Blood-Management Programs: A Clinical and Administrative Model with Program Implementation Strategies

Christopher Tokin; Jose Almeda, MD; Saurabh Jain, MD, MRCS; Jennifer Kim; Randy Henderson; Mitra Nadim, MD; Linda Sher, MD; Robert R Selby, MD

Winter 2009 - Volume 13 Number 1


Jehovah's Witnesses and the Historical Evolution of Blood Conservation

Everything that lives and moves will be food for you. … But you must not eat meat that has its lifeblood still in it. For your lifeblood I will surely demand an accounting.

—Genesis 9:3–5, Old Testament,
New International Version1

Any Israelite or any alien living among them who eats any blood—I will set my face against that person who eats blood and will cut him off from his people. For the life of a creature is in the blood, and I have given it to you to make atonement for yourselves on the altar; it is the blood that makes atonement for one's life. Therefore I say to the Israelites, "None of you may eat blood, nor may an alien living among you eat blood."

—Leviticus 17:10, 12, Old Testament,
New International Version1

You must abstain from eating food offered to idols, from consuming blood or the meat of strangled animals, and from sexual immorality."

—Acts 15:29, New Testament,
New LivingTranslation2

Jehovah's Witnesses is a religious organization whose adherents now number more than six million worldwide. The sect was established in 1870 in an effort to return to a pure, unadulterated, scripture-based form of Christianity; consequently, many of the group's doctrines are derived from literal interpretations of the Bible. Though best known for its evangelical efforts, the organization has gained notoriety for its controversial stance on blood transfusions, which its adherents believe to be a violation of God's law. To them, the "life force" resides in the blood, and oral or intravenous ingestion can result in the forfeiture of eternal life and excommunication from the congregation. Because of their beliefs, Jehovah's Witnesses faced resistance and criticism from the medical community. Fearful of undergoing transfusion against their will or without their knowledge and unable to find hospitals willing to treat them in accordance to their religious precepts, members would, at times, risk their health and well-being to avoid medical intervention. The first bloodless surgery program was developed for this population. By coordinating presurgery counseling, specialized equipment, and physicians trained in perioperative and postoperative nonblood therapies for the prevention and treatment of anemia, blood-management programs ensure that patients can access treatment without having to forfeit their beliefs.



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