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.