Until recently, liver transplantation was contraindicated in Jehovah’s Witness patients because of recipient-imposed restrictions on use of blood products. However, recent improvements in surgical and anaesthetic techniques and new procoagulant agents challenge this practice. We describe two Jehovah’s Witness patients who had successful liver transplantation without blood transfusion. To our knowledge, these are the first such cases in Australasia. The techniques used to minimise blood loss and transfusion requirements could potentially benefit all patients undergoing major surgery.
A 48-year-old farmer with end-stage cirrhosis due to α-1 antitrypsin deficiency had evidence of moderate portal hypertension with splenomegaly and ascites (Child–Pugh score B), but no significant lung disease. He met minimum recipient suitability criteria for liver transplantation, according to the Transplantation Society of Australia and New Zealand (TSANZ) liver standing committee.1 As a Jehovah’s Witness, he would not accept transfusion of red blood cells, fresh frozen plasma or platelets.
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