Hemoglobin-based blood substitutes for Jehovah’s witnesses

Letters to the Editor

Dinna B. Billote, MD Staff Anesthesiologist Columbus Hospital Chicago, IL Silas N. Glisson, PhD Professor of Anesthesiology Northwestern University Medical School Chicago, IL

Reference 1. Billote DB, Glisson SN, Green D, and Wixson RL: Efficacy of preoperative autologous blood donation; analysis of blood loss and transfusion practice in total hip replacement. J Clin Anesth 2000;12:537– 42. PII S0952-8180(01)00300-3

Hemoglobin-based Blood Substitutes for Jehovah’s Witnesses To the Editor: Although it is well known that orthodox Jehovah’s Witnesses may not accept blood transfusions, even when medically necessary, their position on hemoglobin-based synthetic blood, now nearing commercial availability, is less clear. Until recently, it appeared that such products would be banned. For instance, consider the comments of Richard Bailey and Tomonori Ariga who, writing in an official capacity in 1998, explained Watch Tower Bible and Tract Society policy to the medical community: “Jehovah’s Witnesses do not accept whole blood, or major components of blood, namely red blood cells, white blood cells, platelets and plasma. Also they do not accept hemoglobin which is a major part of red blood cells . . . According to these principles then, Jehovah’s Witnesses do not accept a blood substitute which uses hemoglobin taken from a human or animal source.”1 Recently, however, there has been an important but subtle change in policy.* Whereas the Society had previously permitted Witnesses to accept fractions of blood plasma, it appears that they may now accept fractions of all “primary” components. The Society defines primary components as red cells, white cells, platelets, and plasma.

This policy clarification appears to open the door to the use of hemoglobin-based blood substitutes for Witnesses and would be expected to result in a number of lives saved annually. Indeed, newspaper accounts describing compassionate preapproval use of hemoglobin-based blood substitutes in Witness patients have already been published.† Clinicians who are caring for Witnesses with life-threatening anemia thus may wish to consider the administration of hemoglobin-based blood substitutes, even though regulatory approval is still in progress. This process may be initiated by contacting one of the manufacturers of hemoglobin-based blood substitutes provided in the list below, all who have entered into Phase 3 clinical trials: BIOPURE CORPORATION Cambridge, MA (http://www.biopure.com) Product name: Hemopure HEMOSOL INCORPORATED Toronto, Ontario, Canada (http://www.hemosol.com) Product name: Hemolink NORTHFIELD LABORATORIES INCORPORATED Evanston, IL (http://www.northfieldlabs.com) Product name: PolyHeme Because this policy change may be unfamiliar to many Witness patients, I would stress that scrupulous informed patient and/or family consent, including education about available hemoglobin substitutes and their side effects, is imperative in each case. More information is available at www.ajwrb.org, the Web site of Associated Jehovah’s Witnesses for Reform on Blood. (This site is not the official Watchtower site). D. John Doyle MD, PhD, FRCPC Associate Professor of Anesthesia Department of Anesthesia Toronto General Hospital 200 Elizabeth Street Toronto, Ontario, Canada, M5G-2C4

Reference 1. Bailey R, Ariga T. The view of Jehovah’s Witnesses on blood substitutes. Artif Cells Blood Substit Immobil Biotechnol 1998;26: 571– 6. PII S0952-8180(01)00307-5

*Watch Tower Bible and Tract Society. Questions from readers. The Watchtower 2000; June 15:29 –31.

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J. Clin. Anesth., vol. 13, September 2001

†Sacramento Bee. Sacramento, CA: August 24, 2000.