Management of Jehovah’s witnesses before, during and after high bleeding risk surgery

Virginie Faucon, Mona Momeni(1), Patrice Forget(2) Published in the journal : December 2017 Category : Anesthesiology

Summary :

Jehovah witnesses refuse transfusion of labile blood products. This is the reason why blood conserving procedures must be implemented when high bleeding risk surgery is required. Management of these patients consists in a multidisciplinary approach involving the anesthesiologist, intensivist, surgeon, and general practitioner. The procedures have to be initiated as soon as possible and be pursued during the entire hospitalization, while following a specific legal framework. This article provides a series of rules enabling doctors to properly care for their patients.

What is already known about the topic?

Owing to their beliefs, Jehovah's witnesses may prove difficult to handle when procedures with bleeding risk are at stake, the challenge being at the same time medical, legal, and ethical. The medical challenge consists in taking care of these patients in the most secure way possible. The legal challenge means that the specific legal framework must be respected, while the ethical challenge refers to refusing a vitally necessary blood transfusion, as requested by the legal framework. Due to the intransigence of Jehovah's witnesses, blood-saving strategies are currently being developed.

What does this article bring up for us?

Based on current recommendations, this article proposes ways and alternatives that should be followed when taking care of Jehovah's witnesses. These alternatives are primarily aimed at reducing operating risks, in line with their convictions.

Key Words

Jehovah’s witnesses, surgery, bleeding risk, blood conserving procedures, perioperative care, haemostasis, antiplatelet drugs, anticoagulants, erythropoietin, medical-surgical team, psychological context, legal framework