Many physicians seek to accommodate their patients’ beliefs
San Bernardino County Sun, Mar. 8, 2003
By ANNETTE WELLS, Staff Writer
Physicians face a unique challenge when treating Jehovah’s Witnesses.
Members of the denomination an estimated 2 million in the United States do not accept blood, and are reluctant to undergo any organ transplants requiring blood transfusion.
According to information on the Web site for the faith, their religious convictions are based on the belief that all of a person’s traits, including impulses to commit a crime, are contained in blood.
If that’s the case, what are hospitals left to do?
L.C. Cotton, associate director of hospital information services for Jehovah’s Witnesses, said physicians across the world, and especially here in the United States, have made efforts to accommodate their beliefs.
In this country, there are more than 82 bloodless medicine and surgery centers and more than 30,000 physicians capable of treating patients without the use of blood products, Cotton said.
In the world, there are more than 100,000 physicians, he said.
“I think at one point, there was a time when doctors were more paternalistic in their view,’ he said. “It was more of, ‘I will tell you what you need and you don’t question me.’
“Today, more doctors want the patient to have a say in what is done to his body. The patient has a right to bodily self-determination.’
Dr. Julius Ibanez, medical director of the emergency room department at Community Hospital of San Bernardino, and Dr. James Killeen, vice chairman of the department of surgery at Loma Linda University Medical Center, say blood isn’t always needed.
“There are very few surgical procedures where 100 percent of the time you need a blood transfusion,’ Killeen said. “If somebody wanted a liver transplant without blood, that could be done.’
In fact, in the last 20 years, a number of products have been developed for physicians to treat patients who refuse blood.
Those products include fluids that can be used to maintain blood volume, drugs that can stimulate the production of red blood cells, blood salvaging machines and pads that can stop bleeding.
During blood loss, a patient’s blood pressure drops and the heart rate goes up, Ibanez said.
When this occurs, and the patient refuses a blood transfusion, he or she can be given saline solutions or plasma volume expanders to replace the fluid that has been lost in arteries and veins.
“Saline solutions and volume expanders also keep the patient’s blood pressure down,’ Ibanez said. “However, they are not replacements for blood.’
Ibanez said that Community Hospital does not offer hemoglobin substitutes such as PolyHeme or Hemopure. PolyHeme, which is manufactured by Evanston,Ill.-based Northfield Laboratories Inc., is modified hemoglobin.
Manufactured by Cambridge, Mass.-based Biopure Corp., Hemopure is purified oxygen-carrying hemoglobin solution made from cow blood.
In addition, surgeons have tools, and the capability of performing procedures without the use of blood products, said Shane Jason, manager of the Bloodless Medicine and Surgery Program at Fountain Valley Regional Medical Center.
“Even blood tests, which usually require a certain amount of blood, can be done with very small amounts here,’ he said. “Instead of one full vile, we only need two or three drops.’
Started in the early 1980s, Fountain Valley Regional’s bloodless program is one of the oldest in the country, he said.
“Back then, people kind of looked at us like, ‘Are you nuts?’ Now there are more than 200 similar programs across the country,’ he said.
Dr. Vinod Melhotra, director of the bloodless program at Fountain Valley Regional, said about 95 percent of the patients receiving treatment there are Jehovah’s Witnesses.
The other 5 percent fear disease transmittal.
“Unless they are in dire need of surgery, we wait,’ Melhotra said. “If a patient is anemic, then we would postpone surgery so that they can build up their blood count.’
Though Loma Linda University Medical Center doesn’t have a bloodless program, Killeen said surgeons there likely wouldn’t have a conflict if a patient wanted such a procedure.
However, the decision to perform the procedure would be dependent upon the degree of the medical problem, he said.
“If the job entailed a very complicated procedure, some surgeons might not be too comfortable, especially if they had a feeling the patient would not survive,’ he said.
Ibanez said the idea is to know things in advance so that appropriate measures can be taken.
“The first thing we do is try to identity if a patient is a Jehovah’s Witness,’ he said. “That way, if the patient needs blood, we know that we can not give it to them.’
If the patient’s condition is too serious for bloodless products, then there is a little bit of pleading done, he said.
“We explain the gravity and severity of their disease and we plead with them to make an exception in this case which is very, very rare,’ Ibanez said.
“Secondly, we do as much as we can with what we have.’