Bloodless Orthotopic Heart Transplantation in a Jehovah’s Witness

Dallas, Torijaun; Welsby, Ian J.; Bottiger, Brandi; Milano, Carmelo A.; Daneshmand, Mani A.; Guinn, Nicole R.

doi:10.1213/xaa.0000000000000067

Cited by 6 publications

(2 citation statements)

References 8 publications

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“…In the assistance of these specialized devices and techniques, transfusion-free transplantation had been accomplished. To date, successful cases without peri-operative blood transfusion were reported in liver (Garcia et al, 2013), kidney (Hernandez-Navarrete et al, 2013) and heart transplantations (Dallas et al, 2015). Importantly, there were considerable availability and feasibility of these new blood conservation methods performed in certain populations (for example, Jehovah's Witnesses, patients with uncommon blood types or multiple RBC allo-antibodies) that were required for major surgeries accompanied with massive blood loss and transfusion.…”

Section: Discussionmentioning

confidence: 99%

Clinical Practice of Blood Transfusion in Orthotopic Organ Transplantation: A Single Institution Experience

Tsai

Hsieh²,

Chang³

et al. 2015

Asian Pacific Journal of Cancer Prevention

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Background: Orthotopic organ transplantation, a treatment option for irreversible organ dysfunction according to organ failure, severe damaged organ or malignancy in situ, was usually accompanied with massive blood loss thus transfusion was required. We aimed to evaluate the adverse impact of blood transfusion on solid organ transplantation. Materials and Methods: From January, 2009 to December, 2014, patients who received orthotopic organ transplantation at Far Eastern Memorial Hospital medical center were enrolled. Clinical data regarding anemia status and red blood cell (RBC) transfusion before, during and after operation, as well as patient outcomes were collected for further univariate analysis. Results: A total of 105 patients who underwent orthotopic transplantation, including liver, kidney and small intestine were registered. The mean hemoglobin (Hb) level upon admission and before operation were 11.6±1.8 g/dL and 11.7±1.7 g/dL, respectively; and the nadir Hb level post operation and the final Hb level before discharge were 8.3±1.6 g/dL and 10.2±1.6 g/dL, respectively. The median units (interquartile range) of RBC transfusion in pre-operative, peri-operative and post-operative periods were 0 (0-0), 2 (0-12), and 2 (0-6) units, respectively. Furthermore, the median (interquartile range) length of hospital stay (LHS) from admission to discharge and from operation to discharge were 28 (17-44) and 24 (16-37) days, respectively. Both peri-operative and post-operative RBC transfusion were associated with longer LHS from admission to discharge and from operation to discharge. Furthermore, it increased the risk of post-operative septicemia. While peri-operative RBC transfusion elevated the risk of acute graft rejection in patients who received orthotopic transplantation. Conclusions: Worse outcome could be anticipated in those who had received massive RBC transfusion in transplantation operation. Hence, peri-operative RBC transfusion should be avoided as much as possible.

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Section: Discussionmentioning

confidence: 99%

Clinical Practice of Blood Transfusion in Orthotopic Organ Transplantation: A Single Institution Experience

Tsai

Hsieh²,

Chang³

et al. 2015

Asian Pacific Journal of Cancer Prevention

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“…In our case, the patient accepted blood transfusions only in the case of imminent death due to blood loss. Although a case of heart transplantation in a Jehovah's witness has been described, 6 the therapeutic goal of our patient is destination therapy with LVAD support. In case of reoperation, our strategy is minimally invasive LVAD exchange without the use of the heartlung machine.…”

Section: Discussionmentioning

confidence: 90%

Heart-Failing Jehovah's Witness Patient Successfully Treated by Minimally Invasive LVAD Implantation without Any Blood Transfusions

Hanke

Avşar

Haverich

et al. 2015

THORAC CARDIOV SURG Reports

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Left ventricular assist device (LVAD) implantation without the use of any blood products is considered as a challenge. We present a 48-year-old patient (175 cm, 75 kg, body mass index 24.5 kg/m2) who was admitted to our clinic due to end-stage heart failure. The patient is a Jehovah's witness. He declined full blood transfusion as well as use of coagulation factors. Therefore, we interdisciplinary decided to implant an LVAD via minimally invasive technique. The patient experienced an uneventful intrahospital stay and was successfully discharged home on his 17th postoperative day, proving that LVAD implantation without blood transfusions is possible by using a minimally invasive technique. This benefits not only Jehovah's witness patients, but also all patients in need of an LVAD.

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Refusal of Medical Blood Transfusions Among Jehovah’s Witnesses: Emotion Regulation of the Dissonance of Saving and Sacrificing Life

Ringnes

Hegstad

2016

J Relig Health

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This study focuses on the requirement of JWs to refuse medical blood transfusions. We identified a life-death cognitive dissonance among JWs, with the opposing cognitions of being willing to sacrifice life by religious standards, while being unwilling to do so. Using a theory that connects cognitive dissonance with the need to regulate difficult emotions to analyze our qualitative data material, we identified two sets of dissonance reduction strategies among the JWs. Set 1 was tied to the individual-group: selective focus on eternal life, a non-blood support and control system, and increased individualization of treatment choices. Set 2 was in the religion versus medicine intersection: denial of risk combined with optimism, perception of blood as dangerous, and use of medical language to underscore religious doctrine.

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Bloodless Orthotopic Heart Transplantation in a Jehovah’s Witness

Cited by 6 publications

References 8 publications

Clinical Practice of Blood Transfusion in Orthotopic Organ Transplantation: A Single Institution Experience

Clinical Practice of Blood Transfusion in Orthotopic Organ Transplantation: A Single Institution Experience

Heart-Failing Jehovah's Witness Patient Successfully Treated by Minimally Invasive LVAD Implantation without Any Blood Transfusions

Refusal of Medical Blood Transfusions Among Jehovah’s Witnesses: Emotion Regulation of the Dissonance of Saving and Sacrificing Life

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