Bloodless Cardiac Surgery for Religious Groups

Bloodless cardiac surgery is an increasingly widespread technique that avoids the use of blood and blood products. Not only is it indicated for some religious groups that request it, such as Jehovah’s Witnesses, but it also avoids damage that can occur in patients during a blood transfusion, such as transfusion reactions or the spread of viral diseases.

Bloodless cardiac surgery: what it is

Cardiac surgery is a specialty in which, relatively often, the use of blood products is required. Some patients, however, such as Jehovah’s Witnesses, refuse the use of blood and blood products. For most centers that offer cardiac surgery, this is a major drawback when it comes to performing this type of intervention and, above all, to continuing to offer the same results in terms of morbidity and mortality. This fact is a great challenge for healthcare personnel. Our expert team in Cardiac Surgery has been performing bloodless cardiac surgery, i.e. avoiding blood transfusion and any blood products, and we have excellent results, comparable to those obtained in interventions in the general population.

Reasons for the emergence of bloodless cardiac surgery

The need to perform bloodless cardiac surgery is due to the increasing number of patients who, because of their religious circumstances, refuse transfusion of blood and blood products, as in the case mentioned above. The refusal of these patients to blood transfusions arises from a strict interpretation of certain biblical passages (“…only flesh with its soul – its blood – must they not eat”; Genesis 9:3-4).
This refusal confronts two fundamental goods such as the principle of patient autonomy and the physician’s duty to preserve the patient’s life (right to life). It poses a great challenge for the medical team in charge of both surgery and postoperative follow-up, which is the stage where complications requiring the use of blood products are most likely to arise.

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Bloodless cardiac surgery: a widespread practice?

It is a practice that is not so widespread, because most centers do not want to assume the ethical responsibility of having to omit a fundamental measure to preserve the patient’s life. Today there are numerous strategies, both medical and surgical, to reduce transfusion needs. We implement all of them in order to guarantee good results. Our surgical team, which is a reference in bloodless cardiac surgery, has even performed highly complex surgery in these patients, such as reinterventions or surgery on the ascending aorta.

Cases indicated for bloodless cardiac surgery

The team, in general, maintains a tendency to always minimize, as far as possible, the transfusion of blood and blood products. This is done routinely in all the operated cases, since it is well known that blood transfusion is not completely free of potential damage to the patient, such as: transfusion reactions, infection of viral diseases (Hepatitis C, HIV) or Polytransfusion Syndrome. For this reason we have a very low transfusion rate in the interventional population. Of course, this technique is especially indicated for Jehovah’s Witness patients, who are increasingly numerous in our country. There are also other cases in which there are difficulties in transfusion, such as patients who present irregular antibodies against red blood cells and, in the case of receiving a blood transfusion, may present a serious complication, which is called Hemolysis.

However, in general, it is the Jehovah’s Witnesses who are increasingly demanding this type of technique because they are very unprotected since they cannot find centers where this type of surgery can be performed without any restriction whatsoever.