AJWRB grants permission to make this article available for re-use in any form or by any means with acknowledgment of the original source. Please note that this is a working document and will be updated as new information becomes available.
Authors: Lee Elder, AJWRB Director; Dieter Parczany – Former JW – HLC Committee Chairman; Faith McGinn – RN, BSN; AJWRB Leadership Team
Correspondence: AJWRB 5966 N. Mooncrest Dr. | Tucson, AZ 85718-3445
E-mail: [email protected]
As scientists and clinicians search for therapeutics and a cure for COVID-19, there is one tried treatment that is consistently being cited for its potential: convalescent plasma. (https://covidplasma.org/)
Plasma is a product rendered from blood. In medical settings, this is often called fresh frozen plasma (FFP). Individuals who have survived COVID-19 and whose blood has sufficient levels of antibodies for COVID-19 can donate blood. Medical providers can then render plasma from this donated blood to share these antibodies with current COVID-19 sufferers, helping them fight the disease. This plasma can be frozen and when needed, thawed for treating COVID-19 patients.
Fresh frozen plasma (FFP) may be acceptable to some Jehovah’s Witnesses (JWs) who are willing to accept a blood product currently prohibited by their religion’s leadership, in particular younger members. But it is likely that a majority of members would not accept FFP. However, all plasma “fractions” are permitted as shown in the following diagram from Watchtower (WT). This leaves physicians a potential alternative for JW patients.
AJWRB is reminding physicians that cryosupernatant (also known as cryo-depleted plasma and/or cryo-poor plasma) is viewed as a “fraction” of plasma within WT theology.1-5 This could be an important detail when treating JW’s with COVID-19 since cryosupernatant constitutes approximately 99% of the total volume of a unit of FFP. If a JW patient refuses the use of convalescent plasma for treating their COVID-19, the same patient’s religion allows them to accept a transfusion of cryosupernatant, which is rendered from convalescent plasma.
Cryosupernatant contains the vast majority of the immunoglobulin, with little if any remaining in the cryoprecipitate.6,7 Additionally, the journal Transfusion and Apheresis Science has released a pre-proof copy titled “Convalescent Plasma, an Apheresis Research Project Targeting and Motivating the Fully Recovered COVID 19 Patients: A Rousing Message of Clinical Benefit To Both Donors and Recipients Alike”. This article includes cryo-depleted plasma in the discussion of using convalescent plasma during the COVID-19 pandemic on page 1 (p.3 of the pdf file). Here’s a link to the material: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7177094/pdf/main.pdf
It is understandable that physicians and blood bank administrators may find this somewhat disconcerting, wondering what sense it makes to prohibit transfusion of plasma (FFP) but not cryosupernatant, given that cryosupernatant is approximately 99% of FFP (the remaining 1% is the Cryoprecipitate AHF).
AJWRB suggests physicians and blood bank administrators look beyond the disconcert and find a way to use this information to help JW patients fighting COVID-19, particularly since this virus is reportedly taking a heavy toll among JW’s. We know of cases where some members are refusing convalescent plasma at the direction of JW family members, or some WT representatives who lack a complete understanding of the religion’s policy.
It is highly unlikely the WT organization will advertise to the larger medical community, much less their members, that this fractionated plasma product (cryo-depleted plasma or cryo-supernatant) is permissible. This is because it focuses attention on the absurdity of the policy. However, when pressed about the matter, they will inform providers, and JW patients that a JW can accept it as a “matter of personal conscience”.
Implementing this treatment will likely require cooperation with a blood bank processing convalescent plasma to take the additional step of separating the plasma into the separate products of cryoprecipitate and cryosupernatant. It may be necessary for the physician to advocate on behalf of their patient. However, this additional step has the potential to save hundreds, if not thousands of JW lives, including underage minors who have no option but to accept their parent’s religious beliefs.
Due to Watchtower’s numerous technical changes to its policy, and failure to educate its members, most JWs will not realize their religion’s teaching on blood permits them to accept cryosupernatant. However, the WT’s diagram and references below demonstrate this is, in fact, the case; hence we encourage doctors to try to find a way to use this information to help JW patients fighting for their lives.
Additional verification, if needed, can be provided through local HLC (Hospital Liaison Committee) elders or JW’s H.I.S. (Hospital Information Services). https://www.jw.org/en/medical-library/hospital-liaison-committee-hlc-contacts/united-states/
The following references (1-5) document that the religion of JW’s does not prohibit the use of cryosupernatant or cryoprecipitate when used in place of plasma therapy:
1. The Care of the Cardiothoracic Surgical Patient Refusing Transfusion, by Steven E. Hill, MD, published in Medically Challenging Patients Undergoing Cardiothoracic Surgery, Edited by Neal H. Cohen, MD by Society of Cardiovascular Anesthesiologists (2009).
2. Informed Refusal — The Jehovah’s Witness Patient, by James M. West, MD, published in Clinical Ethics in Anesthesiology by Cambridge University Press (2011).
3. Lockart et al, Acceptance of Cryoprecipitate and Cryosupernatant By Adult Jehovah’s Witness Patients After Informed Consent, Transfusion, 2012, Vol. 52, p 113a. (This study was conducted in conjunction with The Duke Center for Blood Conservation which is a consult service to provide informed consent for blood components and fractions specifically to Jehovah’s Witness patients.)
4. Cichon et al, Use of Cryosupernatant in Medical Management of Perioperative Jehovah’s Witnesses Patients: A Review of 2 Cases, Arch Pathol Lab Med, Vol 136, September 2012, p 1077.
(One of the Jehovah’s Witnesses in this review accepted transfusion of 5 units of cryosupernatant. The product was transfused prior to surgery to correct coagulopathy.)
5. Ming et al, Successful Management of Thrombotic Thrombocytopenic Purpura in a Jehovah’s Witness: An Individualized Approach With Joint Decision-Making, Journal of Patient Experience, 2020, Vol. 7(1) 8-11.
6. Bertolini et al, Production of Plasma Proteins for Therapeutic Use (2012), pp 424, 455, 466.
7. El-Ekiaby et al (2015), Minipool Caprylic Acid Fractionation of Plasma Using Disposable Equipment: A Practical Method to Enhance Immnoglobulin Supply in Developing Countries, PLoS – Negl Trop Dis, 9(2): e0003501. Doi:10.1371/journal.pntd.0003501.