BLOOD TRANSFUSIONS CONTROVERSY
:
ARE JWs WINNING?


Part 1


(Investigator 172, 2017 January)




In 1945 Jehovah's Witnesses adopted the belief that the biblical command "abstain from blood" prohibits transfusion of blood into the human body.

The sect 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 States."

Newspapers 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



SURVIVAL-RATE STUDIES

JW survival 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) state:

Jehovah's Witnesses 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 organ transplant.

Denton Cooley 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 from anemia.

Kitchens (1993) examined 16 reports of surgeries (dated 1983 to 1990) on 1,404 JW patients not given blood in "operations during which transfusion is typically given":

The authors 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%).

Kitchens 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, 2007)

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.

The Pattakos 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 received transfusions:

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:

Jehovah's Witnesses were 6% more likely to die after major trauma than Baptists, 20% more likely than Catholics, and as likely as patients from any other religious groups…

The differences in survival were not statistically significant.

Wittmann & 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 either group.

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 women and:

These findings 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.

Schaffer (2015) writes:

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.


BLOOD MANAGEMENT

Saunders and 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…

Blood Management consists of:


TRANSPLANTS

In 2013 a six year old boy had a successful heart transplant without blood transfusion.

Heart, lung and liver transplants formerly associated with life-threatening blood loss are now often done without blood transfusion.

Professor Tony House writing about the history of liver transplants in Western Australia says:

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 Hospital — 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...
Unlike 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)


 COSTS

The extra 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...

Regarding child-birth by JWs Currie et al (2010) write: "Considerable efforts are needed to optimise pre-delivery haemoglobin and identify risk factors for haemorrhage."

However, as new methods get established costs come down — followed by savings (since blood transfusions can each cost $thousands)!


DANGEROUS?

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)

Today the transfer of disease by transfusion is rare. Perrotta and Snyder (2001) write:

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.

Bakdash and Yazer (2007) write: "every transfusion recipient is at risk of a variety of adverse events (termed transfusion reactions)..." However:

Blood transfusions 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.


CHILDREN

Roberts (2010) 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.

Another death 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: 

ADULTS

Despite advances in bloodless surgery JW adults are still dying when blood  might save them. For example:
Many deaths are not publicized because they are recorded in confidential files and/or don't come to reporters' notice.


CHILDBIRTH

In pregnancy and childbirth bleeding can be unexpected and massive.

For an Australian 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.

Currie et al (2010) and Van Wolfswinkel et all (2009) present reviews for England and the Netherlands. The latter discuss a nationwide study and conclude:

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.

Khadra et al (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 transfusion.

Massiah et al (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."

Singla et al (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.


ARTIFICIAL BLOOD

Artificial blood which transports oxygen but lacks clotting factors and other properties of blood began in the 1970s and saved many JW lives. (Gonzalez 1980)

A nationwide 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.

Around 2006 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.


See Part 2 (Investigator #173) for the references and the conclusion to
 whether JWs are winning in the blood transfusion controversy



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