title: Responses of advanced directives by Jehovah's Witnesses on a gynecologic oncology service.
abstract: OBJECTIVE
  To review the responses of advance directives signed by Jehovah's Witness patients prior to undergoing surgery at a gynecologic oncology service.
  
  
  METHODS
  A retrospective chart review of gynecologic oncology patients undergoing surgery at a bloodless surgery center from 1998-2007 was conducted. Demographic, pathologic, and clinical data were recorded. The proportion of patients who accepted and refused various blood-derived products was determined and was compared to previously published results from a similar study of labor and delivery unit patients.
  
  
  RESULTS
  No gynecologic oncology patients agreed to accept transfusions of whole blood, red cells, white cells, platelets, or plasma under any circumstance, whereas 9.8% of pregnant patients accepted transfusion (P=0.0385). However, 98% of gynecologic oncology patients agreed to accept some blood products, including fractions such as albumin, immunoglobulins, and clotting factors, while only 39% of pregnant patients agreed (P<0.0001). In addition, all gynecologic oncology patients (100%) accepted intraoperative hemodilution, compared to 55% of pregnant patients (P<0.0001).
  
  
  CONCLUSIONS
  Our results confirm the commonly held belief that the majority of Jehovah's Witness patients refuse to accept major blood components. However, Jehovah's Witness patients at a gynecologic oncology service will accept a variety of blood-derived products (minor fractions) and interventions designed to optimize outcomes when undergoing transfusion-free surgery. Patients presenting to a gynecologic oncology service respond differently to advanced directives related to bloodless surgery, as compared to patients from an obstetrical service.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, NY, USA ; Englewood Hospital and Medical Center, Englewood, NJ, USA.
authors.forename: Nimesh P
authors.initials: NP
authors.lastname: Nagarsheth
authors.affiliation: Department of Urology, North Shore - Long Island Jewish Health Service, New Hyde Park, NY, USA.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Gupta
authors.affiliation: Department of Endocrinology, Diabetes and Metabolism, St Luke's Hospital of Kansas City, Kansas City, MO, USA.
authors.forename: Arpeta
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Moshier
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Herbert
authors.initials: H
authors.lastname: Gretz
authors.affiliation: Department of Anesthesiology, Englewood Hospital and Medical Center, Englewood, NJ, USA.
authors.forename: Aryeh
authors.initials: A
authors.lastname: Shander
keywords: Jehovah’s Witness; advanced directives; bloodless surgery