Treating JW's with Convalescent Blood Products

by Lee Elder 6 Replies latest watchtower medical

  • Lee Elder
    Lee Elder

    AJWRB has just published a new article on an alternative treatment for Jehovah's Witnesses with Covid-19 using a convalescent blood product permitted by the Watchtower Society's policy. This is potentially life saving information. Please spread the word.

    Treating Jehovah’s Witness COVID-19 Patients with Convalescent Blood Products

    by Lee Elder | May 11, 2020 | Medicine, Science, Watchtower | 0 comments

    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. (

    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:

    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).

    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.

  • Diogenesister

    Thank you so much for all your hard work Lee Elder and all at AJWRB . I will attempt to get a copy of this article to my local hospital which is a designated national Covid19 hospital.

    I will also try my best to email it to the elders based at my local kingdom hall.

    Once again, thank you. I'm not sure if this particular therapeutic is widely used in the UK yet (maybe someone can tell me) but regardless it's important to keep the needs of witnesses in the minds of our local emergency medicine policy makers.

  • snare&racket

    Interesting, but I see many obstacles.

    Firstly, just something that immediately stood out as unsubstantiated, there is no evidence that COVID 19 is " reportedly taking a heavy toll among JW’s." Be careful what you write if you want to be taken seriously, especially right now. The virus has likely genetic prejudices, but non faith based.

    The biggest issue "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..."

    As someone that interacts with blood bank often, this is an absurd ask. Requesting blood bank to alter the plasma is wildly unlikely, you mention it, as a casual request, It would need it's own testing/screening process before it could be used as a treatment in COVID 19.

    JW's arrive with pre-filled advanced directives with what they will accept and any attempt at the bedside to discuss biology/medicine often goes exactly as you imagine it would.

    The patients requiring this treatment are tending to arrive incredibly unwell and require acute intubation, leaving their treatment options to the NOK to decide. The blood/blood product debacle of the JW's is difficult to comprehend and dissect at the best of times, in an emergency, it is unlikely to bend, especially via the NOK who will not want to break the religious confidences of their sick loved one.

    I think your motives and efforts are admirable, to ask people to disseminate this to hospitals is ill advised however.

    The autonomy of the individual trump's all. They will accept and decline treatments as per their conscience. Hospitals have HLC's that JW's may opt to introduce into their care is they so wish. I would never advocate that they introduce untrained, unqualified religious figures to aid in clinical decision making, Informed autonomy should be patient based and it is for the patient to research and decide ALWAYS, if having capacity.

    Me telling a patient what they can and can't have as per doctrine, is no different to WT telling them what they can and can't have. It is a doctrinal game I would never play.

    At the end of the day, JW's are not interested in the biology, the medicine, the science. They are only interested in what WT say's is true and acceptable.

    I am not WT.

    The hospitals are not WT

    Write to WT if you want them to discuss this with JW's. Doctors are not ministers and hospitals will never take on the roll of religious advisors. You are asking that we try to convince using WT literature that they can have a product (not yet provided anywhere) even if they think they can't.

    Isolated cases may prove fruitful but in the middle of a pandemic, this is not the duty of an already stretched healthcare system.

  • BluesBrother

    Excellent, Bro Lee Elder and the team.

    This information has the potential to really save lives. It does highlight the silliness of the WT policy. They really muddied the waters when they added the doctrine of fractions ...Although there seems little clinical difference between this and Plasma, it could mean all the world to a believing Witness.

    I know of witnesses who are covid positive. If I hear of anyone getting seriously ill, I will provide this information.

  • Lee Elder
    Lee Elder

    To snare&racket:

    The Watchtower reports 872 deaths as of April 30, 2020. It is a very specific number which suggests names and documentation, but granted it is anecdotal.

    When life and death is on the line, it is not an absurd ask in our view. We have been in early discussions with the American Red Cross and they have been receptive. We will be providing additional direction as it becomes available. Hospitals with bloodless programs and their own blood bank should be able to do the additional work to remove the precipitate.

    While I respect whatever your experience with JW's may be. I can tell you that I have personally spoke with dozens of Emergency Department doctors and Anesthesiologists, and many of them have related experiences of JW's changing their minds and accepting blood products. Our experience with NOK does align with yours, however.

    The early reports we have received suggest that convalescent plasma is most effective when given earlier in the course of the disease, well before intubation is required.

    We advocate for patient autonomy, and have for more than 20 years. This is the opposite of what Watchtower seeks. They coerce members to accept policies they don't understand. Generally, when HLC comes along and tells a JW that they can have a certain blood product, they almost always decide to accept it. So whose conscience is really at work in these situations?

    Sadly, it is as Dr. Muramoto, and Dr. Gillion, and I have stated for many years. It falls upon the physician to educate their patient so they can make a truly informed choice about their health.

  • smiddy3

    If there are 872 deaths recorded among Jehovah`s Witnesses then that means their are thousands of JW`s who have contracted the virus around the world and that many have recovered .

    So it is good news if the JW who gets Covid 19 agrees to the treatment it could save many lives.

  • Anony Mous
    Anony Mous

    What's nice about convincing JWs about blood products is that you can always find an article that supports the product they need. The flip flopping and inconsistencies are so great, they've both allowed and disallowed pretty much every product and unless you have a medical and theological degree you wouldn't know how correct or how wrong the logic is.

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