Bloodless surgery

A variety of bloodless surgical techniques have been developed for use on patients who refuse blood transfusions for reasons that include concern about AIDS, hepatitis, and other blood-borne infections, or immune system reactions. Many physicians have expressed a willingness to respect patients' preferences and provide bloodless treatment[*need quotation to verify*] and about 200 hospitals offer bloodless medicine and surgery programs for patients who wish to avoid or limit blood transfusions. Bloodless surgery has been successfully performed in significant procedures including open-heart surgery and total hip replacements. A 2012 study in *JAMA Internal Medicine* concluded that "Witnesses do not appear to be at increased risk for surgical complications or long-term mortality when comparisons are properly made by transfusion status. Thus, current extreme blood management strategies do not appear to place patients at heightened risk for reduced long-term survival." The study also stated that "Survival estimates of Witnesses were 86%, 69%, 51%, and 34% at 5, 10, 15, and 20 years after surgery, respectively, vs 74%, 53%, 35%, and 23% among non-Witnesses who received transfusions."

Bloodless medical and surgical techniques have limitations, and surgeons say the use of various allogeneic blood products and pre-operative autologous blood transfusion are appropriate standards of care for certain patient presentations. The Watch Tower Society states that in medical emergencies where blood transfusions seem to be the only available way to save a life, Jehovah's Witnesses request that doctors provide the best alternative care possible under the circumstances with respect for their personal conviction. The Watch Tower Society has acknowledged that some members have died after refusing blood.

In some countries, including Canada and the United Kingdom, a parent or guardian's decision can be legally overruled by medical staff. In this case, medical staff may act without consent, by obtaining a court order in a non-emergency situation, or without such in an emergency. In Japan, children under 15 can be administered blood transfusions against their and their parents' wishes, and children between the ages of 15 and 18 can be similarly treated provided they, or at least one of their legal guardians, consent to the procedure. In the United States, the American Academy of Pediatrics recommends that in cases of "an imminent threat to a child's life", physicians in some cases may "intervene over parental objections".

### Hospital Liaison Committees

In 1988, the Watch Tower Society formed *Hospital Information Services*, a department to help locate doctors or surgical teams who are willing to perform medical procedures on Witnesses without blood transfusions. The department was given oversight of each branch office's *Hospital Information Desk*, and of one hundred *Hospital Liaison Committees* established throughout the United States. As of 2003, about 200 hospitals worldwide provide bloodless medical programs. As of 2006, there are 1,535 Hospital Liaison Committees worldwide coordinating communication between 110,000 physicians.

Hospital Information Services researches medical journals to locate information on the availability and effectiveness of bloodless surgery methods. It disseminates information about treatment options to local Hospital Liaison Committees, and to doctors and hospitals.

### Patient Visitation Groups

Annually since 2004, Jehovah's Witnesses in the United States have been informed that "with your consent, the law allows for the elders to learn of your admission [to hospital] and provide spiritual encouragement", but that "elders serving on a Patient Visitation Group [could] have access to your name" only if patients made their wishes known according to the Health Insurance Portability and Accountability Act (HIPAA).

Jehovah's Witnesses' branch offices communicate directly with congregations regarding "ways to benefit from the activities of the Hospital Liaison Committee (HLC) and the Patient Visitation Group (PVG)." A Jehovah's Witnesses publication in 2000 reported that Argentina had fewer than a hundred HLC committeemen "giving vital information to the medical community", adding that "their work is complemented by hundreds of other self-sacrificing elders who make up Patient Visitation Groups that call on Witness patients to help and encourage them". Each branch office appoints PVG committeemen, who serve as volunteers.