Brief synopsis of articles:
For those interested in the subject, these articles are a must read. The following synopsis in no way can take the place of reading the actual papers as only the high points were here emphasized.
Article #1: Coagulopathy After Cardiopulmonary Bypass in Jehovah's Witness Patients: Management of Two Cases Using Fractionated Components and Factor VIIa
By: Roman M. Sniecinski, MD, Edward P. Chen, MD, Jerrold H. Levy, MD, Fania Szlam, MMSc, Kenichi A. Tenaka, MD
BACKGROUND: Changes in JW blood refusal policy now give members the personal choice to accept certain processed fractions of blood, such as factor concentrates and cryoprecipitate. (Copied statement entirely from journal.)
Article contains experiences of two JW patients who underwent aortic surgery who developed severe bleeding problems after prolonged use of cardiopulmonary bypass. Their successful treatment with certain blood products is discussed. Conclusion: Physicians should learn of all options for JWs. Note statement: Physicians should "thoroughly discuss which processed blood fractions are acceptable to each individual in this patient population" because it is the major theme of the other articles.
Article #2: What Is Blood and What Is Not? Caring for the Jehovah's Witness Patient Undergoing Cardiac Surgery, by Roman Sniecinski, MD and Jerrold H. Levy, MD
Anesthesiologists are familiar with JW policy of blood refusal. Most do not know that in 2000 and 2004, WB&TS defined the "primary components" of blood and informed members these were forbidden. However, the decision to accept fractionations of the primary components was left to the individual JW patient. Many products available to JWs since 1978. Thorough preoperative discussion with JW patients about available products recommended. JW leaders have informed members that some protein fractions from plasma move from mother to fetus and JWs can consider certain preparations, but most JW patients do not know these options exist. Anesthesiologist should also discuss blood salvaging measures. Techniques listed. Many are new. Many hospitals are unaware of changes in JW policy which have broadened the options available to JWs. Physicians need to present options, but allow the patient to decide what is acceptable or not. Best care for JWs happens when doctor understands "each believer's own definition of blood."
Article #3: Optimal Care for Patients Who Are Jehovah's Witnesses, by Harvey Jon Schiller, MD (Schiller is a JW who lives at Patterson Watchtower facility)
Schiller comments on three aspects of Sniecinski's paper. 1) Physicians have learned much about alternatives for treating anemia and coagulopathy. 2) He commends Sniecinski et al. (1) for "capturing the issue" that of acknowledging that the two JW patients did make their own decision to receive processed blood fractions. However, Schiller points out that this is not some recent "official" change of position. As far back as 1981, individual JWs could make a decision to receive fractions as discussed in a WT "position paper" published in a 1981 JAMA. Schiller outlines the basic position of JWs and their understanding of the use of components, commenting that each individual decides if he can accept or reject. 3) Sniecinski believes that the good outcome for the two JW patients was due to blood fractions. Schiller observed that this may be true but can not be sure. Many papers document good outcomes for JWs even when not expected. Each JW decides for himself about fractions and makes a decision based on information physicians provide. Physicians should not "talk a patient into something." The product cryoprecipitate, "pooled from many patients," was given to both patients. Schiller notes some product safety concerns although admits safety has improved. (He outlines possible diseases from product.) Patient should be informed of hazards but morally or legally the decision about risks rests with patient. Schiller commends Sniecinski's statement that physicians should "thoroughly discuss what processed blood fractions are acceptable to each individual in this patient population." Although this may at times be frustrating, Schiller observed, because the viewpoint of one Witness patient about a medical procedure or fraction could be different from another, but faith and conscience call on patient to make his own decision. Physician's responsibility is to help inform and then do his best. Schiller reiterates in the conclusion that boundaries are defined by patient's faith and conscience.
Article #4: Coagulopathy After Cardiopulmonary Bypass in Jehovah's Witness Patients: Management of and for the Individual Rather than the Religious Institution, by Lee Elder
Lee Elder's paper questions JWs claim of abstaining from donor blood when the JWs in the two JW case studies in Sniecinski's paper did in fact accept transfusions from the "donated and stored blood supply." He calls attention to the power of attorney documents published by WT which give JWs the option of "accepting literally everything from a given unit of donated blood so long as it is sufficiently fractionated beforehand." This is difficult for clinicians to understand. Also, difficult for them to understand is the WT "organization's marketing of itself as representing JWs when it comes to medical use of blood." Lee Elder comments that in Sniecinski's report, WT teachings are treated as acceptable to all JWs, when it is not the case. He says, "Despite WT's religious teaching, physicians experience many JW's patients willing to conscientiously accept transfusion of any donated blood product .... so long as the choice is kept confidential." In addition, he points out that over the years, JWs have requested the WT to allow all uses of donor blood. The doctrine is representative of WT hierarchy and not all JWs. AJWRB applauds efforts of physicians but reminds them to treat JWs "as each individual prefers rather than as a religious organization prefers." Elder encouraged physicians to hold private meetings with patients; preference of patient is most important, not that of religion or family and certainly not of the medical clinician.
