title: [Major surgery on Jehovah's Witnesses].
abstract: BACKGROUND
  Jehovah's Witnesses refuse transfusions of the main blood components. This challenges the safety of performing major surgical procedures. At the Norwegian Radium Hospital, we have taken the views of Jehovah's Witnesses regarding blood transfusions into account when planning major surgical procedures and perform these without such transfusions. We present a case and our experiences and routines when performing major cancer surgery on Jehovah's Witness patients.
  
  
  METHODS
  The medical records of Jehovah's Witnesses, who underwent major surgery at the Norwegian Radium Hospital from April 1992 to February 2006, were surveyed retrospectively. Based on relevant literature, our routines and methods are discussed along with some legal and ethical aspects.
  
  
  CONCLUSIONS
  Major transfusion-free surgery can be performed successfully on Jehovah's Witnesses. This requires advanced planning, good routines and close collaborative team efforts. The most relevant techniques to make major surgery feasible are preoperative optimalisation of the haemoglobin levels and acute normovolemic haemodilution and the use of cell saver under surgery.
authors.affiliation: Anestesiavdelingen, Rikshospitalet-Radiumhospitalet, 0027 Oslo, Norway. larsoivind.hoiseth@ulleval.no
authors.forename: Lars Øivind
authors.initials: LØ
authors.lastname: Høiseth
authors.forename: Karl-Erik
authors.initials: KE
authors.lastname: Giercksky
authors.forename: Stein Gunnar
authors.initials: SG
authors.lastname: Larsen
authors.forename: Ulf
authors.initials: U
authors.lastname: Kongsgaard
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000368:Aged; D001803:Blood Transfusion; D004921:Erythropoietin / Q000008:administration & dosage; D005260:Female; D006438:Hemodilution / Q000379:methods; D006801:Humans; D033221:Jehovah's Witnesses; D008297:Male; D009369:Neoplasms / Q000601:surgery*; D010347:Patient Care Planning; D012004:Rectal Neoplasms / Q000601:surgery; D012068:Religion and Medicine; D012189:Retrospective Studies
chemical_list: D004921:Erythropoietin