El País – 16th March 2018
“Renal Transplantation without blood transfusions for Jehovah’s witnesses
“The hospital del Mar displays a protocol to minimize the risk of bleeding and ensure that transfusions will not during the surgical process of these patients
“The religious beliefs of Jehovah’s witnesses – a branch of Christianity that profess some eight million people worldwide, according to its own website – preclude them from accepting blood transfusions during a medical act. ‘The Bible prohibits the consumption of blood. Therefore, Christians should not eat it. We must not accept transfusions of blood or any of their main parts’, justifies the congregation on its website. Commune with this doctrine, however, preclude that this collective be referred to some major oncological intervention or a transplant surgery. Assistance of this type of operations protocols requires patients to sign an informed consent as they accept that surgeons have recourse, if necessary, to a blood transfusion. If they do not allow the possibility of using this procedure, the intervention cannot be done.
“But the hospital del Mar of Barcelona has given a twist to this situation and has deployed a protocol to ensure renal transplantation without blood transfusion to the Jehovah’s witnesses. The doctors involved in the surgery and in the postoperative accept operate without resorting to blood transfusion and, in addition, articulate specific measures even before entering the operating room to minimize the risk of patient bleeding during the intervention or in the postoperative period. ‘The problem with the Jehovah’s witnesses to refuse transfusions is that he supposes an impediment in order to schedule the surgery. And this impairment often is by your collective doctor, who does not want to assume the risks involved to accept not trasfundir, do not use this tool when in the case of acute anemia can cure a person after surgery,’ explains Dr. Lluís Cecchini, head of the Department of urology and transplantation surgery of the hospital del Mar.
“The hospital Protocol of the sea, which has already been applied in a couple of case for a year and half, lots ethical and religious conflict by strengthening security measures. For starters, preoperative, patients with chronic renal failure usually suffer anemia, so before entering the operating room, they must undergo a prior treatment with erythropoietin (EPO), a hormone that stimulates the production of red blood cells. ‘What we are doing to prepare a Jehovah’s witness patient for transplant is to establish higher blood hemoglobin targets those listed elsewhere in patients with chronic renal failure. Our goal is higher for arriving at the time of surgery, if they lose blood, that suppose that from a higher level, we continue being in a safety zone for the patient’, adds Dr. Marta Crespo, Chief of Nephrology section at the hospital del Mar.
“Already in the operating room, nursing specialized units ride and control the so-called cell saver, machines that allow recovering the blood from the patient and transfuse him with its own red blood cells. A kidney transplant operation has a high risk of needing a blood transfusion because, on the one hand, you have a high component of vascular surgery and, in addition, patients with kidney failure not coagulate like a healthy person. ‘Us, home, always hope not to have to trasfundir,’ Cecchini says.
“However, the risk of needing a blood transfusion the day of the operation is 10% and rises to 41% in the period of income after the transplant. That is why protocol beyond surgery and also soak in the approach of the postoperative period. ‘In the majority of cases, the postoperative period is handled conservatively, watching the patient and monitoring with imaging technique. In this group of patients, on the other hand, what I do is reintervenirlos early to prevent blood loss’, particular the urologist of the hospital del Mar.
“The protocol drivers admit that ethical doubts weigh much in these cases. The ‘ethical dilemma’ physician, says the specialist, collides with ‘the autonomy of the patient to choose how you want to be treated’. Therefore, points out, it is necessary that all participants in the clinical process are agree with intervening despite not be able to use the technique of transfusion if necessary.
“‘What we have achieved is a chain of trust between professionals and we are all agreed that we are going to optimize patients and treat them in the best possible way in the surgery and postoperative to minimize the risk of transfusion.But if necessary, we would not accept that transfusion because we have made that commitment. Personnel who are participating in this has to agree,’ warns Cecchini.
“Year and a half ago, the specialists of the hospital del Mar intervened to Jehovah’s witness patient with chronic renal failure who received the kidney from a living donor of the same confession. ‘Or made under this Protocol extraction of donor surgery and transplantation to the receiver along with the removal of one of the kidneys, which had very large,’ concrete Dr. Crespo.In 2017 also took another transplant from a donor cadaver.”