Case 27: A Jehovah’s Witness Patient and a Potentially Bloody Operation
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A 54-year-old male (ASA 1) weight 79 kg and height 5′11″ is scheduled for a prostatectomy. While checking your anesthesia machine in the OR, you hear from the circulating nurse that the patient is a Jehovah’s Witness. The scrub nurse mentions that she has had a patient like this die under a similar operation. In the hope that the patient may take albumin, you get two bottles of 4% albumin from the pharmacy and place it on your anesthetic table behind the anesthesia machine. You meet him for the first time in the preoperative holding area. He is surrounded by 15 of his family and friends. They inform you of the patient’s unbending refusal to accept blood transfusions and all related blood products. You inform the patient that you will abide by his wishes, but tell him, in no uncertain terms that he may die from hypovolemia. His response is to say he’d rather die than get blood products. You write down on paper or enter in your electronic medical record that you have explained the serious consequences of his refusal. If your hospital is still on “paper,” then get him to sign that he does not want any blood products and that he is prepared to die. You get this witnessed by as many of his family and friends that want to sign. You make a copy of this statement for your own record and place the original in the patient’s chart.