Transfusion and refusal: trials and tribulations

Olivier Garraud,1,2 Jean-Daniel Tissot3,4 1Faculty of Medicine, University of Lyon, Saint-Etienne, France; 2Institut National de la Transfusion Sanguine, Paris, France; 3Transfusion Interrégionale CRS, Epalinges, Switzerland; 4Faculty of Biology and Medicine, University of Lausanne, Switzerland Abstract: Transfusion is special, not only because it is a life-saving therapy from caring siblings and, more commonly, anonymous benevolent donors, but also because blood is nontrivial, symbolic, and carries ancestral fears. Blood is generally offered and should be accepted by the beneficiaries, meaning that the question should be addressed to them. Most often, the question is not whether they accept the donated blood, but whether they accept the minimal risk associated with it. This is a different matter, and it can be questioned whether both the questions are actually put to the respondent, that is, the patient needing the transfusion, to present better what transfusion is and what the benefit/risk ratio is. Since acceptance is an issue, refusal is the flipside. Some patients, including those with religious faiths (such as Jehovah’s Witnesses), refuse blood transfusion; they also refuse bloodshed on the battlefield. It is a situation that represents a high medical and psychological burden for healthcare practitioners. Practitioners have, however, strived to respect the beliefs of Jehovah’s Witnesses and have helped advance bloodless medical and surgical interventions that have benefited all those involved. This paper attempts to clarify some of the issues pertaining to blood refusal by groups of believers such as Jehovah’s Witnesses and takes the opportunity to clarify certain blood acceptance issues with regard to its opposite, blood refusal, and decision-making process. Keywords: transfusion, ethics, Jehovah’s Witness, healthcare refusa