Erythopoientin for Jehovah's Witnesses

Based on interpretations of biblical scriptures (Verses 28 and 29 in Acts), Jehovah's witnesses believe that humans must not sustain life with other creatures' blood, and they recognize no difference between ingesting blood and taking it into their blood vessels.1,2

When serious blood loss occurs from trauma, surgery, gastrointestinal bleeding, etc, physicians may be faced with the difficult problem of treating patients who are Jehovah's Witnesses while honoring their religious beliefs. Giving blood or blood products to sustain life may save the patients life, but Jehovah's Witnesses believe that it may ultimately destroy their soul.

P> The Drug Information and Pharmacy Resource Center has received several questions about using erythropoietin (EPO) in Jehovah's Witnesses. EPO is an endogenous hormones produced primarily by the kidneys that stimulates the bone marrow to produce red blood cells in response to hypoxemia. Using recombinant DNA technology, exogenous EPO is now commercially available and is routinely used to treat anemia in predialysis patients, patients with end-stage renal failure, and patients infected with HIV with anemia related to zidovudine therapy. In patients who are Jehovah's Witnesses, EPO has been proposed as an alternative to administering blood products to replace lost blood or to increase their vascular volume before elective surgery.2-5 EPO has been useful in the Jehovah's Witnesses reported in the literature in whom it has been used instead of blood or blood products.

P> There is an issue that has created some debate. In each vial of EPO contains a small amount (ie, 2.5 mg) of human albumin, a blood product, as a carrier protein to prevent adsorptive losses of EPO. 2,6 There is no form of EPO available in this country that does not contain this small amount of albumin. The controversy is whether this small amount of albumin makes the use of exogenous EPO unacceptable in Jehovah's Witnesses.

P> There is no definitive answer to this question. Before treating a Jehovah's Witness with EPO, it must be considered whether it is acceptable to them. The patient or their family may wish to consult their religious leaders for guidance. The Watchtower Society's Bible Information Services has stated that the use of EPO should not objectionable in Jehovah's Witnesses who receive treatment with EPO because this synthetic hormone is a product of recent technology. There might, however, be some individual Jehovah's Witnesses who would find it unacceptable to use a solution that contains albumin. Each individual must decide if it is appropriate.

REFERENCES

ol> LI>Thompson HA. Blood transfusions and Jehovah's Witnesses. Tex Med 1989;85:57-9.