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Anaesthesia. 2019 Jan;74(1):74-82. doi: 10.1111/anae.14441. Epub 2018 Sep 30.

Association of Anaesthetists: anaesthesia and peri-operative care for Jehovah's Witnesses and patients who refuse blood.

Author information

Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK and Chair, Working Party, Association of Anaesthetists.
Anaesthetic Department, Guys and St. Thomas' NHS Foundation Trust, London, UK and Association of Anaesthetists Council Member.
Haematology, NHS Blood and Transplant, and Newcastle upon Tyne NHS Foundation Trust, Newcastle, UK.
Northern School of Anaesthesia and Intensive Care Medicine, UK and Group of Anaesthetists in Training (GAT) Committee Member.
Department of Anaesthesia, Royal Infirmary of Edinburgh, and Royal College of Anaesthetists Representative, Edinburgh, UK.
London, UK.
Honorary Research Lecturer, University of Manchester, Wellcome Trust Research Fellow, Kings College London, UK.
Hospital Liaison Committee for Jehovah's Witnesses, Cambridge.
Department of Anaesthesia and Intensive Care, Freeman Hospital, Newcastle upon Tyne and Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI) representative.
Liverpool Vascular and Endovascular Service, Liverpool,UK and School of Physical Sciences, University of Liverpool and Royal College of Surgeons representative.
Hospital Information Services for Jehovah's Witnesses, London.


There are approximately 8.5 million Jehovah's Witnesses and around 150,000 live in Great Britain and Ireland. Based on their beliefs and core values, Jehovah's Witnesses refuse blood component transfusion (including red cells, plasma and platelets). They regard non-consensual transfusion as a physical violation. Consent to treatment is at the heart of this guideline. Refusal of treatment by an adult with capacity is lawful. The reasons why a patient might refuse transfusion and the implications are examined. The processes and products that are deemed acceptable or unacceptable to Jehovah's Witnesses are described. When a team is faced with a patient who refuses transfusion, a thorough review of the clinical situation is advocated and all options for treatment should be explored. After discussion, a plan should then be made that is acceptable to the patient and appropriate consent obtained. When agreement cannot be reached between the doctor and the patient, referral for a second opinion should be considered. When the patient is a child, the same strategy should be used but on occasion the clinical team may have to obtain legal help.


assault; consent; peri-operative care; transfusion


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