Jehovah's Witnesses and blood transfusions

Jehovah's Witnesses believe that the Bible prohibits ingesting blood and that Christians should not accept blood transfusions or donate or store their own blood for transfusion. The belief is based on an interpretation of scripture that differs from that of other Christian denominations. It is one of the doctrines for which Jehovah's Witnesses are most well known. Watch Tower Society publications teach that the Witnesses' refusal of transfusions of whole blood or its four primary components—red cells, white cells, platelets and plasma—is a non-negotiable religious stand and that those who respect life as a gift from God do not try to sustain life by taking in blood, even in an emergency. Witnesses are taught that the use of fractions such as albumin, immunoglobulins and hemophiliac preparations are "not absolutely prohibited", and are instead a matter of personal choice. The doctrine was introduced in 1945, and has undergone some changes since then. Members of the religion who voluntarily accept a transfusion and are not deemed repentant are regarded as having disassociated themselves from the religion by abandoning its doctrines and are subsequently shunned by members of the organization. Although accepted by the majority of Jehovah's Witnesses, a minority does not endorse this doctrine. The Watch Tower Society has established Hospital Information Services to provide education and facilitate bloodless surgery. This service also maintains Hospital Liaison Committees, whose function is to provide support to adherents. Doctrine: On the basis of various biblical texts, including Genesis 9:4, Leviticus 17:10, and Acts 15:29, Jehovah's Witnesses believe: -Blood represents life and is sacred to God. After it has been removed from a creature, the only use of blood that God has authorized is for the atonement of sins. When a Christian abstains from blood, they are in effect expressing faith that only the shed blood of Jesus Christ can truly redeem them and save their life. -Blood must not be eaten or transfused, even in the case of a medical emergency. -Blood leaving the body of a human or animal must be disposed of. -Certain medical procedures involving blood fractions or that use a patient's own blood during the course of a medical procedure, such as hemodilution or cell salvage, are a matter of personal choice, according to what a person's conscience permits. -A baptized Witness who unrepentantly accepts a blood transfusion is deemed to have disassociated himself from the religion by abandoning its doctrines and is subsequently subject to organized shunning by other members. Certain medical procedures involving blood are specifically prohibited by Jehovah's Witnesses' blood doctrine. This includes the use of red blood cells, white blood cells, platelets and blood plasma. Other fractions derived from blood are not prohibited. Watch Tower publications state that some products derived from one of the four primary components may be so similar to the function of the whole component and carry on such a life-sustaining role in the body that "most Christians would find them objectionable". For procedures where there is no specific doctrinal prohibition, individuals are to obtain details from medical personnel and then make a personal decision. Prohibited procedures: The following medical procedures are prohibited: -Transfusion of allogeneic whole blood, or of its constituents of red cells, white cells, platelets or plasma. -Transfusions of pre-operative self-donated (autologous) blood. Permitted procedures and products: The following procedures and products are not prohibited, and are left to the decision of individual members: -Blood donation strictly for purpose of further fractionation of red cells, white cells, platelets or plasma for either allogeneic or autologous transfusion. -Transfusions of autologous blood part of a "current therapy". -Hemodilution, a modified technique in which equipment is arranged in a circuit that is constantly linked to the patient's circulatory system. -Intraoperative blood salvage (autologous) or cell-saver scavenging, a method of picking up blood that has spilled from the circulatory system into an open wound, cleaning and re-infusing it. -Heart-Lung Machine, a method in which blood is diverted to an artificial heart-lung machine and directed back into the patient. -Dialysis, wherein blood circulates through a machine, is filtered and cleaned, then returned to the patient. -Epidural Blood Patch, consisting of a small amount of the patient's blood injected into the membrane surrounding the spinal cord. -Plasmapheresis, wherein blood is withdrawn and filtered, having the plasma removed and substituted, and returned to the patient. -Labeling or Tagging, blood is withdrawn, mixed with medicine, and then returned to the patient by transfusion. -Platelet Gel, blood is withdrawn and put into a solution rich in platelets and white blood cells. Fractions from red blood cells: -Hemoglobin, the oxygen-carrying component of red blood cells. Fractions from white blood cells: -Interferons -Interleukins Fractions from platelets: -Platelet factor 4 Fractions from blood plasma: -Albumin -Globulins -Cryoprecipitate -Cryosupernatant (cryo-poor plasma) -Clotting factors, including Factor VIII and Factor IX derived from large quantities of stored blood -Wound healing factor -Erythropoietin (EPO). -PolyHeme, a blood substitute solution of chemically modified human hemoglobin. -Hemopure, a blood substitute solution of chemically stabilized bovine hemoglobin derived from cow's blood. Bloodless surgery: A variety of bloodless surgical techniques have been developed for use on patients who refuse blood transfusions for reasons that include concern about AIDS, hepatitis, and other blood-borne infections, or immune system reactions. Thousands of physicians throughout the world have expressed a willingness to respect patients' preferences and provide bloodless treatment and about 200 hospitals offer bloodless medicine and surgery programs for adult and pediatric patients who wish to avoid or limit blood transfusions, or to avoid treatment contrary to Jehovah's Witnesses' blood doctrine. Bloodless surgery has been successfully performed in such invasive operations as open-heart surgery and total hip replacements. However bloodless medical and surgical techniques have limitations, and surgeons say the use of various allogeneic blood products and/or pre-operative autologous blood transfusion is the standard of care for some patient presentations. In cases of certain medical emergencies when bloodless medicine is not available, blood transfusions may seem to be the only available way to save a life. Watch Tower publications suggest that in such instances, Jehovah's Witnesses request that doctors provide the best alternative care possible under the circumstances, with respect for their personal conviction. The Watch Tower Society has acknowledged that some members have died after refusing blood. In some countries, including Canada and the UK, a parent or guardian's decision can be legally overruled by medical staff. In this case, medical staff may act without consent, by obtaining a court order in a non-emergency situation, or without such an order in an emergency. In Japan, a doctor must respect the wish of an adult but can override the wishes of a child and their parents if the child is under 15. If a child is aged 15 to 17, a doctor will not perform a transfusion if the parents and the child refuse the transfusion. If a child aged from 15 to 17 objects to a transfusion but the parents demand the transfusion, then a doctor can override the child's wish. In the United States, the American Academy of Pediatrics recommends that in cases of "an imminent threat to a child's life", physicians in some cases may "intervene over parental objections". Hospital Liaison Committees: In 1988, the Watch Tower Society formed Hospital Information Services, a department to help locate doctors or surgical teams who are willing to perform medical procedures on Witnesses without blood transfusions. The department was given oversight of each branch office's Hospital Information Desk, and of one hundred Hospital Liaison Committees established throughout the United States. As of 2003, about 200 hospitals worldwide provide bloodless medical programs. As of 2006, there are 1,535 Hospital Liaison Committees worldwide coordinating communication between 110,000 physicians. Hospital Information Services researches medical journals to locate information on the availability and effectiveness of bloodless surgery methods. It disseminates information about treatment options to local Hospital Liaison Committees, and to doctors and hospitals. Patient Visitation Groups: Annually since 2004, Jehovah's Witnesses in the United States have been informed that "with your consent, the law allows for the elders to learn of your admission to hospital and provide spiritual encouragement", but that "elders serving on a Patient Visitation Group could have access to your name" only if patients made their wishes known according to the Health Insurance Portability and Accountability Act (HIPAA). Jehovah's Witnesses' branch offices communicate directly with congregations regarding "ways to benefit from the activities of the Hospital Liaison Committee (HLC) and the Patient Visitation Group (PVG)." A Jehovah's Witnesses publication in 2000 reported that Argentina had fewer than a hundred HLC committeemen "giving vital information to the medical community", adding that "their work is complemented by hundreds of other self-sacrificing elders who make up Patient Visitation Groups that call on Witness patients to help and encourage them". Each branch office appoints PVG committeemen, who serve as volunteers.