Patient Beliefs and Considerations
The Bible teachings of Charles Taze Russell are the basis of the beliefs held by Witnesses, which state the transfusion of allogenic whole blood and primary blood components (platelets, white cells, plasma or packed red cells) are unacceptable21,22. Witnesses also decline autologous transfusion, as blood is considered unclean once it has left the body, and blood sampling for use in cross-matching22. The use of a number of related treatments is a matter of personal decision for the individual. The derivatives of primary blood products include albumin, coagulation factors, interferons, haemoglobin and globulins/immunoglobulins. Autologous procedures, such as haemodilution, cardiac bypass and cell salvage, may also be deemed acceptable. Bloodless extracorporeal membrane oxygenation (ECMO) has also previously been utilized in an adolescent witness patient23. It is essential to discuss alternatives with each Witness patient to assess their position, including their right to refuse treatment, especially in situations that would result in loss of life or limb. Discussions should be clearly documented in the notes. In emergency situations, most Witnesses carry a signed and witnessed advance decision card to express their wishes in emergencies, refusing allogenic whole blood and blood components, and also autologous pre-donation. If no such card is present, and the patient is known to be a Witness, every effort should be made to avoid the use of blood and blood products, but the ultimate decision rests with the clinician responsible for that patient22. It is vital the clinician is adequately educated regarding the legal and ethical challenges which a Witness case presents in order to optimise patient management.