Cardiac Surgery and Jehovah’s witness patients
Witness patients undergoing cardiac surgery is not without risk, primarily due to this surgery carrying an increased association with bleeding and the inability to transfuse blood products. In 1964, open heart surgery using cardiopulmonary bypass (CPB) on Witnesses was first described, made possible by the development of bypass techniques13. Witnesses are often not considered for cardiac surgery due to the increased risk of morbidity and mortality, with early research demonstrating a mortality rate of 7-10%14. This perceived risk is affected by the population being referred for cardiac surgery; at later stages in life, with multiple comorbidities, and often the use of new anticoagulants4. As research has evolved, there has been a decrease in mortality rates demonstrated by a range of larger studies15,16; whether this is due to improvements in blood management strategy, technology advances, or careful patient selection is unclear. The majority of these findings are limited to adults, however research has now been extended to include infants and children, highlighting similar results and emphasising the need for more liberal, instead of restrictive, transfusion strategy17,18. Greater complications arise when the size of the patient is taken into consideration18, largely due to the resultant increase in haemodilution from CPB prime volume to the circulating blood volume of neonates and infants17,19. However, Olshove et al.demonstrated that bloodless cardiac surgery is feasible for this population if a comprehensive blood conservation program is adopted20. This can be achieved through careful discussion and a thorough understanding of the patients’ beliefs at the pre-operative stage. This is particularly important to comprehend because not all Witness patients hold identical beliefs and the exact level of acceptance of blood product usage lies with each individual, as discussed below.