Guerra Giselle, Ortigosa-Goggins Mariella, Gaynor Jeffrey J, Ciancio Gaetano
Department of Medicine, Division of Nephrology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA.
Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA.
Ann Transl Med. 2020 Oct;8(19):1249. doi: 10.21037/atm-20-3593.
While Jehovah's Witness (JW) patients refuse transfusions of blood or blood products, they are willing to accept renal allograft transplantation. We describe here a case of what we believe is the oldest (a 70-year-old) JW candidate to undergo a deceased donor kidney transplant reported in the literature. Prior to transplantation, discussions ensued amongst the multidisciplinary transplant team, weighing the potential benefits . risks of performing a kidney transplant on this patient due to her refusal (due to religion) to accept any blood transfusions or blood products combined with her advanced age and having longstanding insulin-dependent, type 2 diabetes mellitus with extensive peripheral vascular disease. Preoperatively, we believed that the odds were in favor of performing the kidney transplant safely without the need for any blood product usage. However, her post-operative course was complicated by severe anemia, which developed by post-transplant day 4. The anemia incapacitated the patient's physical and psychological state, creating medical, social and financial burdens on the patient, family, medical team and hospital. Both family and patient grew concerned about her overall condition. Blood transfusion was offered in order to improve her weakness and shortness of breath that developed due to the severe anemia, but the patient (along with her family) refused such treatment. During the 17 days of hospitalization, it was a continuous struggle between the transplant team, patient, and family for her to continue with the recovery process; at times we had even considered that performing the transplant had been a mistake. While organ transplantation can be performed safely in Jehovah's Witnesses, there are multiple factors seen in this particular case that warrant analyzing: (I) the potential use of stricter transplant exclusionary criteria, given the recipient's advanced age and preexisting co-morbidities, which likely increased her risk of developing severe anemia post-operatively, and (II) the recipient's emotional/psychological post-operative state of high anxiety, which developed while she was experiencing the severe anemia; in hindsight, her anxiety level may have been reduced if we had offered daily post-operative psychological counseling sessions. While the patient's allograft is currently doing well, we probably did not have strict enough criteria for proper selection of a JW candidate for kidney transplantation.
耶和华见证会（JW）的患者拒绝输血或血液制品，但他们愿意接受肾移植。我们在此描述一例据文献报道的可能是接受已故供体肾移植的最年长（70岁）的JW候选者。移植前，多学科移植团队进行了讨论，权衡了对该患者进行肾移植的潜在益处和风险。该患者因宗教原因拒绝接受任何输血或血液制品，且年事已高，患有长期胰岛素依赖型2型糖尿病并伴有广泛的外周血管疾病。术前，我们认为有可能在不使用任何血液制品的情况下安全地进行肾移植。然而，她的术后病程因严重贫血而复杂化，贫血在移植后第4天出现。贫血使患者的身体和心理状态受损，给患者、家庭、医疗团队和医院带来了医疗、社会和经济负担。患者和家属都对她的整体状况感到担忧。为改善因严重贫血导致的虚弱和呼吸急促，曾建议输血，但患者（及其家属）拒绝了这种治疗。在住院的17天里，移植团队、患者和家属为她的康复过程持续斗争；有时我们甚至认为进行移植是个错误。虽然在耶和华见证会信徒中可以安全地进行器官移植，但在这个特殊案例中存在多个因素值得分析：（I）鉴于受者年事已高且存在合并症，可能需要使用更严格的移植排除标准，这可能增加了她术后发生严重贫血的风险；（II）受者术后出现高度焦虑的情绪/心理状态，这是在她经历严重贫血时产生的；事后看来，如果我们术后每天提供心理咨询，她的焦虑程度可能会降低。虽然患者的移植肾目前情况良好，但我们在为JW候选者进行肾移植的合适选择标准可能不够严格。
