Population That Typically Rejects Blood Transfusions
Jehovah's Witnesses are the primary population that rejects blood transfusions based on religious beliefs, as they interpret Biblical scripture to prohibit accepting blood products. 1
Religious Basis for Refusal
Jehovah's Witnesses refuse blood transfusions out of obedience to scriptural directives to "abstain and keep from blood," believing that accepting transfusions risks eternal salvation. 2, 3
This religious conviction makes no distinction between consuming blood orally and receiving it intravenously, viewing both as violations of divine precepts. 3
The blood transfusion taboo functions as a significant mechanism of sectarian boundary maintenance within the Jehovah's Witness community and is rooted in the movement's historical opposition to medical interventions dating back to pre-World War II vaccination resistance. 4
Clinical Recognition and Guidelines
The 2024 American College of Chest Physicians guidelines explicitly recognize that "some patients may reject transfusions based on personal values or religious beliefs." 1
The 2007 American Journal of Kidney Diseases guidelines list "Jehovah's Witness adherents or individuals who refuse transfusion of blood products" as a relative contraindication to living kidney donation, acknowledging this population's unique medical considerations. 1, 5
The 2015 American Society of Anesthesiologists guidelines recommend that "a protocol for avoidance of transfusion may be used as a strategy to reduce blood loss for patients in whom transfusion is refused or is not possible." 1
Clinical Management Considerations
For patients who refuse transfusions, a thorough discussion with the patient or surrogate should occur before any transfusion decision, with documentation of their wishes incorporated into multidisciplinary care. 1
Bloodless medicine and surgery programs have been instrumental in reducing morbidity and mortality risks in Jehovah's Witness patients, with planning prior to anticipated blood loss events being critical. 6
Jehovah's Witness patients generally accept synthetic and recombinant drugs (tranexamic acid, desmopressin, erythropoietin, rFVIIa), acute normovolemic hemodilution (92% acceptance), and cell salvage (96% acceptance). 7
Following detailed explanation, 83% of Jehovah's Witness patients accepted coagulation factor concentrates extracted from human plasma, despite these being traditionally refused. 7
Mortality and Outcomes
In specialized centers managing Jehovah's Witness patients undergoing high-risk surgery, in-hospital mortality was 6.6%, comparable to the 4% generally observed after major surgery in Europe. 7
Postoperative hemoglobin concentrations below 6 g/dL in older Jehovah's Witness patients are associated with high mortality risk due to anemia. 7
With optimal management including bloodless medicine programs, vigilant anemia screening, and early establishment of patient wishes, Jehovah's Witness patients can undergo major surgery without excessive risk of death. 6, 7
Legal and Ethical Framework
Competent adult patients, including Jehovah's Witnesses, have an established constitutional right to refuse medical interventions, including lifesaving blood transfusions, based on religious freedom and privacy rights. 1
This right exists even when medical interventions are immediately lifesaving, and unless decision-making capacity is impaired or refusal threatens public health, the right to refuse is virtually unlimited. 1