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Allowed Blood Components/Procedures

The Watchtower Society (WTS) permits the use of all plasma derivatives. These are concentrates of specific plasma proteins that are prepared from pools (many units) of Plasma. Plasma derivatives are obtained through a process, known as fractionation, developed during World War II, and are heat-treated and/or solvent detergent-treated to kill certain viruses, including HIV and hepatitis B and C. Plasma derivatives include: Factor VIII Concentrate  Factor IX Concentrate  Anti-Inhibitor Coagulation Complex (AICC)  Albumin  Immune Globulins, including Rh Immune Globulin  Anti-Thrombin III Concentrate  Alpha 1-Proteinase Inhibitor Concentrate

Let us consider some of these individually:

Albumin: Blood contains about 2.2 % albumin by volume. As we have seen, leukocytes – which are prohibited – comprise about 1%, many Witnesses are puzzled as to why some larger blood components are permitted and some smaller ones are forbidden. The red blood cell stimulant EPO is an albumin based blood product.1

Albumin is often used to treat burns. A typical treatment for third degree burns (30-50 %) requires 600 grams of albumin. Producing this amount requires about 45 liters of whole blood. How can anyone call this "a small fraction?"

It is also obvious that the blood used to derive albumin is not ‘poured out,’ but stored, which is prohibited for a blood transfusion but permitted in this context. It is of some interest to note the following comment from the Watchotwer:

"While this physician argues for the use of certain blood fractions, particularly albumin, such also come under the Scriptural ban. . - Awake! 09/08/1956 p. 20

The WTS quietly reversed its position on albumin in 1981 leading a number of Jehovah's Witnesses to wonder whether the previous ban on its use was from God or from men. Other blood products commonly used by most Jehovah's Witnesses would include:

Immunoglobulins:Travelers are often injected with cholera vaccine and Jehovah’s Witnesses accept this. A single injection requires 3 liters of whole blood. This blood, again, is donated, stored and processed to produce the WTS approved blood products.

Hepatitis B Immune Globulin (HBIG): Used to treat and prevent Hepatitis B

Tetanus Immune Globulin: (Tetanus Shot)

Rabies Immune Globulin(RIG): Used to treat and prevent rabies.

RhO Immune Globulin (RhoGam): Given to Rh negative mothers to prevent Hemolytic Disease of the newborn in future pregnancies.

Antithrombin III: Used to treat Antithrombin III deficiency.

Human Immune Globulin (HIG): Used to treat and prevent, among other things, Hepatitis A

Hemophiliac preparations (Factor VIII and IX): Effective treatment requires a preparation called factor VIII, which assists in clotting and is made of the pooled blood of many individuals. The WTS has frequently argued that these are small blood fractions. In truth, however, it takes about 9000 kilograms of whole blood to make one 0.1 gram dose of Factor VIII. A person suffering from severe hemophilia typically requires several doses a year.

The Society is not ignorant of this:

"Each batch of Factor VIII is made from plasma that is pooled from as many as 2,500 blood donors." (The Watchtower, June 15, 1985, p. 30)

"Dr. Margaret Hilgartner of the New York Hospital-Cornell Medical Center said: "A severe hemophiliac is exposed to the blood of 800,000 to 1 million different people every year."" (Awake! Oct. 8, 1988, p. 11)

The society ignores these facts when explaining why it allows use of these "small fractions," but cynically emphasizes them when it uses AIDS as propaganda against blood transfusions. Then, of course, it boasts how the blood prohibition protects us from AIDS. But as we see here, Factor VIII is permitted, so the blood prohibition gives no protection to hemophiliacs. This will be further investigated below.

It is bewildering that the WTS society will allow all of the above components to be transfused or injected into a Witnesses patient separately, but if you were to take all of them at once and add water the resultant mix (plasma or FFP) is forbidden. It has been said that this is the equivalent of a doctor telling a patient that he may not eat ham and swiss on rye sandwiches. However, he may take the sandwich apart and eat the separate components of the sandwich.

Cryoprecipitated AHF: The portion of Plasma that is rich in certain clotting factors, including Factor VIII, fibrinogen, von Willebrand factor and Factor XIII. Cryoprecipitated AHF is removed from Plasma by freezing and then slowly thawing the Plasma. It is used to prevent or control bleeding in individuals with hemophilia and von Willebrand’s disease, which are common, inherited major coagulation abnormalities. Its use in these conditions is reserved for times when viral-inactivated concentrates containing Factor VIII and von Willebrand factor are unavailable and Plasma components must be used.

Acceptable Types  of Autologous Blood Transfusion

Use of a heart-lung machine: As we have seen, in a Watchtower article the Society explicitly prohibited pre-operative blood collection for autologous transfusions, but allowed another procedure:

"In a somewhat different process, autologous blood can be diverted from a patient to a hemodialysis device (artificial kidney) or a heart-lung pump. The blood flows out through a tube to the artificial organ that pumps and filters (or oxygenates) it, and then it returns to the patient’s circulatory system. Some Christians have permitted this if the equipment is not primed with stored blood. They have viewed the external tubing as elongating their circulatory system so that blood might pass through an artificial organ. They have felt that the blood in this closed circuit was still part of them and did not need to be ‘poured out.’" (The Watchtower, March 1, 1989, p. 30)

During surgery doctors use blood aspiration with automatic anticoagulant mixing, and the blood is collected into a blood reservoir. It is then drained by gravity into the blood bag, and stored in a lowered position until it is filled. When the blood bag is filled, it is raised to the top of the assembly, and the blood is reinfused. Although it is hard to see the blood as still being a part of the circulatory system, the brothers accept the procedure once they are told that the Society has approved of its use, and that it does not violate any scriptural principles.

It is easy to see that the Society is caught in a maze of legalism and nit-picking. We have seen above that the WTS prohibition against storing blood is hopelessly inconsistent. Many Witnesses would no doubt see that the logic that permits this heart-lung machine procedure also permits storing their own blood, if they were allowed to exercise their own judgment. After all, the only argument against it comes from a rule in the Law of Moses requiring blood from a killed animal to be poured out (Deut 12:24). Following the rule demonstrated that a person understood the animal's life to come from God. Obviously, then, these considerations cannot apply to autologous blood transfusions, since no one has died. The blood is put back into the person from whom it was taken.

References:

1-Human blood is composed of 55% plasma and 45% formed elements (From chart) 1994 Elaine N Marieb R.N. Ph.D. Essentials of Human Anatomy and Physiology - 4th edition p. 291

"Plasma, which is approximately 90% water, is the liquid part of blood." Ibid p. 290

"Solutes make up about 10% of the plasma volume of which 7% are proteins." 1990 Ennio C Rossi, Toby L. Simon, Gerald S. Moss - Principles of Transfusion Medicine p. 307

"The Concentration of Albumin is about 40mg/ml, an amount that represents about 60% of the total plasma protein." Ibid p. 308

Comment: Since 55% of the total blood volume is plasma and 7% of that plasma is protein and 60% of that protein is albumin, then figuring the percentage that albumin comprises of the total blood volume is accomplished by the following computation: .6 X 7 X .55 equals 2.31 percent.

See the following WTS references for a historical verification of changes in policy:

Albumin: Awake! 09/08/1956 p. 20; WT 11/1/61 P. 669; Awake 6/22/82 P. 25; and WT 10/1/94 P.31; WT 6/1/90 P. 31

Vaccines/Serums: Golden Age, 5/1/29, p. 502, #40; WT 12/15/52 P. 764; Awake! 01/08/1954 p. 24; WT 9/15/1958 p. 575; WT 6/1/74 P. 351-352

Illustration from Awake! 10/22/90, p. 4.