Everything that lives and moves will be food for you. … But you must not eat meat that has its lifeblood still in it. For your lifeblood I will surely demand an accounting.—Genesis 9:3–5, Old Testament, New International Version1Any Israelite or any alien living among them who eats any blood—I will set my face against that person who eats blood and will cut him off from his people. For the life of a creature is in the blood, and I have given it to you to make atonement for yourselves on the altar; it is the blood that makes atonement for one's life. Therefore I say to the Israelites, “None of you may eat blood, nor may an alien living among you eat blood.”—Leviticus 17:10, 12, Old Testament, New International1You must abstain from eating food offered to idols, from consuming blood or the meat of strangled animals, and from sexual immorality.”—Acts 15:29, New Testament, New LivingTranslation2
Jehovah's Witnesses is a religious organization whose adherents now number more than six million worldwide. The sect was established in 1870 in an effort to return to a pure, unadulterated, scripture-based form of Christianity; consequently, many of the group's doctrines are derived from literal interpretations of the Bible. Though best known for its evangelical efforts, the organization has gained notoriety for its controversial stance on blood transfusions, which its adherents believe to be a violation of God's law. To them, the “life force” resides in the blood, and oral or intravenous ingestion can result in the forfeiture of eternal life and excommunication from the congregation. Because of their beliefs, Jehovah's Witnesses faced resistance and criticism from the medical community. Fearful of undergoing transfusion against their will or without their knowledge and unable to find hospitals willing to treat them in accordance to their religious precepts, members would, at times, risk their health and well-being to avoid medical intervention. The first bloodless surgery program was developed for this population. By coordinating presurgery counseling, specialized equipment, and physicians trained in perioperative and postoperative nonblood therapies for the prevention and treatment of anemia, blood-management programs ensure that patients can access treatment without having to forfeit their beliefs.
The first bloodless surgery program was established to offer Jehovah's Witnesses access to medical treatment in an environment that coincided with their religious belief system. It and other similar programs were designed to be transfusion-free, using a method of blood management that strictly disallows the administration of allogenic cellular transfusions (red blood cells [RBCs], white blood cells, platelets), as well as many serum protein products, despite the risk of patient mortality. The importance of maintaining a transfusion-free environment requires the hospital to implement comprehensive preoperative, intraoperative, and postoperative safety measures as well as patient tracking systems to prevent inadvertent blood product administration to this specific patient population. Ultimately, the program demands a degree of institutional commitment with administrative and operational precision that many hospitals are unable to provide.
Blood-management programs have since advanced to lie on a spectrum from transfusion-free practice to less restrictive alternatives based in a common effort to minimize blood product administration. Their development, which began as an alternative for those with religious beliefs that prohibit the acceptance of blood products, is also driven by the concept that minimizing blood product administration enhances patient safety and reduces the cost and length of hospital stays. Using many of the same clinical strategies to avoid blood product administration, a blood-conservation program can avoid problems with the availability and escalating costs of blood products and take advantage of the fewer complications and increased patient safety associated with decreased allogenic transfusion. In addition, hospitals that are unable to provide transfusion-free programs still have the opportunity to take advantage of the financial and clinical benefits of a blood-management program without the bureaucratic complexities of unconditional prohibition of cellular transfusion that a transfusion-free program would require.