”. . . Abstain from meats offered to idols, and from blood, and from things strangled, and from fornication; from which if ye keep yourselves, ye shall do well . . .” – Acts 15:29
To Jehovah`s Witnesses, this biblical injunction bans blood transfusions during surgery, and members of that religious group have long sought out surgeons who would vow not to give them blood.
Now that the spread of AIDS and hepatitis has raised questions about the purity of the nation`s blood supply, a very small but increasing number of non-Witnesses are doing the same.
This has led to increased business for a few physicians who bill themselves as ”bloodless surgeons.”
Some of these surgeons say that if a patient specifies that he doesn`t want a transfusion, no blood will be given, even if the patient dies. Other surgeons simply go to great lengths to minimize giving blood.
But mainline surgeons say their ”bloodless” brethren just represent an extreme in a medical trend to reduce transfusions and the amount of blood given.
They say that the blood supply is safer than ever and that at least some bloodless surgeons are taking advantage of AIDS fears involving transfused blood.
Dr. Ron Lapin, chief of surgery at the 126-bed Coast Plaza Medical Center in Norwalk, Calif., bills himself as a bloodless surgeon. He said his opposition to transfusions is based on facts, not self-interest.
The outspoken surgeon has alienated many of his colleagues with strong statements, sometimes on TV talk shows, about the practice and safety of transfusions.
For example, Lapin compares transfusions to the bloodletting that was practiced in centuries past, in which doctors thought they were removing
”evil spirits” or ”evil humors” from patients` bodies.
”I don`t believe in bloodletting, and I don`t believe in the phenomenal, voracious appetite for transfusions that exists today,” Lapin said.
Ninety percent of Lapin`s patients are Jehovah`s Witnesses. But with the rise in AIDS and other blood-borne diseases, there are plenty of other reasons besides religious scruples to avoid transfusions, Lapin said.
”The blood-banking industry has been on a campaign to show that blood is safer than ever,” he said. ”I, for one, don`t believe that.”
Lapin said that all surgical patients should be informed of the risks involved in transfusions before giving or refusing consent for the procedure. Blood banks should be held legally responsible when a patient is harmed by a transfusion, he said.
So long as the patient doesn`t oppose it, Lapin approves of transfusions under a few circumstances, such as cancer operations in which a lot of blood is lost, and for accident victims with massive blood loss.
”But I think we should adhere to strict guidelines and look at blood as a desperate, last-stand resort rather than the first approach,” he said.
Most traditional surgeons look with suspicion, even scorn, on physicians who bill themselves as bloodless surgeons.
”We`re always gun-shy of someone who promotes himself as a bloodless surgeon,” said Dr. Mitchell Karlan, a Beverly Hills surgeon who is past president of the Los Angeles County Medical Association. ”That to me is entrepreneurish.
”Any qualified surgeon will do 1,000 hernias or gallbladders and not give any blood. So we can all wear bands on our arms and call ourselves bloodless surgeons.
”If you`re going to a qualified physician who is a board-certified surgeon, the chances are 99 out of 100 that you`re not going to receive any blood for a major procedure.”
Karlan said that not many surgeons will swear to a patient, Jehovah`s Witness or otherwise, that they will let him die rather than give blood.
”A few will say, `Okay, the patient has sworn me to this covenant, and I`ll agree that if they get into problems and will die on the table, I`ll support their beliefs.”
Lapin said this has not happened to him.
”I have not had to face the problem of watching a patient bleed to death on an operating table,” he said. ”Could it happen? Sure it could.”
He said his surgical team has operated on 15,000 patients without needing to give transfusions, and he estimated that 40 percent would have been given blood by standard surgeons.
Lapin said his views on transfusions have caused a radical drop in referrals from other doctors. But Jehovah`s Witnesses come from throughout the United States to have surgery performed by him.
He said he is not a Witness and not affiliated with the church, which claims a membership of about 1 million in the United States.
”But what they stand for makes tremendous scientific sense to me,”
Lapin said.
”We have been around long enough to see that a lot of biblical principles that we sort of laughed at have turned out to make good sense, about cleanliness, about not eating pork because of all of the worms associated with it.
”If patients don`t want blood, it behooves us to try to learn how to work without it.”
Dr. Mohan Roy, a cardiovascular surgeon at La Mirada Medical Center, operates on Jehovah`s Witnesses but does not bill himself as a bloodless surgeon.
After training at the Cleveland Clinic, he moved to California, where he noted that Witnesses were having a hard time finding surgeons.
”I saw that it was not that difficult to operate without transfusions,” he said. ”If you can do surgery without them, why not?
”Every blood bank is trying to screen more and more thoroughly. But
(disease-ridden blood) still slips through. I sometimes see jaundice and hepatitis, and I read reports about people who had heart surgery and developed AIDS.”
Dr. Mitchell Karlan said mainstream surgeons are not ignoring these problems; most try to ”avoid with a passion” giving blood.
Karlan said there has been a ”dramatic drop” in the use of transfusions and the amount of blood used over the last 10 years.
The trend, which began before the AIDS scare, grew out of concerns about the risk of hepatitis and complications from mismatched blood.
Transfusions are needed most often in complex procedures, such as open-heart surgeries, hip replacements or major cancer operations, according to Karlan.
”You may lose 4 or 5 pints of blood in surgery for cancers of the pancreas,” Karlan said. ”In those situations, you have to set a limit as to what is acceptable to you and your patients, as to how low you allow that blood count to drop.”
But Dr. Stephen Kleinman, medical director of the Los Angeles regional Red Cross blood bank, said the trend in blood use is a complicated issue.
”In more routine surgeries, the amount of blood used per patient has gone down,” Kleinman said. ”Physicians are using better surgical techniques. ”I think the general physician, when faced with the decision whether to transfuse a patient who is not in shock or not losing blood, is probably more conservative than he was five years ago. He`s willing to let the hemoglobin level go lower than he might have then. And I think that`s a good thing.”
But the amount of blood that blood banks collect for hospitals has not been reduced, Kleinman said.
