By Dennis Oda, Star-Bulletin
Dr. Jeffrey Lee explains to Jehovah'sWitnesses about
a new program at St. Francis Hospital that allows
heart-bypass surgery without using blood transfusions.
He stands next to a machine called the pleur-evac
that saves the patient's blood during an operation.
St. Francis offers
The technique should ease theBy Mary Adamski
trauma for Jehovah's Witnesses
The prospect of open heart surgery is frightening for anyone, but for a member of the Jehovah's Witnesses faith, the emotional trauma is escalated because the routine procedure of a blood transfusion violates religious belief.
The religion and medical science have clashed in emergency rooms and courts on the subject, but last night they were in a state of truce as St. Francis Medical Center chose to invite Jehovah's Witnesses to its public unveiling of a new "bloodless" heart surgery program.
A patient's blood loss -- and the need for transfusion -- is halved by the state-of-the-art procedure which has been used for heart bypass surgery on 41 people in Hawaii since May, said Dr. Jeffrey D. Lee, a cardiovascular surgeon. St. Francis is the first hospital in Hawaii to use the 2-year-old procedure, which is done in 70 medical centers on the mainland and was recently featured in a Life magazine cover story.
Aided by the new technology, St. Francis is committed to observing the Jehovah's Witnesses belief, said James Wille, director of the heart center and surgical services.
"Being a Catholic institution, we are well aware of sensitivity to religious beliefs," he said.
The "off pump" process changes the 30-year technique of bypass surgery. That involves stopping the heart during surgery and pumping the blood through a heart-lung machine while blood vessels from a person's leg are sewn onto the heart to bypass clogged arteries.
Lee explained that in the new procedure, only the area being worked on is stilled while "the rest of the heart beats merrily away."
Blood is recycledLee spearheaded the establishment of the "minimally invasive" program that uses "pneum-evac" machinery, which drains blood that leaks during surgery and continuously recyles it back into the body. The standard procedure has been to evacuate the leaked blood and discard it.
He said that the new surgery is safer, with less chance of post-surgery strokes or damage to the lungs or kidneys because the blood itself is not damaged through the process of rapid pumping through the artificial lung. The less-invasive method leads to a shorter hospital stay. Compared to 47 percent of open heart patients, 23 percent of the people in the new procedure were given blood transfusions.
Another facet of the program is drug therapy. Ideally a candidate for bloodless surgery will have at least five days to prepare by taking epogen, which stimulates the blood to create new red cells.
The bloodless protocol at St. Francis will also include taking smaller blood samples from Jehovah's Witnesses. Wille displayed the smaller tubes used for children, compared to the adult laboratory tubes. In addition, he said, each page of a church member's medical record will be stamped with a large "bloodless" instruction and the cover will be a different color than other medical files.
Lee, who came to Hawaii last year after coronary surgery training at Cornell Medical Center in New York, studied the procedure there. He credited Norman Arakaki of the Jehovah's Witnesses with sparking the idea of starting "bloodless" heart surgery here.
Arakaki, one of several members of the church's hospital liaison committee, said he routinely writes to Hawaii physicians and surgeons "looking for a doctor willing to treat Jehovah's Witnesses." Liaison committee members routinely intervene on behalf of believers. "Some of our members are not as well versed in the Bible, so we speak for them with their doctors.
"We'd rather have cooperation than confrontation," Arakaki said.
By Dennis Oda, Star-Bulletin
Norman Arakaki shakes Dr. Jeffrey Lee's hand, thanking
him for explaining the non-transfusion procedure for
bypass operations. At center is Russell Oshiro.
Doctor describes guidelinesDr. Whitney Limm, a transplant surgeon, described the guidelines followed for every patient. "In the case of Jehovah's Witnesses, we just don't give any blood." Limm said the ideal will be to have four to six weeks of the epogen drug use before surgery.
"In emergencies, we do what we can to minimize blood loss. It has been in emergency cases where there has been a bad outcome in Jehovah's Witnesses cases," Limm said.
Lee said that at Cornell, "we had Jehovah's Witnesses coming into the operating room with the surgeon. The most important thing is cooperation."
Church members have suedControversy over blood transfusions has led some doctors and hospitals to decline Jehovah's Witnesses as patients. Church members have sued over being forced to receive transfusions, with mixed decisions in various courts. Local church leaders said they know of no local court case over a forced transfusion.
"If it was forced, it is as if we were raped," said Eric Anderson, of the church's information office. A church member who decides to have a blood transfusion faces possible excommunication or "dis-fellowship." Anderson said that would be decided on an individual basis depending on the circumstances.
He said the basis for the belief is New Testament language, in Acts of the Apostles, Chapter 15, verses 28 and 29. It quotes a letter from the early Christian leaders in Jerusalem to new non-Jewish members telling them that they would not have to observe Jewish practices. But, it says "you are to abstain from food sacrificed to idols, from blood, from the meat of strangled animals and from illicit marriages. Avoid these and you will do what is right."
In the past, blood transfusions "were considered the answer," said Lee. "Then when AIDS and other infectious diseases (transmission through blood) came out, it appears you are certainly justified in this," he told the crowd.
Jehovah's Witness Russell I. Oshiro said, "Our main concern is the integrity of the program, that our belief will be respected in all circumstances."