Jehovah’s Witnesses are widely known for their conscientious objection to blood transfusions, a position rooted in their interpretation of biblical commands to “abstain from blood” (Acts 15:28–29). However, the current policy maintained by the Watch Tower Bible and Tract Society (Watchtower) is far more complex than the phrase “no blood” suggests.
Over the past several decades, the list of blood-derived products that Jehovah’s Witnesses may accept has grown substantially. Today, Witnesses may accept all derivatives of red cells, white cells, platelets, and plasma—components that together account for 100% of blood volume. The Watchtower explicitly permits the use of dozens of these products, while still technically prohibiting transfusion of four “primary components” in their original form. Notably, whole blood is rarely transfused in modern medicine, rendering its prohibition largely symbolic. The distinction between what is permitted and what is not, and the rationale behind it, warrants careful scrutiny. The position can be summarized by the following diagram:
Enjoy Life Forever – Watchtower Bible and Tract Society.
Watchtower’s diagram accurately reflects the separation of blood following centrifugation. We will break down each of these components below, as well as look at various medical procedures and blood products currently approved by the Watchtower for Jehovah’s Witnesses.
Red Blood Cells – Not Approved
Photo by N.I.H.
The erythrocyte (red blood cell) is by far the largest component of blood, comprising about 45% of its volume. A red cell is a tiny doughnut-shaped bag of hemoglobin, as shown here. It has no nucleus and serves to transport hemoglobin throughout the body. The membrane accounts for about 1-3% of the total weight of the red cell.1
Hemoglobin Solution
Hemoglobin (Approved): Hemoglobin is the essential protein responsible for the transport of oxygen and carbon dioxide and is the major component of blood. 1This hemoglobin accounts for about 96% of the dry weight of a red cell and 15% of the total volume of blood. Its approval for use by the Watchtower back in 2000 was startling to long-time observers and most Jehovah’s Witnesses alike.2 At present, hemoglobin-based blood products like Hemopure are approved for use in South Africa and Russia but remain in the research and development stage in most countries3. However, it can be obtained through the FDA’s Expanded Access Program for patients with life-threatening anemia when blood transfusions are not an option and other treatments have been exhausted.4 Jehovah’s Witnesses are using these products, generally on an emergency compassionate use basis.
Hemin (Approved): Hemin is an iron-containing porphyrin compound, specifically iron(III) protoporphyrin IX chloride, and is primarily used to treat acute attacks of acute intermittent porphyria (AIP).5.
White Blood Cells – Not Approved
Nat. Cancer Inst.
There are five different Leukocytes or white cells that can be found in the bloodstream. These are part of the immune system and fight foreign invaders like viruses and bacteria. In total, they comprise about 1% of the blood volume in a healthy person. They are occasionally prescribed for infections that don’t respond to antibiotics.1
Interferons (Approved): Antiviral agents and immune system upregulators. They can be lab-synthesized.
Interleukins (Approved): An important group of Cytokines essential to the function of the immune system. They can be lab-synthesized.
Granulocyte Macrophage – Colony Stimulating Factor (GM-CSF) (Approved): Stimulates the body’s production of neutrophils. They can be lab-synthesized.
Platelets – Not Approved
Nat. Cancer Inst.
Also referred to as “thrombocytes”, they are specialized blood cells responsible for stopping bleeding. Like the red cell, they have no nucleus. They are the smallest of the blood components, amounting to far less than 1% of blood volume (0.1-0.2%), yet they remain banned. They are used to treat Thrombocytopenia, side effects of chemotherapy, or a low platelet count due to lumbar puncture or bone marrow aspiration. The platelet is banned for Jehovah’s Witnesses, but like the red and white cell, everything within it is permitted. Jehovah’s Witnesses may have to select “second best” chemotherapy regimens or discontinue their cancer treatment if their platelet count becomes too low, and this often leads to premature death.6
Platelet-Derived Growth Factor (Approved): Used topically to accelerate wound healing. Found in blood. It can be made from blood or lab-synthesized.
Platelet Gel (Approved): Derived from the patient’s own blood by separating the platelets via centrifuge and special processing. It is typically used for surgical wound healing. This amounts to an autologous blood transfusion. It can also be allogeneic, meaning from a donor.6
Plasma – Not Approved (Clinicians can navigate this by transfusing Cryoprecipitate and Cryosupernatant)
Plasma is a yellowish fluid containing about 92% water, 7% proteins, clotting factors, salt, sugars, fats, hormones, and vitamins.1 Concentrates of the specific proteins are prepared from huge pools of Plasma through a process known as fractionation, developed during World War II.3 They are heat-treated and/or solvent detergent-treated to kill certain viruses, including HIV and hepatitis B and C. Although transfusion of plasma is prohibited, all its derivatives are permitted, including:
Albumin (Approved): Blood contains about 2.2 % albumin by volume. (White Cells – which are prohibited, comprise about 1% of blood volume). 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 originally contained albumin, but no longer does. 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?”1
Watchtower once stated:
“While this physician argues for the use of certain blood fractions, particularly albumin, such also come under the Scriptural ban.” 7
The Watchtower quietly reversed its position on albumin in 1981, without any official acknowledgement.
Alpha 1-Proteinase Inhibitor Concentrate (Approved): Used to treat Emphysema. 8
Antithrombin III (Approved): Used to treat Antithrombin III deficiency. A recombinant “man-made” version is now available.9
Anti-Inhibitor Coagulation Complex (AICC) (Approved): Used for treating Hemophilia A & B to reduce bleeding in acute episodes.
C1 Esterase Inhibitor (Approved): Used to treat acute abdominal or facial attacks of hereditary angioedema.10
Cryoprecipitated AHF (Approved): The portion of Plasma that is rich in certain clotting factors, including Factor VIII, fibrinogen, von Willebrand factor, and Factor XIII11. 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. Though referred to as a fraction, the Australian Red Cross calls it a blood transfusion. It constitutes 3-6% of total blood volume, and about 1% of blood plasma.
That Watchtower realizes this is a major component of blood is shown by their October 21, 2014 letter to all HLC committees in the U.S. wherein they acknowledge and proudly distribute the Dept of Veterans Affairs Directive 1089(1). Therein, Cryoprecipitate is listed among the major components of blood.
Cryosupernatant (Approved): Also referred to as cryo-poor plasma because the Cryoprecipitated AHF has been removed. This single blood product is approximately 99% of blood plasma and 49-52% of total blood volume. It is primarily used in the treatment of thrombotic thrombocytopenic purpura (TTP) and hemolytic-uremic syndrome (HUS). It is also considered in cases of uremic bleeding after other treatments have failed. Clinicians are advised to refer to this product as Cryosupernatant to avoid potentially triggering a fear or anxiety-induced response from the patient over the use of the word plasma.
The Watchtower is aware of this:
“Each batch of Factor VIII is made from plasma that is pooled from as many as 2,500 blood donors.”
“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.””14
More than 250,000 blood donations are required annually to produce the factor VIII and factor IX that are consumed by the Jehovah’s Witness community. Huge vats could be filled with all of the human blood that is stored and processed to meet the needs of Witness Hemophiliacs. The Watchtower 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.15
Immunoglobulins: There are many different uses of these vital blood products. We touch on some of them below.
- Human Immune Globulin (HIG) (Approved): Used to treat and prevent, among other things, Hepatitis A 16
- Rabies Immune Globulin(RIG) (Approved): Used to treat and prevent rabies.
- RhO Immune Globulin (RhoGam) (Approved): Given to Rh-negative mothers to prevent Hemolytic Disease of the newborn in future pregnancies.
- Tetanus Immune Globulin (Approved): (Tetanus Shot)
Profilnine Complex Concentrate (Approved): Used to reverse acquired coagulation factor deficiency in patients with acute bleeding.
Protein C Complex (Approved): Used to treat Congenital Protein C deficiency, thrombosis, and purpura fulminans.
Thrombin (Approved): Aids hemostasis in capillaries when standard control is impractical or ineffective.
Although described by the Watchtower as “fractions,” many of these products are derived from large volumes of stored, pooled human blood and are processed using industrial fractionation techniques.
Permitted Procedures
The Watchtower allows certain medical procedures involving extracorporeal circulation, provided blood is not stored and the system remains closed:
Blood Donation: If done strictly for fractionation.
Dialysis: Where the blood of a Jehovah’s Witness suffering from Kidney failure is regularly circulated through a Dialysis machine to be filtered and returned to the patient.17
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.’” 18.
Cell Saver – Photo by the U.S. Navy 19
Cell Saver/Intraoperative Blood Salvage: This procedure involves collecting a patient’s blood during surgery, mixing it with an anticoagulant, and processing it to remove debris and fat. The salvaged blood is then returned to the patient’s circulatory system. This process is known as autotransfusion, specifically a type of autologous blood transfusion.
Labeling or Tagging (Apheresis with Medication Treatment and Reinfusion): The patient’s blood is withdrawn, processed to isolate or modify certain components, and mixed with medicine, then returned via transfusion.
Epidural Blood Patch: A procedure that uses an injection of your blood to stop a cerebrospinal fluid (CSF) leak near your spinal cord.
Acute Normovolemic Hemodilution: Some of the patient’s blood is removed just before surgery, and blood volume is maintained with intravenous fluids. Following the surgery, the blood is transfused back into the patient either during or after the surgery when surgical blood loss has decreased.
These procedures underscore the policy’s internal complexity. In many cases, the blood is removed from the body and temporarily stored, yet approval is granted if specific criteria are met.
Ethical and Doctrinal Considerations
When evaluated collectively, all components of blood are permitted in fractionated form. The policy hinges on distinctions between “major” and “minor” components, and between “stored” and “circulating” blood. However, these distinctions do not always align with medical or Biblical clarity. Some doctors consider blood components to be fractions because they are separated from whole blood.
For example, Watchtower literature historically condemned albumin as forbidden, yet reversed its stance without formal acknowledgment.21 Similarly, vaccines and blood serums were initially banned and later permitted.22 These shifts highlight the fallibility of organizational interpretation and the challenge it poses to informed consent and ethical medical care.
Further complicating the issue is the inconsistency surrounding the use of stored blood. The Watchtower prohibits autologous transfusion using stored blood, but allows heart-lung machines, dialysis, cell salvage, hemodilution, plasmapheresis, and other procedures where blood can remain outside the body for extended periods.23
If all non-blood alternatives have been exhausted and the patient requires a blood product prohibited by the Watchtower—particularly erythrocytes (red cells) or thrombocytes (platelets)—clinicians may use the following diagram to facilitate an informed discussion with the Jehovah’s Witness patient:
Blood Components by Volume and Watchtower Policy
The vast majority of Jehovah’s Witnesses have never reflected on the fact that the Bible does not mention blood transfusions, components, or fractions. Historically, all of the products shown on the accompanying chart—including vaccines, blood serums, and organ transplants—were at one time categorically prohibited by Watchtower. Only the oldest members of the current patient population are likely to recall these prior bans. Clinicians should therefore treat Jehovah’s Witness patients as individuals, recognizing that most are unfamiliar with the historical evolution of Watchtower policy. Many also harbor deep anxiety or irrational fear regarding blood products, shaped by decades of misinformation from official publications. Wide variation exists among Witnesses in both their understanding of, and willingness to accept, different blood-derived treatments. 23
An additional ethical consideration is the potential for internal religious coercion (organizationally mandated shunning). Acceptance of a blood product that remains officially prohibited is considered a serious offense within the faith community. Jehovah’s Witnesses—including elders, relatives, and even JW healthcare staff—are expected to report such actions to congregation authorities. As such, the clinician must provide each JW patient with a respectful, confidential consultation. Once patients are assured that their informed decisions will remain private and that any permitted treatment will be handled discreetly, their openness to blood-derived therapies often increases. 24
Conclusion
The Watchtower’s blood doctrine is no longer accurately described as a prohibition of blood. Jehovah’s Witnesses may now accept derivatives of every component of blood, comprising 100% of its volume. These products often involve stored, processed, and pooled donor blood from thousands of individuals.
This reality invites serious ethical reflection. The primary question is no longer whether a Witness may accept blood, but which blood products and delivery methods are deemed permissible—and why. The logic underpinning these distinctions appears more administrative than theological, and policy shifts over time reflect a human rather than divine origin.
Understanding this complexity is essential for clinicians, medical ethicists, and Jehovah’s Witnesses themselves. Respect for religious conscience must be balanced with a clear understanding of medical realities and doctrinal history, especially when decisions may mean the difference between life and death.24 25 26 27 28
References
1. Marieb EN. Essentials of Human Anatomy and Physiology. 4th ed. Redwood City: Benjamin/Cummings; 1994. p. 290–291.
2. Watchtower Bible and Tract Society. Our Kingdom Ministry. 2000 Nov; p. 7.
3. Rossi EC, Simon TL, Moss GS. Principles of Transfusion Medicine. Baltimore: Williams & Wilkins; 1990. p. 307–308.
4. U.S. Food and Drug Administration. Expanded Access: Information for Patients. [Internet]. Available from: https://www.fda.gov/news-events/public-health-focus/expanded-access
5. National Organization for Rare Disorders. Acute Intermittent Porphyria. [Internet]. Available from: https://rarediseases.org/rare-diseases/acute-intermittent-porphyria/
6. U.S. Food and Drug Administration. Platelet-derived products for wound healing.
7. Watchtower Bible and Tract Society. Awake! 1956 Sep 8; p. 20. Also see: The Watchtower. 1961 Nov 1; p. 669; Awake! 1982 Jun 22; p. 25; The Watchtower. 1994 Oct 1; p. 31.
8. Watchtower Bible and Tract Society. Awake! 1956 Sep 8; p. 20. Also see: The Watchtower. 1961 Nov 1; p. 669; Awake! 1982 Jun 22; p. 25; The Watchtower. 1994 Oct 1; p. 31.
9. Levi M. Antithrombin III: antithrombotic properties and clinical indications. Thromb Res. 1999;94(1):S93–S97.
10. Zuraw BL. Hereditary angioedema. N Engl J Med. 2008;359:1027–1036.
11. Australian Red Cross Blood Service. Cryoprecipitate and Cryosupernatant Guidelines [Internet]. Available from: https://www.lifeblood.com.au
12. Shander A, Hofmann A, Gombotz H, Theusinger OM, Spahn DR. Fibrin sealants in surgery: review and recommendations. Transfusion. 2007;47(Suppl 1):229S–250S.
13. Orange JS, Ballow M, Stiehm ER, Ballas ZK, Chinen J, de la Morena M, et al. Use of intravenous immunoglobulin in human disease: a review of evidence by members of the Primary Immunodeficiency Committee. J Allergy Clin Immunol. 2006;117(4):S525–S553.
14. Watchtower Bible and Tract Society. The Watchtower. 1985 Jun 15; p. 30.
15. Watchtower Bible and Tract Society. Awake! 1988 Oct 8; p. 11
16. Watchtower Bible and Tract Society. The Watchtower. 2000 Oct 15; p. 30–31.
17. Kaplan A. Plasmapheresis in the treatment of autoimmune diseases. Transfus Apher Sci. 2000;22(2):109–117.
18. Watch Tower Bible and Tract Society. The Watchtower. 1989 Mar 1; p. 30.
19. U.S. Navy Medical Photos. Cell Saver [Internet]. Wikimedia Commons. Available from: https://commons.wikimedia.org/wiki/File:US_Navy_060505-N-2832L-050_Hospital_Corpsman_Megan_Beach,_checks_the_flow_of_blood_through_a_cell_saver,_during_training_for_an_antilogous_blood_transfusion.jpg
20. Kaplan A. Plasmapheresis in the treatment of autoimmune diseases. Transfus Apher Sci. 2000;22(2):109–117.
21. Watchtower Bible and Tract Society. Awake! 1956 Sep 8; p. 20.
22. Watchtower Society. Golden Age. 1929 May 1; p. 502. Also see: The Watchtower. 1952 Dec 15; p. 764; Awake! 1954 Jan 8; p. 24.
23. Muramoto O. Bioethical aspects of the recent changes in the policy of refusal of blood by Jehovah’s Witnesses. BMJ. 2001;322:37–39.
24. Elder L. Why some Jehovah’s Witnesses accept blood and conscientiously reject official Watchtower Society blood policy. J Med Ethics. 2000;26:375–380.
25. Woolley S. Jehovah’s Witnesses in the emergency department: what are their rights? Emerg Med J. 2005;22:869–871.
26. Watchtower Bible and Tract Society. Awake! 2013 Dec; p. 3–7.
27. Watchtower Bible and Tract Society. The Watchtower. 2016 Apr; p. 20–25.
28. Watchtower Bible and Tract Society. Kingdom Ministry. 2015 Jun; insert on Hospital Liaison Committees. Also see: Awake! 2019 Nov; p. 8–12.
I am an ex JW for 46 years. This is one of 18 issues I argued with the body of elders about before I left. Jesus example to the religious leaders about him healing on the sabbath opened my eyes! It showed me when a life is involved, even if there is a rule, we have to look at circumstances and save that life.
An elder in California gave evidence during a preliminary hearing in 1987, that the only
tenent the Watchtower,
Bible & Tract Society has, is to “abstain from blood”. Not the 10 Commandments, not the New Commandment, etc.
Does anyone know if that was/is, true? I know of someone disfellowshipped after death, because of taking a blood transfusion. It was very hard on his young family. I have a very high allergic reaction in my blood. Pro-crit raised my blood count within 12 hours. I was down to 3.9 hemoglobin twice. The doctors in the first hospital told me it would take 2 weeks for the Pro-crit to work. Some people’s blood is just too weak to accept someone else’s blood. Don’t be afraid to push for Pro-crit, (Erythropoetin), as much as the medical staff pushes for blood transfusions. It is an excellent product. It stimulates your bone marrow to produce red blood cells, IF your bone marrow hasn’t stopped producing red blood cells.
A comprehensive review of blood use according to scripture has been posted at beroean dot study on the web.
” NO BLOOD “