Majeski J
Int Surg. 2000 Jul-Sep;85(3):257-65.
Jehovah's Witnesses are an enlarging religious community in the US and throughout the world. Members of this faith refuse administration of blood during medical or surgical therapy even if death may occur as a consequence. The surgeon is consequently faced with difficulties and moral dilemmas of caring for these patients.
From July 1, 1975 to March 1, 1999, the author performed 132 general and vascular surgical procedures on pediatric and adult patients who were Jehovah's Witnesses.
A surgical series of 132 patients who are Jehovah's Witnesses is reported. The series includes general surgical procedures in children and adults. Also, vascular surgical procedures in adults are reported. Thirty-one procedures were of significant magnitude to possibly require a blood transfusion. No patient in this series received a blood transfusion. No patient was refused an indicated surgical procedure. Fourteen complications incurred in this series which included one death. The age range of patients in this surgical series was 9 months to 91 years. There was no difference in the male to female ratio. The spectrum of cases reported represents the entire range of procedures seen in general and vascular surgical practices.
The surgical care of Jehovah's Witnesses has become less of an operative risk over the last decade. There are now significant alternatives to the transfusion of blood, such as erythropoietin, iron dextran, aprotinin and Fluosol-DA 20%. Technological surgical developments and advances, such as the cell saver, argon beam coagulator, acute limited normovolemic hemodilution, autologous whole plasma fibrin gel, and controlled hypotensive anesthesia during anesthesia have contributed substantially to a reduction in the operative loss of blood. The time honored rule of hemoglobin of 10 g/dl and a hematocrit of 30% should not require strict adherence in the postoperative care of most patients. The acceptance of a lower transfusion trigger point of hematocrit of 22% and a hemoglobin of 7 g/dl can significantly reduce transfusion requirements without an increase in morbidity. Ethical considerations are discussed and evaluated when treatment restrictions, such as blood transfusion and other life-preserving therapies are limited by religious beliefs or living wills.
耶和华见证人在美国及全球都是一个不断壮大的宗教群体。该宗教的成员在接受医疗或外科治疗时拒绝输血，即便这可能导致死亡。因此，外科医生在照料这些患者时面临诸多困难和道德困境。
1975年7月1日至1999年3月1日期间，作者对身为耶和华见证人的儿科和成年患者进行了132例普通外科和血管外科手术。
报告了一组132例身为耶和华见证人的外科患者。该组包括儿童和成人的普通外科手术，还报告了成人的血管外科手术。31例手术规模较大，可能需要输血。该组中没有患者接受输血。没有患者被拒绝进行指定的外科手术。该组出现了14例并发症，其中包括1例死亡。该外科组患者的年龄范围为9个月至91岁。男女比例无差异。报告的病例范围涵盖了普通外科和血管外科实践中所见的所有手术类型。
在过去十年中，耶和华见证人的外科护理手术风险已降低。现在有许多重要的输血替代方法，如促红细胞生成素、右旋糖酐铁、抑肽酶和20%的氟碳化合物乳剂。外科技术的发展与进步，如血液回收机、氩气刀、急性有限性等容血液稀释、自体全血浆纤维蛋白凝胶以及麻醉期间的控制性低血压麻醉，在很大程度上有助于减少手术失血。对于大多数患者的术后护理，不应严格遵循血红蛋白10 g/dl和血细胞比容30%这一长期以来的标准。接受血细胞比容22%和血红蛋白7 g/dl这一较低的输血触发点，可显著减少输血需求且不增加发病率。当输血和其他维持生命的治疗等治疗限制因宗教信仰或生前遗嘱而受到限制时，会对伦理考量进行讨论和评估。
