Bloodless surgery growing more common
Fairview and St. Vincent hospitals use technique for a range of patients
Saturday, July 01, 2006
Plain Dealer Reporter
Brenda Landsdowne needed a series of surgeries that would have involved massive blood loss.
But, the 50-year-old Youngstown resident is a Jehovah’s Witness and interpretation of scripture meant she could not consume blood in any way, including a transfusion.
Twenty years ago she probably would have died from blood loss during surgery. But through technological advances and “bloodless” surgery, doctors removed Landsdowne’s bladder as well as multiple tumors. Less than three months later, she’s back at work.
“It was a very, very complicated surgery and I never would have been able to survive without it,” she said.
Landsdowne’s surgery at Fairview Hospital didn’t require a drop of donated blood.
The techniques were pioneered in the late 1970s and early ’80s amid pressure from Jehovah’s Witnesses, doctors attempting to accommodate their patients’ religious beliefs yet live up to their Hippocratic oath, and the early HIV/AIDS hysteria over blood transfusions.
The surgeries are possible because medications such as Procrit and Epogen boost red blood cells before and after an operation. Other special procedures reduce blood loss as well as recycle blood during surgery.
In recent years, bloodless surgeries have been on the rise at Fairview and St. Vincent Charity hospitals, which specialize in the procedure.
St. Vincent was the first hospital in the area to do the surgeries – 54 in 1994, mostly Jehovah’s Witnesses, from all over the country.
Last year there were 352 patients, although Deborah Thomas, director of the Center for Blood Conservation said, “Our numbers are difficult, because we [have treated] all surgeries as if they were bloodless since 2003.”
Jehovah’s Witness Joe Thomas had bloodless surgery at St. Vincent when he was a teenager. Now he is the coordinator of the Center for Advanced Blood Management at Fairview Hospital.
In 2002, 300 patients had bloodless surgeries at Fairview. Last year the number was up to 1,000.
“Ninety percent of the patients we get are not here for religious reasons,” Thomas said.
While this may be true, bloodless surgeries wouldn’t exist if it were not for Jehovah’s Witnesses.
There are over a million Jehovah’s Witnesses in the United States. Ohio has 37,800 – the seventh-largest population.
Pointing to scripture in Acts, Leviticus and Deuteronomy that instructs against eating or drinking blood, the interpretation has resulted in a ban against accepting blood transfusions.
Jehovah’s Witnesses formed hospital liaison groups, which exist all over the world; in Ohio there are six. Art Flynn, chairman of the Cleveland branch, describes them as “individuals who work with the hospitals and our members and make sure they get the religious and medical support they need.”
But as Thomas noted, as local and national numbers have gone up, people of all religious denominations have been getting them done as well.
“The reaction four or five years ago was ‘I’ve never heard of it’ – ‘I’m not sure.’ Today it’s ‘I’ve heard something about this. Tell me more.’ ” said Dr. Richard Treat, medical director of the Center for Advanced Bloodless Medicine and Surgery at Fairview.
One such person is Selma Drake. The 74-year-old Baptist East Clevelander had never had surgery, but she needed a new hip. Her doctor suggested bloodless surgery at St. Vincent.
She began medications in April, a month before her surgery. The operation went smoothly.
“I thought they were nice about it – letting me use my own blood,” she said.
Science and religion intersect frequently and controversy often arises. In this situation though, Jehovah’s Witnesses have contributed to modern medicine in a way that could potentially benefit everyone.
“It’s a peculiar interpretation of a single line of scripture but in an ironic sort of way, I think they’ve done us a service,” said Dr. Stephen Post, professor of bioethics at Case Western University, referring to the mention of consumed blood in Acts.
The health benefits are less clear. The blood supply is, for the most part, well regulated and safe. While everyone can agree that avoiding a blood transfusion is positive – transfusions occasionally overwhelm the immune system – no major scientific studies prove that these surgeries are necessarily better.
“I support their efforts,” said Dr. James AuBuchon, chair of pathology at Dartmouth-Hitchcock Medical Center. “They were beneficial. Whether or not that leads to improved patient outcome remains to be documented.”
While the health benefits may be contested, the financial ones are clear. At $500 to $600 a unit, and with major surgery requiring from two to four units, bloodless surgeries saved Fairview Hospital $600,000 last year.
An estimated 7,000 to 8,000 hospitals do the surgeries, but only a couple hundred have specifically funded programs like Fairview’s and St. Vincent’s.
“Most major hospitals do engage in bloodless surgeries,” AuBuchon said. “Most doctors follow the mind-set that if bleeding can be avoided then it should be. In many ways, this has become a marketing effort, a way for hospitals to distinguish themselves.”