Jehovas’ Witness and Blood

Transfusion
Abstract

Jehovah's witness do not accept blood transfusion or blood products, based on biblical
readings. When such group of people are in need of health care, their faith and belief is an
obstacle for their proper treatment, and poses legal, ethical and medical challenges for
attending health care provider.
Due to the rapid growth in the membership of this group worldwide, nurses attending to
them in emergencies should be prepared to manage such patients. Appropriate management
of such patients entails understanding of ethical and legal issues involved, providing
meticulous medical management, essential interventions and techniques to reduce blood loss
and hence, reduce the risk of subsequent need for blood transfusion.
An extensive literature search was performed using search engines such as Google scholar,
PubMed, MEDLINE, science journals and textbooks using keywords like ‘Jehovah's
witness’, ‘blood haemodilution’, ‘blood salvage’ and ‘blood substitutes’.
Purpose /Objective
• Examine the medical implications of refusal of blood transfusion by
patient for religious reasons
• Analyze the role of the nurse
• Suggest alternative approaches to treatment that recognize the
religious rights of the patient
• Initiate discussions regarding the blood-based and nonblood-based
interventions patients are willing to receive
• Help mitigate morbidity and mortality with careful and extensive planning
through detailed care planning
Intoduction
Blood transfusion to a JWs involved in an accident present a medical and ethical
problem to the nurse and other health care staff involved in his/her care.
The underlying necessity for such consideration of ethical situations
emanates from the patient’s need for:
• Informed Consent as required by law; that is The process by which the care
provider seeks the affirmative allowance of the patient to provide healthcare
after apprising the patient of the benefits and risks of the proposed treatment
• Patient Rights: every competent adult has the right to refuse medical
treatment including the possibilities of death
• Objective medical Care: The expected duties of care required of the nurse and
other health care professionals
JWs and Blood
• 1. Most JWs will generally not accept whole blood or any of its 4 major
components: red blood cells (RBCs), platelets, white blood cells, and plasma

• 2. Some accept blood fractions (eg, albumin, coagulation factors) as

determined by individual discretion.

• 3. Autologous blood transfusion is generally unacceptable, unless the

blood is in a continuous closed loop that circulates back into the
patient so that blood remains in continuity with the body (eg, hemo-
dialysis, cardiopulmonary bypass)
T he Nurse and JW patient
Nurse should:
1. Consult with supervisors and other medical staff to activate and
implement pre-planned treatment and care protocols if any
2. Manage patient care to ensure maximum comfort and to maintain
homeostasis
3. Advocate for other bloodless treatment alternatives to reduce mortality
and morbidity
4. Where the patient is incapable of making informed decision, the
primary nurse can obtain a written consent from other family
members for blood transfusion when it becomes necessary
Conclusion
•  Nurses face ethical decision every day where their values, beliefs,
and faith may be the same or different from their patients.
• The nurse should continue to be the patient’s advocate even if it
does not align with what could be a desirable outcome for the
patient.
• Nurses have an obligation to be the voices for their patients even
if they do not agree with a person’s religious preference.
• However, the ethical principles of autonomy, beneficence to do
good, and nonmaleficence to cause no impairment or damage
should be integrated into nurses’ daily practices.
References
1. Carlton D. Scharman; Debora Burger;Joseph J. Shatzel ;Edward Kim;
Thomas G. DeLoughery: 17 August 2017
•  https://doi.org/10.1002/ajh.24889

2. Management of patients who refuse blood transfusion

• N Kiran Chand, H Bala Subramanya, and G Venkateswara Rao
• Indian J Anaesth. 2014 Sep-Oct; 58(5): 658–664.
• doi: 10.4103/0019-5049.144680

3. Shander A. Surgery without blood. Crit Care Med. 2003;31:S708–14. Erratum in:

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