< Back CME Module 4: Blood Tranfusions and the Jehovah's Witnesses Patient

 

Artificial Blood

 

Although it is well-known that orthodox Jehovah's Witnesses may not accept blood transfusions, even when medically necessary to save life, it is less clear whether artificial blood based on hemoglobin extracted from outdated human blood or from animal sources will be acceptable to Jehovah's Witnesses once these products become available in the next several years. (For example, in 2001 Hemosol Inc. announced completion of its U.S. Phase II cardiac bypass study of Hemolink, its first hemoglobin replacement product.) Until recently, it appeared that such artificial blood would be banned for Jehovah's Witnesses. For instance, in 1998 Richard Bailey and Tomonori Ariga, writing in an official capacity, explained the Watch Tower Bible and Tract Society (WTS) policy to the medical community [42]:

"… Jehovah's Witnesses do not accept whole blood, or major components of blood, namely, red blood cells, white blood cells, platelets and plasma. Also they do not accept hemoglobin which is a major part of red blood cells … According to these principles then, Jehovah's Witnesses do not accept a blood substitute which uses hemoglobin taken from a human or animal source."

More recently however, there has been an important but subtle change in WTS policy that clinicians should be aware of [20]. Whereas the WTS had previously permitted Jehovah's Witnesses to accept fractions of blood plasma, it appears that they may now accept fractions of all "primary" components. The WTS defines "primary" components as red cells, white cells, platelets and plasma.

This policy clarification appears to open the door to the use of hemoglobin-based blood substitutes for Witnesses and would be expected to result in a number of lives saved annually. Indeed, newspaper accounts describing compassionate pre-approval use of hemoglobin-based blood substitutes in Witness patients have already been published [43]. As well, clinical accounts of the use of hemoglobin-based blood substitutes in other circumstances have been published [44]. Clinicians who are caring for Witnesses with life-threatening anemia may thus wish to consider the administration of hemoglobin-based blood substitutes even though regulatory approval is still in progress. This process may be initiated by contacting one of the manufacturers of hemoglobin-based blood substitutes provided in the list below, all of whom have entered into phase 3 clinical trials:

Northfield Laboratories Incorporated
http://www.northfieldlabs.com
Product name: PolyHeme

Biopure Corporation
http://www.biopure.com
Product name: Hemopure

Hemosol Incorporated
http://www.hemosol.com
Product name: Hemolink

 

Conclusions

Jehovah's Witness patients will accept virtually all medical treatments except transfusion of primary blood components (red cells, white cells, platelets and plasma). When patients refuse transfusion of blood and blood components, physicians need to discuss the risks associated with that refusal, as well as the potential alternatives. While physicians are ordinarily taught to preserve life, they also must respect a competent adult patient's right to refuse treatment. By offering alternative therapies, physicians treating Jehovah's Witness patients frequently will be able to realize both their own goals as well as those of their patients.

 

Attention: re Mainport Credits

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Section 3: Self-assessment program

Domain: Anesthesiology

SAP Name: Anesthesia Online.

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