Pediatric and Adolescent Jehovah’s Witnesses: Considerations for Safe and Ethical Orthopaedic Procedures Current Concept Review

Abstract

Jehovah’s Witnesses are members of a restorationist Christian denomination. Among their beliefs, most important for consideration of the pediatric orthopaedic surgeon, is their refusal of blood transfusions, particularly in consideration of the small range of acceptable blood loss in young children and high-risk cases such as spine and pelvic surgery. Thus,  we examined the legal, ethical, and medical issues surrounding treatment of Jehovah’s Witnesses in order to have collaborative conversations towards the best possible care and avoidance of harm. We have found that while previous case rulings have been quite clear in outlining the treatment of young children of Jehovah’s Witnesses, there is much more variability in the treatment of those who are adolescents and who have capacity to consent. Therefore, care must be taken in maintaining frequent communication with pediatric patients’ families and assessing the acceptable treatment for the patient. Preoperatively, planning requires multi-disciplinary coordination, verification of acceptable blood products, and anemia optimization. Furthermore, by utilizing various intraoperative and postoperative techniques, bloodless surgery can be successfully performed with similar outcomes as other patient groups.