Orthotopic liver transplantation in Jehovah's Witnesses

摘要

Orthotopic liver transplantation (OLT) carries significant bleeding risks and has a high dependency on blood and blood-product transfusion. Jehovah's Witnesses conscientiously refuse transfusion of some or all blood products. OLT can be successful without the transfusion of allogeneic blood products. OLTs without blood or blood-product transfusion reduce not only the risks of transfusion reactions and transmission of blood-borne pathogens, but also complications of immunosup-pression and the likelihood of surgical re-intervention. This article explains the beliefs of Jehovah's Witnesses and clearly outlines the products they do and do not accept. An evidence-based protocol is described to meet the needs of these patients, highlighting the importance of multidisciplinary planning in advance. Pre-operative aims of blood augmentation can be achieved using erythropoietin, folic acid and iron supplementation. Intra-operative aims of blood-loss minimization are met surgically by: minimizing operation time; adopting the piggyback method; and using an argon beam coagulator, collagen and cellulose pads, and fibrin glues and sealants. During anaesthesia, patients should be kept hypotensive, normothermic and with low central venous pressure. Phlebotomy or acute normovolaemic haemodilution, intra-operative cell salvage and antifibrinolytics are also discussed. Patients should be monitored closely in the post-operative period. This protocol would be beneficial for all surgical patients and would reduce global blood use.