Faith's ban on transfusions pushes doctors to innovate

San Francisco Chronicle/July 20, 2007
By Matthai Chakko Kuruvila

Surgeons worked Thursday to save a 74-year-old Oakland man's life -- and abide by his religious conviction -- as they performed emergency open-heart surgery without giving him a blood transfusion.

As a Jehovah's Witness, LeRoy Grant believes the Bible forbids blood transfusions. He felt he could not compromise his beliefs.

"If I violate God's law on blood simply to gain a few more days -- or years -- of life, I would be dead spiritually, and my relationship with God would be damaged beyond repair," Grant said recently at his home.

Such a belief once meant almost certain death, but Grant was recuperating late Thursday after the four-hour procedure. Medical technology has advanced to the point that many doctors believe surgeries without blood transfusions should become the norm.

The so-called "bloodless" surgeries use drugs to raise blood counts before an operation and limit blood loss during it. A "cell-saver" machine also allows physicians to collect pooling blood during surgery, wash it and infuse it back into the body intravenously.

"There's no conflict between the avoidance of blood and an excellent patient outcome: They go hand in hand," said Dr. Lawrence Goodnough, a national expert on blood transfusions who is director of transfusion services at Stanford University Medical Center and a professor at the university's medical school.

A once-archaic belief has developed an ally in cutting-edge medicine. Doctors say the faith's fundamentalism has encouraged the advances by showing how patients can survive with less blood than previously thought.

More than 100 hospitals around the nation, as well as Duke and Johns Hopkins universities, have bloodless medical programs that train everyone from technicians to nurses to doctors. But in the Bay Area, Grant had found himself in a medical no-man's land since being told in April that he needed to have surgery or die.

Grant had scrambled for approvals from his insurance company, individual surgeons and the cadre of other medical specialists needed for such an operation. He was set to meet with doctors at Stanford Medical Center this week, but had to be rushed to the San Ramon Regional Medical Center on Thursday with severe breathing problems, said his wife, Evelyn.

Grant still has to avoid infection as he recovers from the surgery to fix a faulty heart valve, which had caused his blood to have less oxygen than needed. He often labored to breathe. In six months, Grant said he had lost 52 pounds, leaving him at 154 pounds.

Jehovah's Witnesses cite several Bible verses to support their beliefs on transfusions, most notably Acts 15:29, which urges believers to abstain from blood. The prohibition on blood transfusions includes strategies such as storing one's own blood.

"Blood removed from an individual is to be poured out or discarded," said J.R. Brown, a spokesperson for the Watchtower Bible and Tract Society, the Brooklyn headquarters for Jehovah's Witnesses.

Goodnough, the Stanford medical center blood transfusions director, said there are a number of advantages to bloodless surgeries.

New pathogens historically have entered blood banks well before tests were developed to detect them. HIV and hepatitis C are two examples in recent decades.

"The good news is that blood (in blood banks) has never been safer," said Goodnough, who like other doctors interviewed for this story is not a Jehovah's Witness. "But I'm very concerned about emerging pathogens."

Goodnough said that more hospitals should have bloodless medical programs, particularly in a world concerned with disasters and terrorism. In the case of a pandemic of a disease such as SARS or avian flu, the entire blood supply could be crippled.

"How are you going to deliver health care without blood?" he said. "The answer is a bloodless medical program. You can't jump-start that in the middle of a catastrophe."

Despite new medical advancements that allow room for long-held beliefs, some former Jehovah's Witnesses say the prohibition on transfusions goes too far.

Amanda Hill said her parents signed liability waivers to prevent her from receiving a transfusion when she was 15 and undergoing a tonsillectomy. It terrified her that her parents would rather see her dead than break a rule.

She said her parents, like other Jehovah's Witnesses, thought that death wasn't necessarily bad because believers are resurrected to live in an eternal paradise on Earth after Armageddon.

"They see the world as a horrible, horrible place to live," said Hill, 34, an Oakland resident who said she was kicked out of her parents' home at age 16 when her parents discovered that she was a sexually active lesbian. "If the child dies, it's almost like you're doing them a favor."

Other former Witnesses say the religion exacts too much control over believers and powerfully dictates belief. Witnesses are taught to socially segregate themselves from all non-Jehovah's Witnesses, and those who leave or violate rules are ostracized, leaving them with little or no support. Critics say that makes belief a matter of force, not faith.

Brown, the Jehovah's Witness spokesperson, said that out of the roughly 7 million Jehovah's Witnesses worldwide, roughly 60,000 Witnesses are "disfellowshiped" every year. Nearly half try to make their way back. Willingly accepting a blood transfusion and not repenting is cause for being "disfellowshiped."

Grant, who leads a West Oakland congregation, was not raised a Jehovah's Witness. He remembers being appalled when he heard in 1962 that the group did not accept blood transfusions.

"There's no way you could tell me I can't give my children blood," he said. "I stopped them from coming to my home."

But his wife joined a Witness Bible study not long after. After several years, he followed. In 1969, at age 36, Grant was baptized at a regional convention at Dodger Stadium in Los Angeles.

"Obeying God's word since I came into the truth has given me the greatest peace of mind because I've seen God's blessings," he said.