![]() Indications for autologous or allogeneic transplantation vary by disease and are determined by various factors, such as cytogenetic abnormalities, response to previous therapy, disease status and prognostic factors, patient age and performance status, and availability of a suitable graft source (Perumbeti & Sacher, 2018). This dependence on blood product transfusions is a complicating factor for Jehovah’s Witness patients diagnosed with a hematologic malignancy because their religious beliefs conflict with the traditional standard of care for patients receiving an SCT. After the patient receives conditioning chemotherapy, blood and platelet transfusions along with other therapies, such as antibiotics, bridge the gap until the transplanted stem cells start producing adequate numbers of red blood cells (RBCs), white blood cells, and platelets. ![]() Blood and platelet transfusions are mainstays of supportive therapy in hematopoietic SCT (HSCT), because high doses of chemotherapy required to minimize any residual hematologic cancer also wipes out the patient’s bone marrow. The common thread among all these bloodless procedures is the ultimate goal of minimizing blood loss and optimizing hematopoiesis to attain the best possible outcomes for these patients while forgoing transfusions.Īlthough Jehovah’s Witnesses constitute just 0.8% of the population in the United States (Pew Research Center, 2015), their refusal of blood product transfusions makes them a particularly compelling community in the context of stem cell transplantation (SCT). There have been favorable outcomes for Jehovah’s Witness patients in complex bloodless surgeries, including cardiac and vascular surgeries and solid organ transplantations (Brunetta et al., 2015 Madueño, Tomás, & Velázquez, 2013 Spasovski, Stankov, & Masin-Spasovska, 2014 Tanaka et al., 2015). However, general agreement exists among ethicists that the wishes of competent, well-informed adult patients to decline blood products should be respected because of the preeminence of patient autonomy in medical decision making (Sagy, Jotkowitz, & Barski, 2016). This blood product refusal can lead to ethical and moral distress when the healthcare team treats these patients, because denying a life-saving transfusion can be perceived as irrational. Blood product refusal was not always the religion’s mandate the Governing Body of Jehovah’s Witnesses officially banned blood product transfusions in 1945 (Wright, 2016). Many Jehovah’s Witness patients are willing to accept the infusion of stem cells because they are perceived to come from the marrow rather than being considered a blood product. ![]() The decision about whether to accept minor blood components, such as albumin, clotting factors, cryoprecipitate, and stem cells, is left up to the individual as a matter of conscience (Lin, Kaye, & Baluch, 2012). ![]() According to Genesis 9:4 (King James Version), “only flesh with its soul-its blood-you must not eat.” Jehovah’s Witnesses interpret this to mean that they cannot accept transfusions of whole blood or its primary components (red and white blood cells, plasma, and platelets). Among the many tenets of the religion, followers are prohibited from accepting blood transfusions, based on their literal interpretation of the bible. Jehovah’s Witnesses are a fundamentalist Christian religious group that was founded in Pittsburgh, Pennsylvania, in 1872. ![]()
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