Jehovah’s Witnesses and Blood Transfusions: Questions Answered by Dr. John Doyle, MD, PhD

Dr. John Doyle, MD, PhD

This Q&A aims to address common concerns held by Jehovah’s Witnesses about blood transfusions, presented with sensitivity to religious beliefs and grounded in medical evidence.

Disclaimer: This Q&A reflects current medical understanding and is intended for informational purposes. Individual decisions should be made in consultation with qualified healthcare professionals.

Professor Doyle served as a consultant to AJWRB for many years and authored several articles published at AJWRB. He passed away in 2025 at the age of 66. AJWRB gratefully acknowledges his service and contributions. He will be missed.

QUESTION: The Watch Tower Society permits the use of certain blood components or fractions. Are these really considered blood?

ANSWER: While these components (like albumin or clotting factors) are not whole blood, they are derived through the fractionation of donated blood. Medically, they are considered blood products.1

QUESTION: Aren’t there always alternatives to blood transfusions?

ANSWER: In many situations, yes. Techniques such as fluid resuscitation using saline or Ringer’s lactate can maintain blood volume during surgery. Additionally, preoperative planning, cell salvage, and medications like erythropoietin can reduce the need for transfusions. However, these methods do not replace the oxygen-carrying function of red blood cells. When hemoglobin levels drop below 6 g/dL, the risk of organ failure and death due to oxygen deprivation increases significantly. In such critical cases, transfusions can be life-saving.

For example, in one study of Jehovah’s Witness surgical patients who needed but refused blood transfusion, over 60% of those with a hemoglobin concentration under 6 g/dl died. By the way, efforts to make true blood substitutes that carry oxygen (salt solutions do not carry significant amounts of oxygen) are in progress. These substitutes are made from discarded human or bovine blood and could be widely available in the future. Some, like Hemopure, may be available now in some locations on a compassionate use basis. Hemopure is approved for use in South Africa and the Russian Federation. 2,6,7

QUESTION: Aren’t blood transfusions extremely risky? What about diseases like HIV or hepatitis?

ANSWER: All medical treatments carry some risk, but transfusions are now safer than ever due to stringent screening and testing. Modern testing for HIV, hepatitis B and C, HTLV, and syphilis significantly reduces the risk of transmission. For example, in Canada, the estimated risk of contracting HIV from a transfusion is about 1 in 913,000 units; for hepatitis C, 1 in 103,000; and for hepatitis B, 1 in 60,000. While not zero, these risks are extremely low.

The bloodless surgery movement, which I enthusiastically support (see my Web pages on the topic), is aimed at reducing potential complications from blood transfusions. As a result of the AIDS and hepatitis scare in the 1980’s, physicians have thoroughly revised their thinking about when blood transfusions are appropriate (see more of my Web pages for sample transfusion guidelines). This fact, coupled with the availability of new tests for blood-borne pathogens (see earlier question), puts the benefit-to-risk ratio for blood transfusions at an all-time high. In my opinion, the ratio of lives saved to lives lost from blood transfusions is now likely many thousands to one. 3,4

QUESTION: Do surgeons use blood to cover up sloppy surgical technique?

ANSWER: Surgeons, like lawyers, car mechanics, teachers, and golf pros, all vary in capabilities. As an anesthesiologist, I have noted wide variations in the skills of surgeons in reducing blood loss. Many hospitals have an audit process to let surgeons know when their patients consistently require more blood than average.

Still, some surgical procedures (radical prostatectomy, craniofacial surgery, spinal surgery, for example) are associated with large blood losses even in the best of hands. Even then, predonation (“autologous transfusions”) can sometimes be used to reduce the risk of disease transmission.

However, in the final analysis, patients cared for by surgeons who are sloppy about hemostasis (the prevention of surgical bleeding) will, on average, require more blood transfusions than those cared for by meticulous surgeons. 9

QUESTION: Have blood transfusions saved lives, or do people often die regardless?

A: The benefit of a blood transfusion depends on the clinical context. In patients with terminal illnesses or catastrophic injuries, transfusions may only offer a modest benefit. However, in otherwise healthy individuals experiencing acute blood loss—such as from trauma or surgery—transfusions can be life-saving. 2,7

QUESTION: Do doctors profit from ordering blood transfusions?

A: No. In most healthcare systems, including Canada’s, physicians do not receive financial incentives for ordering transfusions. 9

QUESTION: Don’t blood transfusions complicate cancer treatment? Doesn’t that make them bad medicine?

A: Like many treatments, transfusions carry potential side effects, such as immune suppression. However, they are often necessary in cancer care to treat anemia caused by chemotherapy or bone marrow failure. Their use is weighed carefully against the risks, as with any medical intervention. 5

QUESTION: I believe accepting blood is a test of faith. How can I trust what doctors say?

A: A good physician respects your beliefs and will explain the medical rationale for treatment options, including transfusion. If you are concerned, seeking a second opinion or speaking with a physician experienced in bloodless medicine can help you make an informed decision aligned with your values. 1

QUESTION: Is it true that transfused red blood cells don’t carry oxygen for the first 48 hours?

ANSWER: No. This is a common misconception. Transfused red blood cells begin transporting oxygen immediately after entering the bloodstream. 2

QUESTION:What tests are performed to ensure blood is safe?

A: Donated blood is rigorously tested for a variety of infectious agents, including:

• HIV-1 and HIV-2
• Hepatitis B and C
• HTLV-I and II
• Syphilis

These safeguards have drastically improved transfusion safety. 8

QUESTION: How likely is it that a unit of blood is contaminated?

A: While the risk is not zero, it is extremely low. For example, in Canada:

• HIV: 1 in 913,000
• Hepatitis C: 1 in 103,000
• Hepatitis B: 1 in 60,000

These rates continue to fall due to advanced screening technologies and donor deferral policies. 3,4

Conclusion:

Medical professionals recognize that blood transfusions are both powerful and potentially risky tools. They are not used lightly. Modern medicine offers many strategies to avoid or minimize transfusions, but in certain situations, they remain essential. Patients are encouraged to make informed decisions in consultation with their healthcare providers and to seek care from institutions experienced in respecting bloodless treatment preferences.

Endnotes:

1. Goodnough LT, Shander A, Spence RK. Bloodless medicine: clinical care without allogeneic blood transfusion. Transfusion. 2003;43(5):668-676.
2. Carson JL, Grossman BJ, Kleinman S, et al. Red blood cell transfusion: a clinical practice guideline from the AABB. Ann Intern Med. 2012;157(1):49-58.
3. Centers for Disease Control and Prevention (CDC). HIV Surveillance Report. 2023. https://www.cdc.gov/hiv
4. Canadian Blood Services. Risks of Transfusion. 2024. https://www.blood.ca
5. Vamvakas EC, Blajchman MA. Deleterious clinical effects of transfusion-associated immunomodulation: fact or fiction? Blood. 2001;97(5):1180-1195.
6. Weiskopf RB. Hemoglobin-based oxygen carriers: potential, promise, and problems. Anesthesiology. 2007;106(5):1079-1081.
7. Hébert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med. 1999;340(6):409-417.
8. World Health Organization. Screening donated blood for transfusion-transmissible infections: recommendations. Geneva: WHO; 2010.
9. Shander A, Hofmann A, Ozawa S, et al. Activity-based costs of blood transfusions in surgical patients at four hospitals. Transfusion. 2010;50(4):753-765.

D. John Doyle MD PhD FRCPC
Toronto Hospital and University of Toronto