Anesthesia for laparoscopic adrenalectomy (pheochromocytoma) in an anemic adult Jehovah's Witness

Resection of Large Urological Tumors With or Without Inferior Vena Cava Extension in Jehova's Witnesses

Background: Renal and adrenal tumors with/without tumor thrombus in the inferior vena cava (IVC) pose a challenge to the surgeon due to the potential for massive hemorrhage and tumor thromboemboli. The situation would be more critical for Jehovah's Witness (JW) patients which refuse blood transfusion. A transplant-based (TB) approach to these tumors in JWs would result a safe surgical method, providing limited blood loss and perioperative complications. We report our experience using a TB surgical approach in JW harboring large adrenal/renal tumors with/without tumor thrombus trying to determine its usefulness in this setting.

Patients and Methods: From 2003 to 2011, 7 patients underwent resection of renal/adrenal tumors with/without tumor thrombus in the IVC by means of a TB approach. Thrombus level was renal (n = 2), retrohepatic (n = 1), and suprahepatic (n = 1). The remaining 3 patients did not present thrombus. No pre-operative optimization or cell-saver were used. Estimated blood loss, perioperative complications (Clavien-Dindo and cause), hemoglobin/hematocrit loss, and length of stay were considered main outcomes.

Results: The intervention was successfully completed without transfusion in all cases. Operative time and blood loss were 2.5 h (range: 1.83–5.75) and 150 cc (range: 100–750), respectively. No major post-operative complications were registered. However, minor complications were detected in 57% of the patients included. Median hemoglobin loss was 1.13 mg/dL, which translated a median hematocrit loss of 2.3%. Patients were discharged in a median of 7 days (range 5–20).

Conclusions: A TB-surgical approach provides enhanced retroperitoneal exposure and optimal vascular control, thus limiting operative blood loss or major complication development, thus resulting useful in JWs.

Laparoscopic nephron-sparing surgery in a Jehovah's Witness patient

An obese 76-year-old woman with type II diabetes, hypertension, coronary artery disease, and gastroesophageal reflux was found to have a 6-cm lower-pole mass in a solitary functional right kidney. Because her religious beliefs prohibited blood transfusion, minimally invasive surgery--a laparoscopic partial nephrectomy--was performed, with a good result. Minimally invasive surgery, perhaps with administration of erythropoietin, iron-dextran, or both, is often a good option for severely anemic patients or those whose religious beliefs are opposed to transfusion. Methods of minimizing blood loss intraoperatively are reviewed.

Blood transfusions and the Jehovah's Witness patient

This paper provides a brief history of the evolution of the Jehovah's Witness faith with a short discussion on the biblical justification for followers' refusal of blood transfusions. It also briefly considers the ethical principles leading to potential conflicts between health care workers and Jehovah's Witnesses patients and examines several significant legal rulings in the United States and Canada that caregivers should be aware of. A discussion of what blood products are and are not currently acceptable is also presented. Finally, the impact of the Jehovah's Witness reform movement aimed at allowing blood transfusions and the nature of recent doctrinal shifts in the Jehovah's Witness faith on the matter of blood transfusions are discussed.