Pioneering Bloodless Surgery With Jehovah’s Witnesses
JEHOVAH’S WITNESSES have frequently made the headlines in recent years because they do not accept blood transfusions. Though the reason for their refusal is Scriptural, there are also recognized physical dangers. (Genesis 9:3, 4; Leviticus 17:10-12; Acts 15:28, 29) Their stand has resulted in confrontations with doctors, hospitals, and the courts. Adult Witnesses have been denied surgical procedures because they have refused transfusions; their children have been forced to submit by court order.
There is now some shifting of positions on blood transfusions. Blood supplies are often contaminated. Diseases, some of them lethal, are transmitted by transfusions. Greed has become a factor as blood has become big business and its routine use is encouraged—adding further unnecessary risk to surgery.* For these and other reasons, many besides Jehovah’s Witnesses are reconsidering the acceptance of routine blood transfusions.
Jehovah’s Witnesses have played a role in all of this. Thousands of them have had operations and in many cases have recovered even faster than people who received transfusions. The experience of the Witnesses shows that surgeons can perform surgery with much less loss of blood and that in some cases blood counts can go much lower than was previously thought to be safe. Moreover, their cases have demonstrated that many alternative approaches are now available, thus cutting the expense and removing the risk of transfusions. Their court victories have also returned to patients their right to accept or refuse certain medical procedures.
Jehovah’s Witnesses have accomplished much of this by dealing cooperatively with doctors and hospitals. In recent years they have established at their world headquarters a department called Hospital Information Services (HIS). Representatives of this department have toured countries in many parts of the world, conducting seminars at some of the Watch Tower Society’s branch offices and forming Hospital Liaison Committees that contact hospitals and doctors as the need arises. While with larger branch offices, HIS representatives also establish a Hospital Information Services desk to carry on the work after their departure.
The seminars train these committees to talk with doctors and hospital personnel, discussing suitable alternatives to blood transfusion and explaining that meticulous surgical skills can drastically reduce blood loss. Finally, the visiting members of HIS give on-the-job training to the new liaison committees by taking them to talk with doctors and hospital administrators.
As a start, 18 seminars were conducted in the United States. After that, four were conducted in the Pacific area, one each in Australia, Japan, the Philippines, and Hawaii, serving eight of the Watch Tower Society’s branches in those areas.* In November and December 1990, three members of HIS conducted ten additional seminars in Europe, Latin America, and the Caribbean. The following is a report on the results of those seminars.
Five were held in Europe—one each in England, Sweden, France, Germany, and Spain. These five seminars served 20 of the Watch Tower Society’s branches and trained more than 1,700 elders for Hospital Liaison Committee work.
One French surgeon acknowledged that Jehovah’s Witnesses, by their firm stand on blood, have helped the medical profession to make progress in the field of bloodless surgery. He said that no other religion has gone to such lengths to help its people cope with difficult issues.
The most advanced hospital in Madrid, Spain, had been quite hostile to Witnesses on this issue. One Witness needing spinal surgery was denied treatment because she refused a blood transfusion. When she declined to leave the hospital, they forced her out by denying her food and drink. The HIS members, however, got an appointment and had a two-hour meeting with the medical director and the chief of surgery. The result? They agreed to perform the surgery and phoned the ousted Witness to come back for the operation.
Witnesses in Italy returned from the seminar and were immediately confronted with an attempt to force a blood transfusion on a premature baby. As they put it: “With the information we got from the seminar, we were able to defuse the situation, and the child was successfully treated without blood.”
On to Latin America and the Caribbean
The next five seminars were held in Mexico, Argentina, Brazil, Ecuador, and Puerto Rico. Thirty-two branches of the Watch Tower Society were served by these five seminars.
The director of the Mexico City blood bank said that Jehovah’s Witnesses had spearheaded bloodless surgery and that now there was sufficient expertise in the field so that others can benefit from those pioneering efforts. He looked over the HIS sheet that lists alternative procedures in treating cases of hemorrhage.* Then he said: ‘I want to make copies of this for the bulletin boards of every hospital in Mexico City. I will ask doctors to copy it for their information. Then, in the future, when they call this blood bank for blood, we will first ask them to get out this sheet, and then we will ask them, “Did you use this? Did you try that?” If they have not tried these alternatives first, they will not get blood from us until they do!’
The director of the blood bank in northern Argentina was also helpful. In that area, there is a policy that anyone who comes to a State-run hospital must arrange for relatives or friends to donate at least two units of blood in advance or he is denied treatment. Witnesses could not comply and were refused surgery. After we explained our sincere convictions about the use of blood, the director arranged for a change in this policy when next rewritten. In the meantime, Witnesses who show their Advance Medical Directive card when admitted to a hospital will be exempt from the requirement to donate blood.
In Ecuador there is a prominent and influential surgeon who has performed more than 2,500 surgical procedures on Witnesses and non-Witnesses without using blood. He said that he plans to start a campaign to encourage bloodless surgery in that land because of the many dangers to the patient from the blood supply.
Following the seminar in Ecuador, a surgeon who attended the presentation said: “If these people are capable of this caliber of research in medicine, it says something about their study of the Bible and makes me feel that their religion is worthy of investigation.”
A welcome change in attitude was found in Puerto Rico. In the past, adult Witnesses were at times strapped down and had blood forced on them; some of them later died. HIS representatives met with both the vice president and the legal counsel for the Puerto Rico Hospital Association; the latter gentleman was also a hospital administrator. Immediately after formal introductions and before the HIS presentation began, the lawyer said he had something to say. To the surprise of the Witnesses, he began a description of a plan for improving patients’ rights in the island’s hospitals, and it covered the main points of the presentation! He also asked permission to copy some of the information that was left with him; he wanted to include it in an article being prepared for the hospital association magazine.
Results Obtained in the United States
One doctor—James J. Riley, chairman of the department of surgery at his hospital—made a significant statement to the local liaison committee: “You men, as I perceive it, are on the cutting edge of medical and legal information on blood use.”
At a large hospital in the Washington, D.C., area, the Hospital Liaison Committee met with a group of administrative and medical personnel who pledged their support and especially expressed their appreciation for “the Watchtower’s commitment to help its own people in a time of need with a support arrangement such as this.”
The head of a patient-care department at a hospital in Wisconsin stated how misinformed she had been about Jehovah’s Witnesses. She encouraged the Hospital Liaison Committee to “press on to get this message to all medical providers.”
One feature of the work of HIS is to mail out medical and legal items to designated doctors, hospitals, and hospital and medical associations. A response from a risk manager at a hospital in Baltimore, Maryland, said: “Thank you for the extensive material forwarded to my attention regarding blood transfusions and Jehovah’s Witnesses. This information will be most helpful in assisting our hospital to revise our policies regarding the treatment of Jehovah’s Witnesses.”
In the United States alone, nearly 10,000 doctors are on the list of those willing to perform bloodless surgery on Jehovah’s Witnesses.
Thus far, by means of the 32 seminars held to date, liaison committees have been set up in 62 branch offices to meet the needs of Jehovah’s Witnesses in various parts of the world. These are now ready to look after millions of Jehovah’s Witnesses. The results indicate that Jehovah is indeed blessing the efforts of HIS.
For details, see Awake! of October 22, 1990, pages 2-15.
For a report on these countries, see Awake! of November 22, 1990, the article entitled “Bridging the Gap Between Doctors and Witness Patients.”
This sheet is reproduced on page 10 of this magazine.
[Box on page 10]
Preventing and Controlling Hemorrhage Without Blood Transfusion
1. Surgical Devices:
b. Laser surgery
c. Argon beam coagulator
d. Gamma knife radiosurgery
2. Techniques and Devices to Locate and Arrest Internal Bleeding:
a. Endoscopy to identify location of internal bleeding
b. Flexible suction coagulator electrode (Papp, J. P., JAMA, November 1, 1976, pages 2076-9)
c. Arterial embolization (JAMA, November 18, 1974, pages 952-3)
d. Controlled hypotension (until bleeding can be stopped)
e. Tissue adhesives (Dr. S. E. Silvas, MWN, September 5, 1977)
3. Operative and Anesthetic Techniques:
a. Hypotensive anesthesia (lowering the blood pressure)
b. Hypothermia (lowering body temperature)
c. Intraoperative hemodilution
d. Intraoperative blood salvage machines, e.g., “cell-saver”
e. Meticulous hemostasis and operative technique
f. Increased members in surgical team to reduce operative time
4. Monitoring Devices:
a. Transcutaneous oxygen monitor
5. Volume Expanders:
(1) Ringer’s lactate (Eichner, E. R., Surgery Annual, January 1982, pages 85-99)
(2) Normal saline
(2) Gelatin (Howell, P. J., Anaesthesia, January 1987, pages 44-8)
6. Chemical Hemostats:
e. Many others
7. Therapeutics for Low Hemoglobin:
b. Hyperbaric oxygen chamber (Hart, G. B., JAMA, May 20, 1974, pages 1028-9)
c. Iron dextran (Dudrick, S. J., Archives of Surgery, June 1985, pages 721-7)
d. Folic acid
e. Erythropoietin—stimulates bone marrow to produce blood
f. Anabolic steroids, e.g., Decadurabolin or synthetic growth hormone
g. Vitamin B-12 intramuscular injection
h. Vitamin C
i. Vitamin E (especially in newborn)
8. External Measures:
a. For bleeding:
(1) Applied direct pressure
(2) Ice packs
(3) Positioning of body (e.g., raising injured limb to slow bleeding)
b. For shock:
(1) Apply pressure cuffs to legs
(2) Antishock trousers
(3) Raising both legs to maintain blood pressure
9. Drugs for Patients With Blood Problems:
a. DDAVP, desmopressin (Kobrinsky, N. L., Lancet, May 26, 1984, pages 1145-8)
b. E-aminocaproic acid (Schwartz, S. I., Contemporary Surgery, May 1977, pages 37-40)
c. Vitamin K
d. Bioflavonoids (Physician’s Desk Reference)
e. Carbazochrome salicylate
f. Tranexamic acid (Transfusion Medicine Topic Update, May 1989)
10. Other Points:
a. A moderate fall in blood pressure to about 90-100 mm of Hg may help bleeding to stop by natural clotting in a cut artery
b. Rule of minimum 10g hemoglobin for surgery has no valid scientific support
c. Surgical patients have survived with hemoglobin as low as 1.8 (Anaesthesia, 1987, Volume 42, pages 44-8)
d. Lower hemoglobin results in lower blood viscosity, in turn reducing the load on the heart and improving tissue perfusion and oxygenation