Kidney transplants without blood transfusion for Jehovah's Witness patients

Those who follow this branch of Christianity are against the use of blood transfusions, which means in the even of a patient needing an organ transplant, this would not have been possible and could cost the person his or her life.

But the Hospital del Mar, one of Catalunya's top six kidney transplant centres, reveals that it carried out transplants in 2016 and 2017, one using a live donor and the other a deceased donor, in which all three of the living persons involved were Jehovah's Witnesses.

The procedure, established nationwide, involves having to find medical professionals willing to agree to perform surgery without the use of donated blood, and includes close teamwork between nephrology, urology, anaesthetists, transplant surgeons and their related nursing staff.

And the hospital has to sign a contract agreeing to 'respect all religious beliefs' in performing operations, so that Jehovah's Witnesses can feel safe in the knowledge they will not be given a 'sneaky' transfusion whilst under anaesthetic.

For the process to be successful without endangering the patient's health, 'much stricter requirements' are put in place as regards haemoglobin, or red blood-cell levels, before operating.

Patients are required to take a course of the drug Erithropoyetine, which stimulates haemotite production, since kidney failure or disease suppresses the body's ability to create these cells.

Normally, Erithropoyetine is used at a lower dose in non-Jehovah's Witness patients, since they do not need to produce as many red blood cells ahead of the transplant as any drop in haemoglobin can be treated with a transfusion.

Levels of anaemia which would be 'tolerable' in patients with no objection to blood transfusions would not be allowed prior to an operation on a patient who does not consent to receiving donor blood.

Additionally, theatre nurses use 'cell-saver' equipment to collect patients' blood during the operation if they haemorrhage, meaning this can be transfused back into the person.

'Auto-transfusions', or a patient's own blood being used in transfusion does not go against Jehovah's Witnesses' beliefs.

Staff have to be specially trained in cell-saver use and in blood-cell count management, the Hospital del Mar explains.

Patients are transferred to the post-op recovery unit after surgery and closely monitored to detect possible bleeding or falls in haemoglobin count at the earliest possible stage, as well as the usual stringent checks on breathing and pain control.

After 24 to 48 hours, the patient will then be transferred to the nephrology ward, and will not be discharged until red blood-cell counts are completely stable and there is no pain.

Barcelona's Hospital del Mar carried out a record 116 kidney transplants last year alone, of which 12 involved organs from live donors.

The centre has only released details of the 2016 and 2017 transfusion-less transplants this week, since the patients have had to be closely monitored since to ensure they had been a success.