West Midlands Regional Training Package for Safe Blood Transfusion Practice

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West Midlands Regional Training Package for Safe
Blood Transfusion Practice
MODULE 15 Jehovahs Witnesses and Blood
Transfusion

• The West Midlands Regional Transfusion Committee

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Module 15 Jehovahs Witnesses and Blood
Transfusion

• Contents
• An introduction to Jehovahs Witnesses beliefs
• What is acceptable or unacceptable to Jehovahs
  Witnesses?
• Elective Surgical Procedures
• Emergency Situations
• Children of Jehovahs Witnesses

Aim To give a better understanding of the
treatments acceptable to Jehovahs Witnesses, and
in conjunction with Module 4, a knowledge of when
and how to use these alternatives.

• Objectives
• To explain the basis of the Jehovahs Witness
  beliefs.
• State what is acceptable or unacceptable to the
  Jehovahs Witness.
• Explain how to proceed with elective surgery.
• List the guidance for an emergency situation.
• State how to treat children of Jehovahs
  Witnesses.
• Discuss the legal situation.

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How do you report to SHOT?
Module 15 Jehovahs Witnesses and Blood
Transfusion
Jehovahs Witnesses have refused blood and
primary blood components since these have been
universally available. Whatever the views of the
Health Care Professional, it should be remembered
that theabstaining from blood is a deeply held
core value for Jehovahs Witnesses and that they
regard transfusion without consent a gross
physical violation. It should also be considered
that the transfusion of blood or blood components
to anyone without consent may be unlawful and
could result in legal proceedings. The Jehovahs
Witness beliefs are based on scriptural commands
from both the Old and New Testaments as quoted
below.
Contact for Help and Advice Hospital Liaison
Committee Network for Jehovahs Witnesses 24 Hour
Contact No 0208 906 2211
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What is acceptable or unacceptable to Jehovahs
Witnesses?
Module 15 Jehovahs Witnesses and Blood
Transfusion
Jehovahs Witnesses are usually well informed
both doctrinally regarding their right
to refuse treatment. It is not the role of the
health professional to question these principles.
Your local Trust informed consent policy should
be followed use your Trusts Consent for
Treatment form to document procedures the
patient is unwilling to receive.
Jehovahs Witnesses do not have a set accepted
/ unaccepted rule it is up to the
individuals conscience as to which components
/ fractions / alternatives to allogeneic
transfusion they as an individual will accept.
All available blood components and possible
alternative procedures (Refer to Module 4
Appropriate Use of Blood / Alternatives) should
be discussed with individual Jehovahs Witness
patients.
Some Jehovahs Witness patients will accept
autologous intra-operative cell salvage blood
where as others will not.
Although recombinant blood products are
acceptable to many Jehovahs Witnesses, some do
contain traces of albumin and so may not be
acceptable to all. Explanations of fractions of
products may help in their decisions on the
acceptability of the product.
The patient should be given sufficient
information to make an informed decision as to
the acceptability of the products and procedures
available.
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Elective Surgical Procedures
Module 15 Jehovahs Witnesses and Blood
Transfusion
The use of alternatives to allogeneic blood has
developed considerably and they are in
routine use for many elective procedures (Refer
to Module 4 Alternatives to Allogeneic
Transfusion). But there is always the
possibility that it may be necessary to use
allogeneic blood to support the alternative
technique chosen. This, of course, is
unacceptable for the Jehovahs Witness.
Elective surgery in Jehovahs Witness
patients requires careful advance planning
The patient can be advised to contact their local
Hospital Liaison Committee for Jehovahs
Witnesses to assist in finding a suitably
qualified person to take over the case
Your own Trust will normally have a 24 hour
contact number for a Trust solicitor should
advice be required
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Elective Surgical Procedures additional points
to note
Module 15 Jehovahs Witnesses and Blood
Transfusion
The consultant surgeon, anaesthetist, and
haematologist should all be involved in the
planning discussions. It is usual for these to
take place four weeks previously, to allow time
for transfusion alternatives to be considered.
The patient should be encouraged to consult with
their local Jehovahs Witnesses Hospital Liaison
Committee to discuss the planned procedure, in
advance of any meeting/procedure at the hospital.
The patient should always be given an opportunity
to discuss key issues of their consent on their
own without relatives/associates present. This
may be outside the meeting as described above.
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Elective Surgical Procedures additional points
to note
Module 15 Jehovahs Witnesses and Blood
Transfusion
In procedures where it is anticipated there may
be blood loss, a meeting with the consultant
surgeon, consultant anaesthetist, and the
patient should be scheduled. The following
points should be covered
Risks associated with surgery
Techniques to be used as alternatives to the use
of allogeneic blood
The actions that are/are not sanctioned by the
patient if they are unconscious or otherwise
unable to communicate and dying of unexpected
blood loss .
If the patient has completed a health care
advance directive form or an advance
medical directive card, these should be placed in
the patients case notes
Different therapeutic agents available should be
discussed as to their acceptability to the
patient
Decision to proceed or not may be made at this
meeting, with terms agreed and written consent
obtained. Use your appropriate Trust consent form.
All details of these meetings should be fully
documented with advice given on transfusion
alternatives and the patients understanding of
these.
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Emergency Situations
Module 15 Jehovahs Witnesses and Blood
Transfusion
The basic principles previously outlined should
be followed if time and the condition of the
patient permit. In the event of an extreme
emergency with life threatening bleeding NOTE
also refer to local hospital policy.
Inform senior colleagues.
If time permits, check if the patient has lodged
an advance directive or has completed
an advanced decision document stating that he /
she will not accept blood components in the
event of life-threatening bleeding. This
document will often state exactly which
treatments and components the patient will /
will not accept. A copy of this document is often
lodged with the bearers GP. If time permits,
the relatives or associates of the patient can be
asked if they are aware of an advanced decision
/ directive. A copy should be placed in the
patients case notes.
The contents of this advanced directive should be
respected at all times.
If time permits, the doctor in charge of the case
should discuss with the relatives the
implications of withholding blood.
If the doctor is aware that the patient is a
Jehovahs Witness, but there is no documentary
evidence of refusal to accept a blood
transfusion, the use of blood should be postponed
for as long as possible. Make every effort to
clarify the situation.
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Emergency Situations for Jehovahs Witnesses
Module 15 Jehovahs Witnesses and Blood
Transfusion
If all reasonable efforts to locate a valid
advance directive document have failed, the
doctor should act in the best interests of the
patient which may involve giving blood in an
imminently life-threatening situation.
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Children of Jehovahs Witnesses
Module 15 Jehovahs Witnesses and Blood
Transfusion
The Legal Situation A child below the age of 18
must not be allowed to die from lack of
transfusion Any clinician who allows this to
happen will be open to criminal prosecution
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Points to note when dealing with transfusion
issues in children of Jehovahs Witnesses
Module 15 Jehovahs Witnesses and Blood
Transfusion
Where blood or components are refused, the use of
alternatives should be fully explored and every
effort made to comply with the wishes of the
child and parents
The child and parents should be included in the
decision making process, and there should be
effective communication of all risks involved
Remember that individual Jehovahs Witnesses have
varying beliefs, and it should not be assumed
that consent will always be refused
A Specific Issue Order may be sought from the
courts, if time allows -follow your local trust
policy for this procedure
Treatment in an emergency situation follows the
same procedure as described above for adults
All alternatives for minimising blood
requirements should be followed (see module 4)
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Key Points
Module 15 Jehovahs Witnesses and Blood
Transfusion

• Discuss and explain all relevant issues with
  patient and relatives.
• Document all discussions and outcomes.
• Explore all possible alternatives to allogeneic
  blood use.
• Act professionally and legally - follow your
  local guidelines.
• Further support and assistance can be obtained
  from your Jehovahs Witness Hospital Liaison
  Committee.

Always respect the views and beliefs of the
Jehovahs Witness even though they may not be
the same as your own.
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Module 15 - Quiz
Module 15 Jehovahs Witnesses and Blood
Transfusion

• Question 1 of 5
• Below is a list of blood, components, and
  products. Which of these are definitely NOT
  acceptable to Jehovahs Witnesses (more than one
  may apply)?
• A. Allogeneic Red cells
• B. Saline
• C. Crystalloids
• D. Platelets
• E. EPO
• F. Fresh Frozen Plasma

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Module 15 - Quiz
Module 15 Jehovahs Witnesses and Blood
Transfusion

• Question 2 of 5
• If a child under the age of 18, is allowed to die
  from lack of transfusion, the clinician involved
  is open to criminal prosecution
• True / False

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Module 15 - Quiz
Module 15 Jehovahs Witnesses and Blood
Transfusion

• Question 3 of 5
• The Hospital Liaison Committee Network for
  Jehovahs Witnesses can be contacted for help and
  advice.
• True / False

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Module 15 - Quiz
Module 15 Jehovahs Witnesses and Blood
Transfusion

• Question 4 of 5
• In an acute, emergency, life-threatening
  situation, the contents of an advanced
  directive can be ignored in order to save life.
• True / False

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Module 15 - Quiz
Module 15 Jehovahs Witnesses and Blood
Transfusion

• Question 5 of 5
• For children under the age of 18, permission to
  transfuse may be sought from the courts (specific
  issue order).
• True / False

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Module 15 quiz answers

• Question 1 A, D and F
• Question 2 True
• Question 3 True
• Question 4 False
• Question 5 True