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Watchtower Blood Policy Changes

The June 15, 2000 Watchtower presents a “Questions From Readers” article that has a direct bearing on the work of AJWRB and that represents a historic shift in the Watchtower Society's (WTS) blood policy. We believe that it is imperative that every Jehovah's Witness carefully consider the implications of these changes.

The article presents what appear as subtle changes but upon closer examination reveal very significant reforms. The revised policy continues to prohibit JWs from accepting any of the “primary” components of blood, namely red cells, white cells, platelets and plasma. This policy lacks any meaningful basis for a Christian since the bible does not define what a primary or secondary component of blood is and seems to reflect the fact that blood banks commonly separate blood in this manner. It must be noted, however, that many of the blood components permitted by the WTS are considered to be major or primary by doctors and scientists.

Perhaps most interesting is the fact that the article goes on to state that:

"...when it comes to fractions of any of the primary components, each Christian, after careful and prayerful meditation, must conscientiously decide for himself." [1]
The statement is subtle and some JWs will initially miss its importance. Nevertheless, it signals an important shift in that JWs may now conscientiously accept any blood product that is fractionated from the WTS list of “primary” components. Previously, JWs had permission from the WTS to accept fractions of blood plasma such as albumin, immunoglobulins, fibrinogen and clotting factors. See our discussion of WTS permitted blood components and our database of Watchtower quotes to research and confirm what the WTS previous positions have been on the use of blood components that are now permitted. 

The new policy will  permit JWs to accept blood fractions of previously prohibited cellular components, namely red cells, white cells and platelets. The article gives examples of interferons and interleukins from white cells and a wound healing factor from platelets. Regarding those fractions, the article states:

"Such therapies are not transfusions of those primary components; they usually involve parts or fractions thereof. Should Christians accept these fractions in medical treatment? We cannot say. The Bible does not give details, so a Christian must make his own conscientious decision before God." [1]
The careful reader will notice that the above statement implies that the Bible does give details regarding the use of red cells, white cells, platelets and plasma. Clearly it does not. In any event, the new policy will open the door to JWs accepting many additional blood products and eventually blood substitutes that are hemoglobin based.

For any who might question whether or not this is in fact a change in policy, we direct your attention to the comments of Richard Bailey and Tomonori Ariga of the Hospital Information Services of the WTS who in 1998 wrote to a journal for the researchers of blood substitutes as follows[3]:

"Based on this religious understanding, Jehovah's Witnesses do not accept whole blood, or major components of blood, namely, red blood cells, white blood cells, platelets and plasma. Also they do not accept hemoglobin which is a major part of red blood cells....According to these principles then, Jehovah's Witnesses do not accept a blood substitute which uses hemoglobin taken from a human or animal source." [2]
We believe this single change in policy could potentially reduce the death toll among JWs by one half once the blood substitutes become commercially available in most countries. AJWRB is very pleased by this development although we are concerned about the level of confusion among both JWs and the medical community since the WTS in typical fashion has endeavored to make this change in a manner that is designed to not alert the membership and provide their Public Affairs office with some basis for plausible deniability once the media begin to catch on.

It bears noting that the new policy probably raises more questions than it answers. For example, although blood plasma remains banned as one of the WTS "primary" components, what about (FFP) or fresh frozen plasma which is produced after the secondary fractionation of platelet rich plasma then frozen within eight hours. Technically, the process of secondary fractionation, freezing and thawing could qualify FFP as a secondary fraction. To further complicate matters, a new blood product called SD Plasma, see the Consumer Reports article, undergoes much more extensive processing in addition to that mentioned above. For example, after secondary fractionation of platelet rich plasma it undergoes solvent detergent treatment, hydrophobic chromatography and filtration. Could a JW accept SD plasma if he were to conclude that it is a secondary fraction of blood plasma, especially in light of the fact that JWs accept albumin, fibrinogen and the clotting factors which are the remaining primary elements of SD Plasma?

One must wonder how quickly the WTS will move to update their blood brochure, medical power of attorney forms and advance directives. How many Jehovah's Witnesses will end up rejecting potentially life saving therapies due to confusion over this extremely complex blood policy. Even AJWRB with its team of doctors and WTS blood policy specialists is left in a state of confusion on some of these issues. Where does this leave the average JW who will give little thought to these complex issues up until such time as an emergency arises?

There are new ethical issues to be considered as well. With more and more Jehovah's Witnesses accepting blood products one must wonder how the WTS can continue to justify a policy that effectively prohibits JWs from donating blood or blood plasma. The combined demands of a group of six million people on the blood supply must be staggering, even if they are only accepting blood components or fractions.

AJWRB will be pursuing various means to advise the medical community, the JW community and the general public of these changes and their implications. Additionally,  we will continue to advance our agenda of reform so that eventually all Jehovah's Witnesses will have a free choice in their medical treatment without controls or sanctions from the WTS or member congregations.

The June 15, 2000 Questions From Readers article is presented in its entirety at the conclusion of this article.

We are receiving a number of responses from various  individuals to these developments and have set up a special section where you can view these responses. Please feel free to forward your comments to us at: info@ajwrb.org
and advise us if you require anonymity.

1 Watch Tower Bible and Tract Society. Questions From Readers. The Watchtower 2000; June 15:29-31.
2  Bailey R, Ariga T. The view of Jehovah's Witnesses on blood substitutes. Artif Cells Blood Substit Immobil Biotechnol 1998;26:571-576.



Dateline June 15, 2000
 
 
Danish television carried a news story on the changes introduced by the June 15, 2000 Watchtower and interviewed WTS spokesman Tommy Jensen. The story was reported on news channel dr1 on  June 6, 2000. An English transcript of the program follows below.

(Speaker Sten Bostrup):

Jehovah’s Witnesses are now permitting their members to receive blood during operations and doctors estimate that it will save human lives.

(Female speaker):

As late as in 1996 a 24 year old woman died because she refused to receive a blood transfusion during a delivery. The woman was one of Jehovah’s witnesses and according to her belief, she was not allowed to receive any blood. A similar situation can be avoided in the future. Now, it is possible to derive fractions from blood and Jehovah’s witnesses will leave it up to each individual Witness to decide whether they will receive transfusions with this or not. Consulting physician Henning Sorensen believes that it is going to save human lives.

(Consultant physician Henning Sørensen):

People have died because they were not allowed to receive blood transfusions. Some have died because of hemorrhaging and similar cases will probably be prevented with the aid of these substances. Yes, it will be possible to save human lives.

(Female speaker):

According to the Bible, Jehovah´s Witnesses are not allowed to receive blood from another person, but a new product derived from the hemoglobin from the red blood cells has been accepted by the religious community, anyway. The red blood cells are important because they are aiding the oxygen to circulate inside the body and now it is also up to each individual Jehovah´s witness to decide if they will receive treatment with this product. Jehovah’s Witnesses do not wish to decide whether it is real blood or not.

(TOMMY JENSEN, WATCHTOWER SOCIETY, HOLBÆK):

AS A RELIGIOUS COMMUNITY, JEHOVAH`S WITNESSES DO NOT DECIDE ON THE MATTER OF WHETHER HEMOGLOBIN WHICH IS DERIVED FROM THE RED BLOOD CELLS AND IF IT IS BLOOD IN THE BIBLICAL SENSE AND THEREFORE INCLUDED IN THE  BIBLICAL COMMANDMENT, BUT IT IS A QUESTION FOR EACH INDIVIDUAL TO DECIDE.

(Female speaker):

Jehovah’s witnesses do not consider it to be bending any of the biblical rules, when the members are now allowed to decide for themselves whether they will receive treatment with this new product or not.

(TOMMY JENSEN, WATCHTOWER SOCIETY, HOLBÆK):

YES, IT IS DERIVED FROM BLOOD AND BLOOD CONSISTS OF SO MANY THINGS -WATER, SALTS AND MINERALS, ETC.; AND WHEN WE ARE MAKING FRACTIONS OUT OF IT OR SEPARATING IT DOWN TO VERY SMALL ELEMENTS, SO BIT BY BIT, IT IS NOT BLOOD ANYMORE, AND WE CANNOT AS A RELIGIOUS COMMUNITY DECIDE WHETHER IT IS BLOOD OR NOT.

(Consultant physician Henning Sørensen):

It is splitting hairs, BUT IT IS HEMOGLOBIN AND IT IS A PART OF THE BLOOD, and it originates from blood when it is taken out, SO IT IS BLOOD; and this is the manner in which we detect blood by detecting the hemoglobin.

(Speaker Sten Bostrup):

There are about 15,000 Jehovah’s witnesses in Denmark.


June 15, 2000 - Questions From Readers
 

Do Jehovah's Witnesses accept any medical products derived from blood?

The fundamental answer is that Jehovah's Witnesses do not accept blood.  We firmly believe that God’s law on blood is not open to reform to fit shifting opinions. Still, new issues arise because blood can now be processed into four primary components. In deciding whether to accept such, a Christian should look beyond possible medical benefits and risks. His concern should be what the Bible says and the potential effect on his relationship with Almighty God.

The key issues are quite simple. As an aid to seeing why that is some consider some Biblical, historical, and medical background.

Jehovah God told our common ancestor Noah that blood must be treated as something special. (Genesis 9:3,4) Later, God’s laws to Israel reflected the sacredness of blood: “As for any man of the house of Israel or some alien resident…who says any sort of blood, I shall certainly set my face against the soul that is eating the blood.” By rejecting God’s law, an Israelite could contaminate other; thus, God added: “I shall indeed cut him off from among his people.” (Leviticus 17:10) Later, at a meeting in Jerusalem, the apostles and older men decreed that we must ‘abstain from blood.’ Doing so is as vital as abstaining from sexual immorality and idolatry. – Acts 15:28,29.

What would “abstaining” have meant back then? Christians did not consume blood, whether fresh or coagulated: nor did they eat meat from an unbled animal. Also ruled out would be foods to which blood was added, such as blood sausage. Taking in blood in any of those ways would violate God’s law. – 1 Samuel 14:32, 33.

Most people in ancient times would not have been troubled over the consuming of blood, as we can see from the writings of Tertullian (second and third centuries C.E.). Responding to false charges that Christians consumed blood, Tertullian mentioned tribes that sealed treaties by tasting blood. He also noted that “ when a show is given in the arena, [some] with greedy thirst have caught the fresh blood of the guilty…as a cure for their epilepsy.”

Those practices (even if some Romans did them for health reasons) were wrong for Christians: “We do not include even animals’ blood in our natural diet,” wrote Tertullian. The Romans used food containing blood as a test of the integrity of real Christians. Tertullian added: “Now, I ask you, what sort of a thing is it, that when you are confident [that Christians] will turn with horror from animals’ blood, you should suppose them greedy for human blood?”

Today, few people would think that the laws of Almighty God are at issue if a physician suggested their taking blood. While Jehovah’s Witnesses certainly want to keep living, we are committed to obey Jehovah’s law on blood. What does this mean in the light of current medical practice?

As transfusions of whole blood became common after World War II, Jehovah’s Witnesses saw that this was contrary to God’s law – and we still believe that. Yet, medicine has changed over time. Today, most transfusions are not of whole blood but of one of its primary components: (1) red cells; (2) white cells; (3) platelets; (4) plasma (serum), the fluid part. Depending on the condition of the patient, physicians might prescribe red cells, white cells, platelets, or plasma. Transfusing these major components allows a single unit of blood to be divided among more patients. Jehovah’s Witnesses hold that accepting whole blood or any of those four primary components violates God’s law. Significantly, keeping to this Bible-based position has protected them from many risks, including such diseases as hepatitis and AIDS that can be contracted from blood.

However, since blood can be processed beyond those primary components, questions arise about fractions derived from the primary blood components. How are such fractions used, and what should a Christian consider when deciding on them?

Blood is complex. Even the plasma – which is 90 percent water – carries scores of hormones, inorganic salts, enzymes, and nutrients, including minerals and sugar. Plasma also carries such proteins as albumin, clotting factors, and antibodies to fight diseases. Technicians isolate and use many plasma proteins. For example, clotting factor VIII has been given to hemophiliacs, who bleed easily. Or if someone is exposed to certain diseases, doctors might prescribe injections of gamma globulin, extracted from the blood plasma of people who already had immunity. Other plasma proteins are used medically, but the above mentioned illustrate how a primary blood component (plasma) may be processed to obtain fractions. *

Footnote: See “Questions From Readers” in The Watchtower of June 15, 1978, and October 1, 1994. Pharmaceutical firms have developed recombinant products that are not taken from blood and that may prescribed in place of some blood fractions used in the past.

Just as blood plasma can be a source of various fractions, the other primary components (red cells, white cells, platelets) can be processed to isolate smaller parts. For example, white blood cells may be a source of interferons and interleukins, used to treat some viral infections and cancers. Platelets can be processed to extract a wound healing factor.  And other medicines are coming along that involved (at least initially) extracts from blood components. Such therapies are not transfusions of those primary components; they usually involve parts or fractions thereof. Should Christians accept these fractions in medical treatment? We cannot say. The Bible does not give details, so a Christian must make his own conscientious decision before God.

Some would refuse anything derived from blood (even fractions intended to provide temporary passive immunity). That is how they understand God’s command to ‘abstain from blood.’ They reason that his law to Israel required that blood removed from a creature be ‘poured out on the ground.’ (Deuteronomy 12: 22-24) Why is that relevant? Well, to prepare gamma globulin, blood-based clotting factors, and so on, requires that blood be collected and processed. Hence, some Christians reject such products, just as they reject transfusions of whole blood or of its four primary components. Their sincere, conscientious stand should be respected.

Other Christians decide differently. They too refuse transfusions of whole blood, red cells, white cells, platelets, or plasma. Yet, they might allow a physician to treat them with a fraction extracted from the primary components. Even here there may be differences. One Christian may accept a gamma globulin injection, but he may or may not agree to an injection containing something extracted from red or white cells. Overall, though, what might lead some Christians to conclude that they could accept blood fractions?

BOX: “SUGGESTED QUESTIONS FOR THE DOCTOR”

If you face surgery or a treatment that might involve a blood product, ask:

Do all the medical personnel involved know that, as one of Jehovah’s Witnesses, I direct that no blood transfusions (whole blood, red cells, white cells, platelets, or blood plasma) be given to me under any circumstances?

If any medicine to be prescribed may be made from blood plasma, red or white cells, or platelets, ask:

Has the medicine been made from one of the four primary blood components? If so, would you explain its makeup?

How much of this blood-derived medicine might be administered, and in what way?

If my conscience permits me to accept this fraction, what medical risks are there?

If my conscience moves me to decline this fraction, what other therapy might be used?

After I have considered this matter further, when may I inform you of my decision? (End of Box)

“Questions From Readers” in The Watchtower of June 1, 1990, noted that plasma proteins (fractions) move from a pregnant woman’s blood to the separate blood system of her fetus. Thus a mother passes immunoglobulins to her child, providing valuable immunity. Separately, as a fetus’ red cells complete their normal life span, their oxygen-carrying portion is processed. Some of it becomes bilirubin, which crosses the placenta to the mother and is eliminated with her body wastes. Some Christians may conclude that since blood fractions can pass to another person in this natural setting, they could accept blood fraction derived from blood plasma or cells.

Does the fact that opinions and conscientious decisions may differ mean that the issue inconsequential? No. It is serious. Yet, there is a basic simplicity. The above material shows that Jehovah’s Witnesses refuse transfusions of both whole blood and its primary blood components. The Bible directs Christians to ‘abstain from things sacrificed to idols and from blood and from fornication’. (Acts 15:29) Beyond that, when it comes to fractions of any of the primary components, each Christian, after careful and prayerful meditation, must conscientiously decide for himself.

Many people would be willing accept any therapy that seems to offer immediate benefit, even a therapy have know health risks, as is true of blood products. The sincere Christian endeavors to have a broader, more balanced view that involves more than just the physical aspects. Jehovah’s Witnesses appreciate efforts to provide quality medical care, and they weight the risk/benefit ratio of any treatment. However, when it comes to products derived from blood, they carefully weigh what God says and their personal relationship with our Life-Giver. – Psalm 36:9.

What a blessing for a Christian to have such confidence as the psalmist who wrote: “Jehovah God is a sun and a shield; favor and glory are what he gives. Jehovah himself will not hold back anything good from those waking in faultlessness. O Jehovah…., happy is the man that is trusting in you”! Psalm 84: 11, 12.



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. Although 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.

CLAY COTHREN, M.D.
ERNEST E. MOORE, M.D.
PATRICK J. OFFNER, M.D.
JAMES B. HAENEL, R.R.T.
JEFFREY L. JOHNSON, M.D.
Denver Health Medical Center
Denver, CO 80204
ernest.moore@dhha.org

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
The following documents were provided to us by a Jehovah's Witnesses elder who was an HLC (Hospital Liaison Committee member) who chooses to remain anonymous for fear of being identified as an apostate and disfellowshipped. These documents clearly show the Watchtower Society's new policy and how it officially permits the use of hemoglobin.



The following document shows just how complex the Watchtower Society's policy on the use of blood has become and why it is necessary to have an entire class of specially trained clergy members (elders) just to interpret the policy. These elders are referred to as HLC or Hospital Liaison Committee members. As you review the next page, remember that this is purportedly a biblical policy - one that is grounded in the Bible. Medical professionals may be able to help their patients think objectively about the validity of such a policy by showing them this Watchtower document and asking them where in the Bible it explains which of these various blood products Christians may accept.