“The refusal of blood transfusion for surgical procedures at high risk of bleeding, such as pancreatic resection, forces surgeons to face ethical challenges and raises concerns about appropriate perioperative management. In the last two decade the rate of transfusion in high volume centers has gradually decreased thanks to the application of patient blood management (PBM) protocols.”

“In our single-institution experience, patients that categorically refused transfusion were Jehovah’s Witnesses (JW). JW is a religious movement, membership in which accounts for about 0.3% of Western countries’ populations, with USA and Italy having the highest percentages of followers. JW followers believe neither whole blood nor its four major components, namely red cells, white cells, platelets and plasma, should be donated, stored, or accepted in any circumstance, even in life-threatening situations. Advances in transfusion medicine have led the JW’s denomination to modify its position about what is deemed acceptable.”

“Pancreatic surgery still carries a significant risk of large amounts of blood loss.
Perioperative blood transfusion in patients undergoing pancreatectomy is independently associated with increased 30-day major morbidity and mortality, prolonged length of stay and significantly lower five-year survival after pancreatic surgery with curative intent. Treatment of Jehovah’s Witnesses during the past 50 years has led to a greater awareness of blood-conservation techniques and advances in bloodless surgery. Bloodless surgery in JW patients can be viewed as the extreme application of PBM protocols, which are generally aimed at minimizing unnecessary exposure to blood products in order to improve patient outcome.”

De Bellis, Mario et al. “Pancreatic resections in patients who refuse blood transfusions. The application of a perioperative protocol for a true bloodless surgery.” Pancreatology : official journal of the International Association of Pancreatology (IAP) … [et al.] vol. 20,7 (2020): 1550-1557.