There remains a great deal of confusion regarding whether or not a Jehovah?s Witness may use hemoglobin. This is understandable since hemoglobin is the only component of the prohibited red cell. In fact, the red cell is nothing more than a tiny doughnut shaped bag of hemoglobin.
Additionally, published comments from the Watchtower Society give strong indication that hemoglobin is prohibited. For example:
"Is it wrong to sustain life by administering a transfusion of blood or plasma or red cells or others of the component parts of the blood? Yes!...The prohibition includes "any blood at all." (Leviticus 3:17) - Blood, Medicine and the Law of God, 1961, pp. 13, 14
"?various tonics and tablets sold by druggists show on their labels that they contain blood fractions such as hemoglobin. So it is necessary for one to be alert? if they are to keep themselves ?without spot from the world.??Jas. 1:27." The Watchtower, 9/15/61, p. 557.
"Early in man?s history, our Creator ruled that humans should not eat blood. (Genesis 9:3, 4) He stated that blood represents life, which is a gift from him. Blood removed from a creature could be used only in sacrifice, such as on the altar. Otherwise, blood from a creature was to be poured on the ground, in a sense giving it back to God ...It would be right, of course, to avoid products that listed things such as blood, blood plasma, plasma, globin (or globulin) protein, or hemoglobin (or globin) iron." The Watchtower, 10/15/92 - Questions From Readers. (Italics added)
As recently as 1998 two officials from the Watchtower Society?s "Hospital Information Services" wrote that Jehovah's Witnesses "do not accept hemoglobin which is a major part of red blood cells.... Jehovah?s Witnesses do not accept a blood substitute which uses hemoglobin taken from a human or animal source." Bailey R, Ariga T. The view of Jehovah's Witnesses on blood substitutes. Artif Cells Blood Substit Immobil Biotechnol 1998;26:571-576.
All of this changed, however, in June of 2000 when the Watchtower restructured its blood policy to permit the use of all blood products fractionated from red cells, white cells, platelets and plasma. However, the Watchtower continues to obfuscate its intentions regarding hemoglobin. Sadly, to this date there has been no official notification to the average member that hemoglobin is now permitted.
http://www.ajwrb.org/basics/change.shtmlThinking persons might question why God would change his mind on such issues but Jehovah?s Witnesses are not permitted to seriously contemplate such matters without being identified as weak, doubters, even apostates. Some have been disfellowshipped and are shunned by their Jehovah?s Witness family members for questioning the policy and pointing out the irrational aspects.
The change on the use of hemoglobin is so dramatic that many Jehovah?s Witnesses, even 3 ½ years later, either don?t believe it or are unaware of the change. How can we assist them in understanding the Watchtower?s current policy?
We are providing two tools for you in this regard. The first is an article published by the New England Journal of Medicine and is presented below. It explains how Jehovah?s Witness elders agreed to the use of PolyHeme. (As a side point, this also demonstrates how the average Jehovah?s Witness really does not make informed, conscientious choices about their health care but rather simply follow instructions from Watchtower representatives about what they may or may not accept in the way of blood products).
The second tool we are providing you at this time is a photocopy of the diagram provided to Jehovah's Witness elders who are HLC members. This diagram clearly shows that hemoglobin is now permitted. You may view the document at:
http://www.ajwrb.org/images/hlc1.jpg http://www.ajwrb.org/images/hlc2.jpg
We hope that you will be able to make use of this information to educate others regarding this important change in Watchtower policy. Hemoglobin solutions can save lives and their use among Jehovah?s Witnesses is likely to raise even more troubling questions for the Watchtower and its representatives.
An important question to consider is this: Since a red blood cell is 97% hemoglobin (by dry weight), is it reasonable to conclude that a Jehovah?s Witness who does not have access to PolyHeme or Hemopure should have to sacrifice their life simply because they only have access to red cells? Does God really condemn them as willfully wicked and worthy of eternal destruction because they chose to accept the other 3% (red cell membrane)? Where is any of this explained in the Bible? If a Jehovah?s Witness permits their child to die rather than accept this membrane material, is it logical that God accepts such an explanation?
We hope this information will be of some assistance to you as you endeavor to educate other Jehovah?s Witnesses and the medical professionals who provide their care.
Blood Substitute and Erythropoietin Therapy in a Severely Injured Jehovah?s Witness
To the Editor:
Since a 1945 church decision, Jehovah?s Witnesses have refused blood transfusions, even in cases of life-threatening hemorrhage. As a result, physicians need to be aware of alternative therapeutic options for Jehovah?s Witnesses.A 44-year-old Jehovah?s Witness was injured in a motor vehicle collision. She sustained a temporal subarachnoid hemorrhage; an orbital tripod fracture; facial lacerations, which were closed urgently for hemostasis; bilateral pulmonary contusions; three rib fractures; and a grade 1 splenic laceration. She was hemodynamically stable, and the initial hemoglobin level was 11 g per deciliter. When the hemoglobin
level fell to 5.4 g per deciliter, the family and church elders agreed to the use of erythropoietin and PolyHeme, a polymerized hemoglobin-based blood substitute derived from outdated human red cells (Northfield Laboratories, Evanston, Ill.). 1 The patient?s own hemoglobin level fell to 3.2 g per deciliter three days after the injury (Fig. 1). A total of five PolyHeme units (500 ml per unit, containing 50 g of hemoglobin) were transfused. These transfusions maintained the plasma hemoglobin level at 6 g per deciliter
or higher. Erythropoietin (600 units per kilogram of body weight) was administered 24 and 48 hours after the
injury, with 300 units per kilogram given on days 3, 4, and 5. Blood loss was diminished by hormonally suppressing the patient?s menstrual cycle and limiting phlebotomy with the use of pediatric-size tubes. The patient received enteral and intramuscular iron, supplemental ascorbic acid, and parenteral nutrition. She was discharged home, after surgical repair of her orbital fracture, on day 19 after the injury, with a hemoglobin level of 9.8 g per deciliter.
Few patients can survive a hemoglobin level of less than 5 g per deciliter without transfusion.
2,3 Blood substitutes are an attractive alternative to standard blood transfusion for Jehovah?s Witnesses. 1,4,5 Blood substitutes provide adequate oxygen-carrying capacity and can act as a bridge until bone marrow production compensates for the loss of red cells. Exogenous erythropoietin stimulates red-cell production. Al-though the optimal dose of erythropoietin in a critically ill patient remains to be established, our empirically chosen high dose was associated with a rapid response. Combination therapy with erythropoietin and PolyHeme may be particularly useful in the case of a critically ill Jehovah?s Witness.
C
LAY C OTHREN , M.D.E
RNEST E. M OORE , M.D.P
ATRICK J. O FFNER , M.D.J
AMES B. H AENEL , R.R.T.J
EFFREY L. J OHNSON , M.D.Denver Health Medical Center
Denver, CO 80204
[email protected]1.
Gould SA, Moore EE, Hoyt DB, et al. The first randomized trial of human polymerized hemoglobin as a blood substitute in acute trauma and emergent surgery. J Am Coll Surg 1998;187:113-22.2.
Brimacombe J, Skippen P, Talbutt P. Acute anemia to a haemoglobin of 4 g.l-1 with survival. Anesth Intensive Care 1991;19:581-3.3.
Kale PB, Sklar GE, Wesolowicz LA, DiLisio RE. Fluosol: therapeutic failure in severe anemia. Ann Pharmacother 1993;27:1452-4.4.
Gould S, Sehgal L, Sehgal H, Toyooka E, Moss G. Clinical experience with human polymerized hemoglobin. Transfusion 1993;33:Suppl:60S. abstract.5.
Johnson JL, Moore EE, Offner PJ, Haenel JB, Hides GA, Tamura DY. Resuscitation of the injured patient with polymerized stroma-free hemoglobin does not produce systemic or pulmonary hypertension. Am J Surg 1998;176:612-7.Correspondence Copyright © 2002 Massachusetts Medical Society.
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N Engl J Med, Vol. 346, No. 14 · April 4, 2002