Jehovah's Witness and Blood Refusal in OR

Specialties Operating Room

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Hey! Last week I circulated with another nurse (I am still on orientation). We had a patient who was a Jehovah's Witness, so along with a signed surgical consent there was a signed refusal for blood. I was told to have 2 units of PRBCs on hand in the fridge by the surgeon. I pointed out to my co-circulator that the patient was a Jehovah's Witness and had a signed blood refusal and showed it to him. I asked him if we should show it to the surgeon as a reminder. He said not to show it and told me to have them brought up anyway because when the patient is on the table it falls to the surgeon to make the call between saving a life and letting the patient bleed out. I thought that this was wrong but did what I was told and had the blood sent up. Thankfully we didn't need it, but I want to know for next time how to handle the situation.

Very interesting question. In your OR, is it the RNs responsibility to hand blood or is it anesthesia's role? I only ask because I worked with an anesthesiologist a number of years back that actually told the parents of a JW child that if the child's life depended on the blood transfusion, he would give the transfusion. Very tense to say the least.

Specializes in Pedi.
Very interesting question. In your OR, is it the RNs responsibility to hand blood or is it anesthesia's role? I only ask because I worked with an anesthesiologist a number of years back that actually told the parents of a JW child that if the child's life depended on the blood transfusion, he would give the transfusion. Very tense to say the least.

It's different with children though. In the case of a child you get a court order to administer blood products against the parents' wishes. Most pediatric hospitals that care for JW children have relationships with judges who will expedite such an order. In the case of adults, they have the right to refuse.

Specializes in Med-Surg, LTC, Psych, Addictions..
as an almost new nurse entering the field, this discussion has been very helpful.

It is the hardest thing as a healthcare worker, hardwired to save lives with resources available, to not use those resources.

See it from the pts point of view. They believe that their ETERNAL LIFE is in danger if they disobey Gods command to abstain from blood. It is not up to the surgeon or nurse to decide for them. Taking in blood is NOT negotiable to a JW. Its our right.

Hi Shaunta,

I am a JW too and also graduating as an LPN in a few weeks. I just wanted to say "hi" and that I thought what you said here was right on.

Specializes in O.R., ED, M/S.

Not all JWs abide by their beliefs because I have had a few over the years who sign the refusal but also state that if it was the difference between living and dying, give me the blood! So this is an issue that should be resolved BEFORE surgery and yes the surgeon isn't always right.

PS this has only been a few over 37 years in the OR kind of like Holiday Catholics or Jack Mormons

There is also controversy that many consider Jehovah's Witnesses a cult because if they accept a blood transfusion willingly they are shunned by their family and community so knowing that some may want a transfusion but be too afraid to accept one.

I'm always very clear and specific about exactly what the patient will and won't accept, ie, albumin, ffp, cell saver etc. It does vary from time to time. What I'm also very clear about is that death isn't the only consequence of not enough red blood cells.

Irreversible brain damage and / or heart or kidney damage leading to permanent disability and the need for long term care/dialysis is more probable than death.

I will say that at least in part, their reluctance to receive blood has lead to the realization that we transfused way too much blood in the past. Transfusion triggers have been revised drastically in the last 20 years.

There is also controversy that many consider Jehovah's Witnesses a cult because if they accept a blood transfusion willingly they are shunned by their family and community so knowing that some may want a transfusion but be too afraid to accept one.

They're going to need that community after they've had their stroke. But that's their call. The best we can do is be very sure they understand the consequences.

Right I agree but also I think it is important for nurses/HCPs to understand that these patients are in a double bind and acknowledge that they understand the consequences of accepting blood for them and if they choose to do so they will keep it confidential and be careful with those who visit (because other JWs are required to report on those not compliant with doctrine). That way they can feel that if they do choose blood they can do so without the loss of community .

Specializes in OR.

The overwhelming majority of the JW patients that i have done pre-op anything for, for elective surgery have toted in with them, a folder with signed paperwork that states something to the effect of "i am one of Jehovah's Witnesses and then goes on to delineate what fractions/blood products what have you that they will/won't accept. I have seen some that are okay with cell saver, in a closed circuit and some that are not. As above poster stated, it falls to the individual's conscience as to the specific stance.

Whatever my patient documents as their wish, I am going to abide by it. Once the patient has been educated on what may happen if they decline blood products, my job is done. I am there to speak for them at a time when they cannot and it is my responsibility to honor the patient's decisions, never mind whether I agree with them or not. My opinion regarding what faiths are/are not "cults" is inappropriate and irrelevant in this setting.

That way they can feel that if they do choose blood they can do so without the loss of community .

There is no keeping secret the fact that a JW received blood. That would be a reassurance I would be very hesitant to give. If they say they don't want it and they're a mature, informed adult, they don't get blood from me.

Specializes in Surgery.

In the OR, you, the RN Circulator, are the patient's advocate and have the responsibility to speak for the patient when they cannot speak for themselves. It is highly likely that the surgeon did not know about the patient's religious practices or had forgotten, especially if it is a big case. You must inform the surgeon of this before they order blood.

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