BLOOD
TRANSFUSIONS:
ARE JWs WINNING?
Part II [Back to Part 1)
(Investigator 173,
2017 March)
BLOOD
STILL NEEDED
Current
alternatives to blood transfusion often fail in rapid, massive blood
loss as occurs in some maternity cases, accidents and wounds.
Hunt (1993)
reported that a man received "400 pints of blood" after a lorry crushed
his pelvis and mentions another case when a policeman was stabbed and
required 300 pints. The Advertiser
reported that a woman received "nearly eight litres of blood" following
a "rare complication after she gave birth". (July 19, 2013)
In a study of
1958 JWs who had surgery without blood transfusions Tobian et al (2009)
found that "Mortality increases as hemoglobin levels fall." 117
patients had postoperative hemoglobin levels below 6 gram/deciliter of
whom 39 died. (Normal levels are 14-17 g/dl for men and 12-15 g/dl for
women.)
Many
commentators mention "risks of infections" from blood.
However, in high-income countries such risks are tiny:
•
HIV: 3/100,000
•
Hepatitis B: 30/100,000
•
Hepatitis C: 20/100,000 (WHO 2016)
It
is far riskier to reject blood when surgeons think transfusion
necessary.
DIVISIVENESS
In
the 1980s the JW Governing Body introduced added monitoring by
establishing "Hospital Liaison Committees", and have also advised JWs
to
give power of attorney to another JW. Yet
many JWs still accepted
blood or blood components banned to them. Varela et al (2003) write:
"blood
transfusions are performed in up to 7% of Jehovah's Witnesses cases…"
Kerry
Louderback-Wood (2005) is an American lawyer and former JW whose mother
died after rejecting a transfusion. She suggests that the possible
misrepresentation of medical risks in JW publications makes the
Watchtower Society vulnerable to law suits by relatives of people who
died from following the teaching. She argues that constitutional
guarantees of freedom of religion do not remove the legal
responsibility regarding misrepresenting secular fact.
The Associated
Jehovah’s Witnesses for Reform on Blood (AJWRB), founded in 1997 claim
to have thousands of supporters in 25 countries including elders,
doctors, and members of Hospital Liaison Committees. The founder Lee
Elder (a pseudonym) says his grandmother died due to obeying the blood
ban.
Further
divisiveness is doctrinal revision. In 1961 JWs opposed donation,
storage and infusing of both blood and blood fractions:
The Bible is very
clear that blood could properly be used only on the altar; otherwise it
was to be poured out on the ground. (Lev. 17:11-13) The entire modern
medical practice involving the use of blood is objectionable from the
Christian standpoint. Therefore the taking of a blood
transfusion, or, in lieu of that, the infusing of some blood fraction
to sustain one’s life is wrong. (Watchtower 1961 11/1 670)
In the 1970s
this
total ban began revision by making blood fractions a conscience matter.
(Watchtower 1990 6/1 30-31; How Can Blood Save Your Life?
1990, 27)
In 1975
the JW Governing Body banned JW hemophiliacs from receiving clotting
factors such as Factor VIII (Awake! 1975 2/22 30) but later permitted
clotting factors. (Watchtower 1978 6/15 30)
Transfusions of
whole blood (including one's own self-donated blood), red cells, white
cells, platelets and plasma are still prohibited. Wikipedia (2016)
lists the following as now acceptable:
•
Blood donation for purpose of fractionation of red cells, white cells,
platelets or plasma for either allogeneic or autologous transfusion.
•
Hemodilution (when equipment is arranged in a circuit with patients'
circulatory systems).
•
Blood salvage — reinfusing blood spilt during surgery.
•
Heart-Lung Machine.
•
Dialysis.
•
Epidural Blood Patch.
•
Plasmapheresis — blood withdrawn, filtered and plasma removed, and
returned to the patient.
•
Fractions from red blood cells.
•
Fractions from white blood cells — Interferons and Interleukins.
•
Fractions from platelets — Platelet factor 4.
•
Fractions from blood plasma — Albumin, Globulins, Cryoprecipitate, Clotting factors
including Factor VIII and Factor IX.
ESTIMATED
DEATHS
Investigator #12 (1990) cited news
reports of four JW deaths from bleeding in South Australia. About
1/700th of JWs worldwide lived in SA; therefore a world total of JW
deaths until 1990 was estimated at 700x4 = 2800.
A similar
calculation, based on New Zealand with about 1/500th of JWs, and 5
known deaths, is 500x5 = 2500
Such
calculations show promise but are questionable because:
•
Sample sizes are too small;
•
Newspapers may not report all JW bleeding-deaths;
•
Probably not all newspaper reports were found;
•
Patients in hospital are there because they are injured or sick and may
die whether they receive blood or not.
Singla et al
(2001) calculated a maternal death rate of 512 per 100,000 live births
among USA JW women. [In most countries the rate for all women is below 70
— www.indexmundi.com/g/r.aspx?v=2223] Assuming a birth rate of 20
per thousand women per year, and JW females in the 1990s numbering
3,000,000 worldwide, suggests about 300 JW maternal deaths annually in
childbirth. Again, the sample is small, based on few actual known
deaths.
Most JWs
survived surgery, even major surgery. Ott and Cooley (1977) reported
cardiovascular surgery in 542 JWs and, "anemia was a contributing
factor in 12 deaths, and loss of blood was the direct cause of three
deaths." Such
positive
results, however, may not be as impressive as appears since the
surgeons probably "cherry picked" JW patients for their survival
potential and bypassed riskier, more-difficult cases.
The total
unnecessary JW deaths since 1945 surely number thousands but less than
the 250,000 claimed on some websites!
WHO
WON?
The conflict
with the medical profession originally started when JWs wanted
treatment in hospitals but died rather than accept blood.
JWs are right in
that blood transfusions were over-used, sometimes transmitted disease,
and have other risks associated with them. (Nowak 2008) However,
a small risk of disease is tolerable compared to death when bleeding is
severe.
In 1961 the JW
blood ban included blood fractions. JWs lost that debate when they
began to accept blood fractions. This contradicted their teaching that
even collection and storage of blood is unbiblical. JWs also sometimes
removed children from hospital and hid them to prevent transfusions but
that practice apparently stopped.
Investigator #8 suggested the JW
Governing Body would retain their blood ban despite the dubious
theology behind it in the hope that new technology will reduce the need
for transfusions. JWs have endured numerous revisions to their "Bible
truth" (i.e. their doctrines), including other medical conflicts and
false dates for Armageddon, and might not cope well if it's also
admitted that thousands died needlessly.
Technology
indeed "came to the rescue" including hyperbaric oxygen therapy, blood
fractions, "blood management", laser surgery, faster surgery times,
artificial blood, and in future possibly stem cells:
Blood donations may
become a thing of the past due to advances in stem cell technology...
The Daily Telegraph says that a new way has been discovered of growing
“potentially unlimited supplies of blood in the lab”… (Harborough Mail,
19 August, 2008)
Advances in
technology, however, require the work of highly trained graduates
whereas JW theology discourages education beyond high-school:
If you are a young
person, you also need to face the fact that you will never grow old in
this present system of things. Why not? Because all the evidence
in fulfillment of Bible prophecy indicates that this corrupt system is
due to end in a few years. Of the generation that observed the
beginning of the "last days" in 1914, Jesus foretold: "This generation
will by no means pass away until all these things occur."—Matt. 24:34.
Therefore,
as a young person, you will never fulfill any career that this system
offers. If you are in high school and thinking about a college
education, it means at least four, perhaps six or eight more years to
graduate into a specialized career. But where will this system of
things be by that time? It will be well on the way toward its finish,
if not actually gone! (Awake! 1969 May 22, page 15)
The advanced
education criticized and discouraged by JWs has saved thousands of
their
lives! Ironic!
The main losers
are the JWs who died unnecessarily believing they won't stay dead for
long because Armageddon would come in "the twentieth
century".
But on the
propaganda front JWs are winners. The conflict with courts,
hospitals
and critics, along with JWs being useful as volunteers in medical
research, gained the sect much free publicity.
REFERENCES:
Alexi-Meskishvili
V., Stiller B, Koster A., Böttcher W., Hübler M., Photiadis
J., Lange P.E., Hetzer R. Correction of congenital heart defects in
Jehovah's Witness children, The
Journal of Thoracic and Cardiovascular Surgery, June 2004,
52(3):141-146
Angouras, D.C.
11 February, 2013
http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1570244
Bakdash, S.,
Yazer, M.H. What every physician should know about transfusion
reactions, Canadian Medical
Association Journal, July 17, 2007, 177(2): 141–147
Busch, M.P.,
Kleinman, S.H., Nemo, G.J. Current and Emerging Infectious Risks of
Blood Transfusions, JAMA,
February 26, 2003, 289(8), 961
Carson, J.L.,
Poses, R.M., Spence, R.K., Bonavita, G. Severity of anaemia and
operative mortality and morbidity, Lancet,
1988, April 2, 727-729
https://www.ncbi.nlm.nih.gov/pubmed/2895260
Carson, V. 18
April, 2013
www.dailytelegraph.com.au
Carter, C. 2014 Mail Online, 8 December, 2014
http://www.dailymail.co.uk/news/article-2865363
Cooley, D.A.
Open Heart Surgery in Jehovah's Witnesses, American Journal of Cardiology,
June 1964, 13:779-781
Corderoy, A.
Pregnant Jehovah's Witness' decision to refuse treatment 'harrowing'
for hospital staff after mother and baby die
Sydney Morning Herald, 6 April,
2015
Currie J., Hogg
M., Patel N., Madgwick K., Yoong W. Management of women who decline
blood and blood products in pregnancy, The Obstetrician & Gynaecologist,
2010, 12:13–20
Davis, N. Better
Than Blood? Popular Science,
November 2006, 89-94
Department of
Health. Report on Confidential
Enquiries into Maternal Deaths in the United Kingdom 1994–1996.
Why Mothers Die. London. The Stationery Office, 1998, 1-275.
Detry O. et al
2005 Liver transplantation in Jehovah's witnesses, Transplant International, August
2005, 18(8), 929–936
Dictionary
of Jehovah's Witnesses
https://ed5015.tripod.com/jwdictionary/CONTENTS.html
Doyle, D.J.
Blood Transfusions and the Jehovah's Witness Patient, American Journal of Surgery,
September-October 2002, 9(5), 417-424
www.ncbi.nlm.nih.gov/pubmed/12237734
Geddes, L. Bags
of blood and not a donor in sight, New
Scientist, 12 November 2011, 8-9
Gonzalez, E.R.
The saga of 'artificial blood', JAMA,
February 22/29, 1980, 243(8), 719-724
Henderson, M. 10
August, 2012
www.theaustralian.com.au/news/latest-news/.../story-fn3dxiwe-1226447338350
House, T. Transplant History
liverfoundation.org.au/display/index/about-transplant
Hunt, L. The Independent Online, 25 May 1993
www.independent.co.uk/news/accident-victim-gets-400-pints-of-blood-transfusion-service-appeals-for-donors-2324986
Hyslop, L.
Ex-Jehovah's Witness bled to death after surgery, Marlborough Express, 20 October,
2014
International
Anesthesia Research Society
www.openanesthesia.org/jehovahs_witness_patients/
Investigator Magazine 1989 #8; 1990
#12
Jabbour, N.
(editor) 2005 Transfusion Free
Medicine and Surgery, Blackwell
Khadra, M.,
Rigby, C., Warren, P., Leighton, N., Johanson, R. 2002 A criterion
audit of women's awareness of blood transfusion in pregnancy
http://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-2-7
Kidson-Gerber,
G., Kerridge, I., Farmer, S., Stewart, C.L., Savoia, H., Challis, D.
Caring for pregnant women for whom transfusion is not an option... Australian and New Zealand Journal of
Obstetrics and Gynaecology, April 2016, Volume 56(2), 127–136
http://onlinelibrary.wiley.com/doi/10.1111/ajo.12420/full
Kitchens, C.S.
Are transfusions overrated? Surgical outcome of Jehovah's Witnesses, The American Journal of Medicine,
February 1993, 94:117-119
Kumari, N. and
R. Surgical management in treatment of Jehovah's witness in trauma
surgery in Indian subcontinent, Journal
of Emergencies, Trauma, and Shock, July-September 2014, 7(3),
215-221
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4126123
Langone, J. New
Methods for Saving Blood, Time,
December 5, 1988
Lauder, S.
Synthetic blood saves a life
www.abc.au/worldtoday/content/2011/s3208571.htm
Lee, E.S., Kim,
M.J., Park, B.R., Kim, J.S., Choi, G.Y., Lee, J.J., Lee, I.S.
Avoiding unnecessary blood transfusions in women with profound anaemia,
Australian and New Zealand Journal of
Obstetrics and Gynaecology, 5 June, 2015, 55 (3), 262–267
http://onlinelibrary.wiley.com/doi/10.1111/ajo.12329/full
Louderback-Wood,
K. 2005 Jehovah's Witnesses, Blood Transfusions, and the Tort of
Misrepresentation, Journal of Church
and State, December 13, 2005
Marinakis, S.,
Van der Linden, P., Tortora, R., Massaut, J., Pierrakos, C., Wauthy, P.
2016 Outcomes from cardiac surgery in Jehovah’s witness patients:
experience over twenty-one years, Journal
of Cardiothoracic Surgery, 4 April, 2016, 11:67
https://cardiothoracicsurgery.biomedcentral.com/articles/10.1186/s13019-016-0455-6
Massiah, N.,
Athimulam, S., Loo, C., Okolo, S., Yoong, W. Obstetric care of
Jehovah's Witnesses: a 14-year observational study, Archives of Gynecology and Obstetrics,
October 2007, 276(4):339-343
Michael, S.
& Beers, L. Daily Mail, 7
April, 2015
www.dailymail.co.uk/news/article-3027599
Muramoto, O.
Bioethics of the refusal of Blood by Jehovah's Witnesses: Part 1, Journal of Medical Ethics 1998,
24:223-230; Part 2, 24:295-301
jme.bmj.com/content/24/4/223.full.pdf
jmebeta.bmj.com/content/medethics/24/5/295.full.pdf
Nowak, R. Blood
doesn't always save lives, New
Scientist, 26 April, 2008, 8-9
Oakes, D.
Treating patients like Jehovah's Witnesses could save lives... The Age, 28 May, 2007
Ostrow, N.
Jehovah's Witnesses recover best from surgery, despite refusing blood, Sydney Morning Herald, 4 July, 2012
Ott, D.A.;
Cooley, D.A. Cardiovascular Surgery in Jehovah's Witnesses Report of
542 Operations Without Blood Transfusions, JAMA, 1977, 238(12), 1256-1258
Pattakos, G.,
Koch, C.G., Brizzio, M.E. et al, Outcome of Patients Who Refuse
Transfusion After Cardiac Surgery, Archives
of Internal Medicine, 2012, 172(15), 1154-1160
Perrotta P.L.,
Snyder, E.L. Non-infectious complications of transfusion therapy, Blood Reviews, June 2001,
15(2):69-83
www.bloodreviews.com/article/S0268-960X(01)90151-1
Raftery, I. 2015
http://kuow.org/post/when-14-year-old-chooses-die-because-religion-can-anyone-stop-him
Roberts, L. 18
May, 2010
http://www.telegraph.co.uk/news/health/news/7734480/Teenage-Jehovahs-Witness-refuses-blood-transfusion-and-dies.html
Sack, K. 24
February, 2013
Bloodless Lung
Transplants Offer Hint at Surgery's Future
www.nytimes.com/2013/02/25/us/bloodless-lung-transplants-for-jehovahs-witnesses.html
Saltus, R.
Medical dilemma: Patients dying in artificial blood experiment, S.F. Sunday Examiner & Chronicle,
October 3, 1982, A17
Saunders, C.
& Saxon, M. 20 May, 2014 How two Jehovah’s Witnesses were paid
millions to restrict WA blood transfusions
www.perthnow.com/
Schaffer, A. How
Jehovah’s Witnesses Are Changing Medicine, The New Yorker, August 12, 2015
Schaffer, A. The
Ethics of Bloodless Medicine
www.newyorker.com/news/news-desk/the-ethics-of-bloodless-medicine/
Shafer, W.
Adverse Effects of Transfusions, Southern
Medical Journal, April 1976, Volume 69(4), 476-478
Singla, A.K.,
Lapinski, R.H., Berkowitz, R.L., Saphier, C.J. Are women who are
Jehovah's Witnesses at risk of maternal death? American Journal of Obstetrics and
Gynaecology, October 2001, 185(4), 893–895
Stamou, S.C.,
White, T., Barnett, S., Boyce, S.W., Corso, P.J., Lefrak, E.A.
Comparisons of cardiac surgery outcomes in Jehovah's versus
Non-Jehovah's Witnesses, American
Journal of Cardiology, 1 November, 2006, 98(9), 1223-1225
https://www.ncbi.nlm.nih.gov/pubmed/17056333
Stein, J.I.,
Gombotz, H., Rigler, B., Metzler, H., Suppan, C., Beitzke, A. Open
heart
surgery in children of Jehovah's witnesses: Extreme hemodilution on
cardiopulmonary bypass, Pediatric
Cardiology, 1991, 12(3), 170-174
http://link.springer.com/article/10.1007/BF02238525
The Australian, 10 November, 2011,
Blood transfusion would likely have saved Jehova's Witness patient
Tobian, A.A.,
Ness, P.M., Noveck, H., Carson, J.L. Time course and etiology in
patients with severe anemia, Transfusion,
July 2009, 49(7), 1395-1399
Van Wolfswinkel
M.E., Zwart J.J., Schutte J.M. et al. Maternal mortality and serious
maternal morbidity in Jehovah's witnesses in the Netherlands. BJOG: An International Journal of
Obstetrics and Gynaecology, 2009, Volume 116(8), 1103–1110
http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2009.02191.x/full
Varela, J.E.,
Gomez-Marin, O., Fleming, L.E., Cohn, S.M. The Risk of Death for
Jehovah's Witnesses after Major Trauma, The Journal of Trauma: Injury, Infection,
and Critical Care, May 2003, 54(5), 967-972
www.ncbi.nlm.nih.gov.pubmed/12777911
Venter, Z.
17 June, 2014
www.iol.co.za/news/south-africa/kwazulu-natal/jehovahs-witness-girl-saved-by-court-1700022.htm
Walker R.H.T
Transfusion risks, American Journal
of Clinical Pathology, 1987, 88: 374-378
WHO 2016 Fact Sheet
www.who.int/mediacentre/factsheets/fs279/en/
Wittmann, P.H.
and F.W. Total Hip Replacement Surgery Without Blood Transfusion, British Journal of Anaesthesia,
1992, 68(3), 306-307
https://www.ncbi.nlm.nih.gov/pubmed/1547056
Wooding, N.
Costs
incurred by one severely ill Jehovah's Witness could run one unit in
Africa for one year. British Medical
Journal, 1999, 27 March, 318:873
Woolley, S.
Children of Jehovah’s Witnesses and adolescent Jehovah’s Witnesses:
what are their rights? Archives of
Disease in Children, 2005, 90:715–719
Zaorski, J.R.,
Hallman, G.L.; Cooley, D.A. Open Heart Surgery for Acquired Heart
Disease in Jehovah's Witnesses, The
American Journal of Cardiology, February 1972, Volume 29, 186-189
http://europepmc.org/abstract/med/1998423
https://en.wikipedia.org/wiki/Blood_transfusion.htm
https://www.ncbi.nlm.nih.gov/pubmed/2782596
https://www.ncbi.nlm.nih.gov/pubmed/8191563
https://www.ncbi.nlm.nih.gov/pubmed/8874456
www.chron.com/news/houston-texas/article/Houston-surgeons-perform-transplants-without-3432497.php
www.hopkinsmedicine.org/bloodless_medicine_surgery/
www.news-medical.net/news/20110705/First-bloodless-heart-transplant-on-6-year-old-boy-performed-at-Nationwide-Childrens-Hospital.aspx
www.redcrossblood.org/learn-about-blood/blood-facts-and-statistics
www.theatlantic.com/health/archive/2015/06/blood-management-bloodless-medicine-transfusions/395054/
Get accurate
knowledge about JWs on this website: