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NoBlood.org - Cell-salvage, Irradiation + Jehovah's Witnesses
#1
09-18-2003, 09:09 AM
John Viney
At a recent medical conference, a case was put concerning a female Jehovah's Witness patient with extensive hip osteosarcoma undergoing hemipelvectomy, who consented to the use of blood salvage with irradiation. The medical argument was irradiation over leucodepletion filters, the filters only reducing cancerous cells whereas irradiation eliminating the cells completely.
The interesting thing for me as a Patient Representative was what was involved in irradiation. The doctor explained that up to 3 units were processed by being transferred to an irradiation bag, labelled for identification, irradiated at another location outside the operating theatre and returned to the theatre for re-transfusion within 10 to 30 minutes. During questions after the lecture, another doctor raised the point that this procedure was not acceptable to Jehovah's Witnesses, but the speaker assured the audience that it was. (There is a potential 'spiritual' aspect which I would be happy to continue privately by email)
Have any directors or managers of bloodless centres had this situation and is irradiation in use with cell-salvage in USA (This case was from Europe)
#2
09-18-2003, 09:38 AM
Jo Valenti
Hi John, I heard that same presentation. I had the same questions about it. So I initiated a conversation with Jorge Martinez who also was in the room and heard the presentation. Jorge and I agreed that since there is nowhere in print any actual length of time requirements and in this case, the blood is not removed for storage but for a procedure being done to it, some Jehovah's Witness patients might not object to it.
That being said, I wonder how I would explain it to a patient.....
Jo
__________________
Jo Valenti, RN
CBMS
Hackensack University Medical Center
#3
09-18-2003, 10:45 AM
Todd Hofmeister
The Explanation to a Jehovah's Witness is that this is part of an ONGOING THERAPYand that the blood is not stored at any time. The Watchtower Bible and Tract Society leaves these decisions up to the individual. As a result, some will accept this procedure and others will not.
#4
09-19-2003, 06:59 AM
Deb Arceneaux
Mr. Viney: This is an interesting subject. According to your description, this is part of an on-going therapy and is therefore a personal decision for a Jehovah's Witness. In the USA, the Witnesses' Durable Power of Attorney for Healthcare no longer describes conscience matter(s) for them being part of a 'continuous loop' but part of an "ongoing therapy". This could include such alternatives as platelet gel, tagging, and others. I hope this helps answer your concern.
#5
09-19-2003, 02:02 PM
jvarisco
Hi Jo & John,
I had the same feelings about the patient's blood leaving the room. I had the opportunity to eat dinner with the physician who spoke on this occasion and presented the case. I happened to be the only Jehovah's Witness at the table, so I daringly posed the question to the physician. He said that he went over the whole process with the patient and with her "clergyman" (who I assumed was on the HLC), and the patient agreed to the process involved. I told the physician that possibly different patients might object to that process, so don't be thrown off guard if that happens. Each individual has to make a personal choice, since the Bible does not consider all the medical interventions that exist today. The personal decisions a Jehovah's Witness makes concerning how their blood is to be treated becomes a matter of sacredness.
Some patients, even after viewing the "No Blood" video, object to cellsalvage, so I guess just explaining the process in plain terms and allowing the patient to make a totally informed decision is the only way to go.
I'm so glad others were concerned with this process and voiced that concern.
Jessica Varisco
Blood Conservation Program Coordinator
Houston, TX
__________________
Jessica Varisco, BMPC
Advance Directives Educator
Blood Conservation/Management Program Coordinator
Houston, TX
#6
09-22-2003, 01:25 PM
DanFriedman
I agree with all comments made, and they are in accord with my last conversation with H.I.S. I'm just not sure when the "issue" changed from "blood leaving the body" to "storage"...
Regards,
Dan Friedman
Bloodless Healthcare Development
#7
09-23-2003, 02:00 PM
rjbsec
These posts reminds me that one of the dangers in liaison with JW patient and medical staff, that we must be ever aware of, is perhaps in trying to "justify" (if that is not too strong a word) the use of any form of treatment. It is so easy for us to find a solution to a problem by telling one of our brothers or sisters that a procedure, is in effect, "okay" because of another Witness having accepted it or "the Society says it's okay" etc. Indeed some of our brothers might WANT us to tell them that it is okay!
Guidance received to date seems to indicate that a full and detailed explanation of the procedure involved is the best way to help our brothers decide. This, together with a review of scriptural principles and the latest guidance from the Society, provides them with the means to decide about treatment options for them. Prayerful consideration by the patient of both the procedure and the scriptural position then allows them to make an informed decision on the basis of their own conscience, rather then being swayed by the conscience of another (either for or against) and feeling regret afterwards.
“But if he has doubts, he is already condemned if he eats, because he does not eat out of faith. Indeed, everything that is not out of faith is sin.” (Rom. 14:23) The apostle directs this remark to those professing to be Christians, not to unbelievers. What a person does should be something that in no way makes his conscience uncomfortable. If his conscience is bothered, he is self-condemned. And he should constantly strive for a clear picture of the Christian faith, so as to achieve a more balanced conscience. While not all things that a Christian does have a direct connection with the proclamation of the “good news,” what he does, even in recreation and relaxation, he does with the view of upbuilding himself and others."
Teaching grandmother to suck eggs maybe, but still a useful reminder.
#8
09-24-2003, 12:00 PM
jbwade
Hmmm
I think we are treading on a slippery slope by discussing anecdotal comments or conversations with HIS. The lastest information occurring in the October 15 'Questions From Readers' is the last word I know of on this subject.
I am attaching it.
Here are a couple of statement from the article. The word stored is used because PAD is being discussed. Is it possible that blood can be poured out and then reinfused if it is done in the name of an "ongoing medical prodedure"? I lean toward the "if it looks like a duck and walks like a duck its probably a duck" school of thought. Also a rose by any other name is still a rose is it not?
"Occasionally, a doctor will urge a patient to deposit his own blood weeks before surgery (preoperative autologous blood donation, or PAD) so that if the need arises, he could transfuse the patient with his own stored blood. However, such collecting, storing, and transfusing of blood directly contradicts what is said in Leviticus and Deuteronomy.
Blood is not to be stored; it is to be poured out—returned to God, as it were. Granted, the Mosaic Law is not in force now. Nevertheless, Jehovah’s Witnesses respect the principles God included in it, and they are determined to ‘abstain from blood.’ Hence, we do not donate blood, nor do we store for transfusion our blood that should be ‘poured out.’ That practice conflicts with God’s law..." "Other procedures or tests involving an individual’s own blood are not so clearly in conflict with God’s stated principles. For instance, many
Christians have allowed some of their blood to be withdrawn for testing or analysis, after which the sample is discarded. Other more complex procedures involving one’s blood may also be recommended." "There are also tests in which a quantity of blood is withdrawn in order to tag it or to mix it with medicine, whereupon it is put back into the patient." "The details may vary, and new procedures, treatments, and tests will certainly be developed. It is not our place to analyze each variation and render a decision. A Christian must decide for himself how his own blood will be handled in the course of a surgical procedure, medical test, or current therapy. Ahead of time, he should obtain from the doctor or technician the facts about what might be done with his blood during the procedure. Then he must decide according to what his conscience permits."
Attached Files
w00 10 QR.doc (25.5 KB, 16 views)
__________________
Jan Wade
Developer/Manager
Blood Management Programs
Seattle, WA
Skype me!
Last edited by jbwade : 09-24-2003 at 04:09 PM.
#9
09-24-2003, 03:25 PM
John Viney
Thank you for your comments concerning cell-salvaged blood, irradiation and the issue for Jehovah's Witnesses. This medical experience highlights the point made in the Q from R article, "The details may vary, and new procedures, treatments, and tests will certainly be developed".
A "new procedure" is now being offered and no doubt will be available to many more patients as it gains acceptance in the medical world.
What about the next point: "It is not our place to analyze each variation and render a decision. A Christian must decide for himself how his own blood will be handled in the course of a surgical procedure, medical test, or current therapy. ...Then he must decide
according to what his conscience permits." This is the definitive answer. As Patient Representatives on HLC's we sometimes have to hear doctors explain their prefered choice of treatment to patients so the patient can decide what to accept or decline. The maxim still applies 'Doctors advise, Patients decide'. If the above 'procedure' was offered and accepted by a Jehovah's Witness patient, it would fall into the parameters of the above Q from R. We may not choose such an option, but it IS an option that they can choose. The bottom line is this: If the patient agreed to irradiate cell-salvaged blood by removing it to another location and then returning it for re-infusion during the course of an operation, no form of Judicial action would be taken and hence would be acceptable if that is their decision.
It was my intention just to bring to the forefront that this procedure is being offered so that when it is discussed with doctors, we give a unified response: That response is "It is up to the patient to decide."
Finally , my actual question on this thread was "Is this procedure currently being offered in USA? The case came from Europe and I wondered if it was available over there?
#10
09-24-2003, 04:12 PM
jbwade
irradiation
I haven't seen it here in Fresno, California.
__________________
Jan Wade
Developer/Manager
Blood Management Programs
Seattle, WA
Skype me!
#11
09-25-2003, 03:14 PM
Vernon
Irradiation is something I heard about at a conference in the Netherlands last year. Dr. Hansen (from Germany) gave an excellent lecture on his experience with the technique. I came home hopeful that some of the US hospitals would consider this as an option in cancer surgery, however the response has been somewhat disappointing, yet realistic. The logistics of sending blood to the blood bank (as the majority of hospitals do not have irradiators in the OR), irradating, and sending back is problematic. First, who is the runner, second, what if the irradiator is in use, third the turn-around time back to OR and finally another transporter. And, with all of this, you have the potential for human error and the reduced amount of time you now have to reinfuse the blood. In the discussion at the SABM conference, the US physicians agreed. It is possible that one of the major cancer centers may have experimented with this technique, however I am not aware of any published literature on the process. Highlighting, once again, that Europe reaches beyond the confines of the FDA.
#12
09-29-2003, 03:45 PM
John Viney
Join Date: Mar 2003
Sorry - I have a virus
In my first posting I suggested that anyone wanting a private discussion contact me through e-mail. My computer has had a virus and I have not been able to access my e-mails for a week. I mention this in case anyone did contact me and I have not replied. I CAN access the private message on this site until I get the 'bug' sorted, if you dont mind re-sending.
Thanks John Viney
