to five times greater chance of developing post-operative infections.  Based on information in: The New York Times, 4-21-98