ARE JWs WINNING?
(Investigator 172, 2017 January)
Jehovah's Witnesses adopted the belief that the biblical command
"abstain from blood" prohibits transfusion of blood into the human body.
declared blood transfusions "dangerous" and publicized
transfusion-transmitted diseases, deaths from mismatched blood, and
stories of JWs who survived surgery without transfusions.
The Illinois Medical Journal (April
1973, p. 349) reported that blood transfusions in the USA annually
killed 2500 people, or 0.1% of recipients, mainly from hepatitis.
Shafer (1976) wrote: "It has been estimated ... that between 3,000 and
30,000 deaths attributable to transfusions occur annually in the United
regularly published reports of JWs bleeding to death and medical
journals agreed that anemia and blood loss can kill:
In a case-control
study of 125 surgical patients who declined blood transfusions for
religious reasons operative mortality was inversely related to the
preoperative haemoglobin level, rising from 7.1% for patients with
levels above 10 g/dl to 61.5% for those with levels below 6 g/dl.
Mortality rates were also related to blood loss during surgery, rising
from 8% for patients who lost less than 500 ml to 42.9% for those who
lost more than 2000 ml. (Carson et al 1988)
Who is right?
12-page JW brochure 1960
rates improved with new technology and methods to reduce bleeding.
(Langone 1988) In the 1970s JWs also began to switch from rejecting all
blood products to accepting blood “fractions”. Khadra et al (2002)
will not accept transfusions of whole blood, packed red cells, white
cells, plasma, and platelets. However, Jehovah's Witnesses will accept
non blood products such as Ringer's lactate, normal saline, hypertonic
saline, dextran, gelatine (gelofusine/haemaccel), and hetastarch.
Matters of patient choice include immunogloulins, clotting factors,
albumin, dialysis, intra-operative cell salvage, haemodilution, and
pioneered "bloodless" open-heart surgery on JWs. A 1964 report of seven
surgeries attributed one death to bleeding. (Cooley 1964)
Zaorski et al
(1972) reported 42 surgeries on JWs of whom three died but only one
examined 16 reports of surgeries (dated 1983 to 1990) on 1,404 JW
patients not given blood in "operations during which transfusion is
implicated a lack of blood as the primary cause of death in 8 patients
(0.6%) and contributing to death in another 12 patients, yielding a
total of 20 deaths (1.4%).
contrasted the 1.4% deaths with Walker (1987) who writes: "...each
[blood] transfusion event has an aggregate 20% chance for some adverse
reaction, some of which are minor but others deleterious." Therefore,
although 1.4% of the JW patients died from bleeding, each survivor
avoided a 20% risk of other complications!
Stein et al
(1991) report open heart surgery on 15 JW children in Austria between
1979 and 1989 and conclude: "Our results demonstrate that bloodless
cardiac surgery on bypass is feasible in children..."
Alexi-Meskishvili et al (2004) report on 14 JW children with congenital
heart defects who underwent 16 operations. There were no deaths and:
"Bloodless cardiac surgery ... can be safely performed in Jehovah's
Witness infants and children."
Stamou et al
(2006) compared 49 JW patients who underwent open cardiac surgery with
196 non-JWs. Clinical outcomes were: "comparable to those of
non-Jehovah's Witnesses by adhering to blood conservation protocols."
The Age newspaper reported comments
by American cardiothoracic specialist Bruce Spiess:
Professor Spiess said
a study in Sweden of 499 Witnesses showed their survival rates were
higher than people who received transfusions… He emphasised that in
cases of severe trauma, blood transfusions were necessary... (May 28,
Pattakos et al
(2012) report a study of 322 JWs who refused transfusions for cardiac
surgery, and 87,453 other patients of whom 38,467 also did not receive
transfusions. JWs had an 86% chance of survival at five years and a 34%
chance at 20 years, compared with 74% at five years and 23% at 20 years
for patients who had transfusions.
study may be flawed because: "Witnesses who came to our center and who
were accepted by our surgeons likely represent a select group who might
have been expected by their physicians to have better outcomes." The
accompanying editorial by V.A. Ferraris says: "Witnesses who undergo
cardiac surgery are likely a healthier subgroup of Witnesses because
those who are believed by their surgeons to require blood transfusions
to survive cardiac surgery presumably never go to the operating table."
(pp 1160-1161) (See also Angouras 2013)
Marinakis et al
(2016) report complex cardiac surgery in Belgium on 31 JWs compared to
a matched control group of 62 non-JWs who underwent the same surgical
procedures by the same senior surgeons. 17 of the control group
There was no
significant difference in surgical outcomes. Hospital mortality was 3 %
for Jehovah’s Witnesses versus 2 % for control group ... complex
procedures and reoperations can be performed in Jehovah's Witnesses
provided rigorous preoperative preparations, perioperative hemostasis,
and postoperative management.
Varela et al
(2003) compared the risks of death after major trauma of 82 JWs, 52
Baptists, 101 Catholics and 321 patients of other religions between
1992 and 1999 in a trauma center:
were 6% more likely to die after major trauma than Baptists, 20% more
likely than Catholics, and as likely as patients from any other
in survival were not statistically significant.
Wittmann (1992) describe: "total hip replacement surgery without blood
transfusion … in 12 Jehovah's Witnesses…" Comparison with another group
where each patient received 3 units of blood revealed no deaths in
Lee et al (2015)
did a: "Retrospective analysis over a 10-year time frame of severely
anaemic women (Hb <50 g/L) with benign conditions who had requested
not to receive a blood transfusion." There were no deaths among the 19
suggest that young and otherwise healthy women can tolerate profound
anaemia (Hb <50 g/L) permitting corrective strategies to be
successfully implemented without the need for blood transfusion.
In the past several
decades, specialty programs in “bloodless medicine” that cater to
Jehovah’s Witnesses have grown up at dozens of hospitals. Surprisingly,
doctors’ experience in these programs has often led them to order blood
far less frequently for other patients, as well...
The USA has
about 5000 hospitals of which over 100 now run bloodless programs.
Saxon (2014) reported the implementation of a "Patient Blood Management
Program" in Western Australia:
THE WA Department of
Health has paid almost $4 million to two Jehovah’s Witnesses … to roll
out a statewide program to cut blood transfusions to thousands of
patients being treated in public hospitals…
- Intravenous iron or
- Prior removal of some
of the patient's blood through tubes to a collection bag to re-infuse
during the operation. The tubes remain in place so that JWs can
regard the removed blood as still part of the
circulation — since they don't accept transfusions of their own removed
- Cell salvage — blood
is suctioned into a cell-salvage machine, filtered, and centrifuged to
separate red blood cells which are later returned to the body.
In 2013 a six
year old boy had a successful heart transplant without blood
Heart, lung and
liver transplants formerly associated with life-threatening blood loss
are now often done without blood transfusion.
House writing about the history of liver transplants in Western
In 2001 a further
dilemma was faced and solved when a Jehovah witness presented requiring
a transplant. Considerable debate regarding the feasibility and ethics
of such a transplant was generated in the unit and nationally. The
process initiated a change to the unit’s blood management transplant
protocol to enable efficient blood use and a successful transplant. The
patient recovered well enough to return to farming. The transplant was
an exercise in efficient blood conservation...
Detry et al
(2005) reported liver transplants in 9 JWs between by "teams
experienced with bloodless medical care" and "a multidisciplinary
approach". A six-year-old girl developed "deep anaemia" and "received
one unit of red cells against her parent's will" and survived. Another
was transfused "as required by his family, but died from aspergillus
infection." The authors conclude that equal results to the general
population can be achieved with "prepared and selected" JWs.
In 2013 the
Houston Chronicle reported that a 27-year-old JW woman received a lung
transplant at Methodist Hospital in Houston and was the fifth patient
in its bloodless transplantation program. Dr Scott A. Scheinin who
started this program says that the techniques to minimize blood loss in
JWs are now being used for other patients.
The New York
Times reported the 11th bloodless transplant at Methodist
69-year-old Rebecca Tomczak — and reveals that the program selects
patients with low odds of complications:
By cherry-picking patients with low
odds of complications, Dr. Scheinin felt he could operate almost
as safely without blood as with it...
other patients, Ms. Tomczak would have no backstop. Explicit in her
understanding with Dr. Scheinin was that if something went terribly
wrong, he would allow her to bleed to death. He had watched Witness
patients die before, with a lifesaving elixir at hand... (Sack, 2013)
attention bloodless-surgery patients require can be costly. A
67-year-old JW survived surgery for a "leaking abdominal aortic
aneurysm" but required 14 weeks of intensive care and treatments to
increase his hemoglobin production. Wooding (1999) comments:
Such a stay must
easily have cost a six figure sum. Here in Uganda for £250000 a
year we can treat 25000 outpatients and 7000 inpatients, conduct over
1000 deliveries, and perform 1500 operations. We run a community health
programme for 500000 people. The costs incurred by this one patient
might run our unit for a whole year...
child-birth by JWs Currie et al (2010) write: "Considerable efforts are
needed to optimise pre-delivery haemoglobin and identify risk factors
However, as new
methods get established costs come down — followed by savings (since
blood transfusions can each cost $thousands)!
The Sunday Mail [Australia] in 2004
reported that 20,000 Australians received the hepatitis C virus from
blood transfusions in the 1980s and 1990s. The virus can stay in the
blood for decades and cause liver cancer. (2004, June 13)
transfer of disease by transfusion is rare. Perrotta and Snyder (2001)
Blood transfusion is
considered safe when the infused blood is tested using state of the art
viral assays developed over the past several decades. Only rarely are
known viruses like HIV and hepatitis C transmitted by transfusion when
blood donors are screened using these sensitive laboratory tests.
Yazer (2007) write: "every transfusion recipient is at risk of a
variety of adverse events (termed transfusion reactions)..." However:
can be life-saving in the appropriate setting.... The screening and
testing methods used today make the chances of getting a disease from a
blood transfusion very low — about 1 in 1.5-3 million for hepatitis C
and 1 in 1.5-8 million for HIV... If your doctor thinks that you need a
transfusion, your risk of becoming very sick or even dying without it
would probably be much higher than the risk of acquiring a disease.
reported that a 15-year-old boy was hit by a car but carried a "No
Blood" card and verbally repeated this instruction to doctors. His
decision was respected; he died.
Awake! magazine in 1992 referred to
a "young boy" given blood under court order and said: "There are
numerous other cases pending in appeals courts and new ones arising
daily." (Awake! 1992 9/22 12)
The Watchtower said: "The
accusation that numerous children of Jehovah's Witnesses die each year
as a result of refusing blood transfusions is totally unfounded."
(w1998 12/1 14) However, Awake!
(1994 May 22) has pictures of 26
youngsters on the cover and says: "In former times thousands of youths
died for putting God first. They are still doing it, only today the
drama is played out in hospitals and courtrooms, with blood
transfusions the issue." Of the 26 kids three get specific mention
(pages 10, 8, 14) as having died after rejecting blood.
was 15-year-old Kumiko who had leukemia: "Trying to lengthen her life
... was not worth what it would cost her in the long run." (Watchtower
1995 1/15 7)
Most JW kids who
require blood are saved by court order, but hospitals permit some to
die if courts deem them legally competent:
- Carson (2013)
reported a case of Hodgkin's Disease in Sydney Children's Hospital:
"Justice Ian Gzell immediately ordered a blood transfusion after
doctors said the 17-year-old's life depended on it..."
- The Courier Mail reported: "A
BRISBANE hospital will be allowed to give a boy, 7, a life-saving blood
transfusion during a planned liver transplant, against the wishes of
his Jehovah’s Witness parents..." (2015, June 25)
- Venter (2014)
reported: "Pretoria - The life of a 10-year-old girl was saved after a
high court ... granted an urgent application authorising a doctor to
commence immediately with a blood transfusion..."
- Carter (2014)
reported: "High Court judge has ruled that the son of two devout
Jehovah's Witnesses can be given a blood transfusion despite religious
objections from his parents..."
- In Washington State a
boy, 14, was allowed to reject blood transfusions to treat bone marrow
cancer and died. (Raftery 2015)
in bloodless surgery JW adults are still dying when blood might
save them. For example:
- The Australian reported the death
of 49-year-old woman: "A Jehovah's Witness who died of complications
after surgery would probably have survived if she had accepted a blood
transfusion, a Tasmanian coroner has found." (November 10, 2011)
- In 2012 a lawyer
advised doctors to let a 22-year-old with sickle cell anemia die: "Medical
staff were understandably upset ... knowing a simple procedure
... would have saved his life..." www.independent.co.uk/life-style/health-and-families/heal
- In 2014 an ex-JW
woman in New Zealand who rejected blood died after minor surgery. Her
gall-bladder removal had seemed successful but internal bleeding
developed and she could not be transferred to a better equipped
hospital quickly enough. (Hyslop 2014)
- Carter (2014)
reported the death of a JW woman after doctors received permission to
withhold blood transfusion. The doctors had argued that the woman
"lacked the mental capacity to make or communicate decisions about
treatment" but the judge concluded she had made her decision earlier
when she did have the mental capacity.
- A 7-month pregnant
28-year-old JW woman and her unborn infant died in Sydney after she
refused blood to treat leukemia. Michael and Beers (2015) reported,
"Hospital staff were 'distressed' over what were perceived to be two
avoidable deaths, as 83 percent of pregnant leukemia sufferers go into
remission with treatment."
Many deaths are not
publicized because they are recorded in confidential files and/or don't
come to reporters' notice.
childbirth bleeding can be unexpected and massive.
review of precautions, preparation, and patient-care when blood
transfusion during childbirth is not an option see Kidson-Gerber et all
(2016). Risk factors, alternative treatments, patient management during
hemorrhage, post partum anemia, and legal considerations are addressed.
(2010) and Van Wolfswinkel et all (2009) present reviews for England
and the Netherlands. The latter discuss a nationwide study and
Women who are
Jehovah’s witnesses are at a six times increased risk for maternal
death, at a 130 times increased risk for maternal death because of
major obstetric haemorrhage and at a 3.1 times increased risk for
serious maternal morbidity because of obstetric haemorrhage, compared
to the general Dutch population.
(2002) write that most maternity wards were not organized to manage
blood-refusal situations although the risk of death for JWs giving
birth was 100 times greater:
The death rate in
this group was 1 per 1,000 maternities compared with an expected
incidence of less than 1 per 100,000 maternities. A survey of 147
labour wards in the United Kingdom found only two units had
recommendations for the management of women who refuse blood
(2007) reviewed the obstetric outcome over 14 years of JWs in a
hospital. Of 90 women, one died — "which when extrapolated, resulted in
a 65-fold increased risk compared with the national rate."
(2001) did a study of the maternal death rate among JW women in the
USA. The calculated death rate — based on two maternal deaths out of
332 JW women — came to 512 deaths per 100,000 live births, which was 44
times higher than for non-JWs.
which transports oxygen but lacks clotting factors and other properties
of blood began in the 1970s and saved many JW lives. (Gonzalez 1980)
test of Fluosol-DA in 1979-1982 included 50 JWs. (Saltus 1982) An
improved version, Fluosol-DA20, was approved in 1989 but withdrawn in
1994 due to side-effects.
there were trials with Polyheme, Hemospan and Hemopure. (Davis 2006)
Henderson (2012) reported how two JWs in Australia were saved with
Hemopure which "contains oxygen-carrying haemoglobin extracted from the
red blood cells of cows." Currently there are trials with Oxycite.
2 (Investigator #173) for the
references and the conclusion to
whether JWs are winning in the