Our experience of lung resection in patients who decline blood transfusion for religious reasons

Abstract

Objective: Surgical treatment for patients who refuse blood transfusion due to religious beliefs is an important issue related to medical safety. Few reports have examined pulmonary surgery for these patients, and we analyzed clinical characteristics in such cases.

Methods: Ten Jehovah's Witness (JW) patients with lung tumor resection who declined blood transfusion for religious reasons between December 2013 and February 2020 at the Fukushima Medical University Hospital were included. Median total intraoperative blood loss was 17.5 mL (range 5-150 mL). Fibrin glue was used intraoperatively for 8 patients. Final pathological examination revealed pulmonary adenocarcinoma in 9 cases and metastasis of bladder cancer in 1 case. In 8 patients with pulmonary adenocarcinoma examined for epidermal growth factor receptor (EGFR) gene mutation, 6 cases showed mutation. No patients had serious complications, but 1 patient displayed temporary anemia due to postoperative hemorrhagic gastrointestinal ulcer.

Result and conclusions: Our findings confirm that pulmonary resection is feasible and safe for JW patients if performed by experienced medical staff. However, awareness of complications associated with perioperative bleeding is important. Each JW patient should be interviewed individually and every available perioperative option aimed at blood-sparing management, including use of blood coagulation factors and fibrinogen concentrates, should be carefully discussed and clarified. In this study, the EGFR gene mutation rate was higher than usual for cases of lung adenocarcinoma. Further studies are necessary to assess clinical features in JW patients with lung cancer.

Keywords: Autologous blood transfusion; EGFR mutation; Jehovah’s witness; Lung cancer; Lung resection.

Fig. 1

Disclaimer documents from our institution. In our hospital, we obtain the consent of each JW patient to undergo surgery under a policy of absolute bloodlessness using this disclaimer document based on the guidelines for religious rejection of blood transfusion in Japan before the operation. We also check with each JW patient one by one for the types of blood products they reject, including coagulation factors