#OA3-AM25-ST-22 - Outcomes of Bloodless Cardiac Surgery in Jehovah’s Witnesses: A Meta-Analysis of Comparative Studies Since 2000

Jehovah’s Witnesses (JWs) refuse allogeneic blood transfusions on religious grounds, posing ethical and clinical challenges in procedures such as cardiac surgery, where transfusion is often considered essential. However, modern blood conservation techniques including erythropoietin (EPO), iron supplementation, and cell salvage may enable comparable outcomes without transfusion. This study evaluates whether JWs undergoing bloodless cardiac surgery experience different outcomes than non-Witness patients (Control) receiving transfusions.


Study

Design/Methods:

We conducted a systematic search of PubMed on April 14, 2025, using the MeSH terms "Cardiac Surgery" and "Jehovah’s Witness*." Inclusion criteria were comparative studies published in English since 2000 involving adult cardiac surgery patients with outcome data for both JWs and controls. Studies were excluded if they were single-patient case reports, noncardiac or pediatric procedures, or lacked sufficient data. Out of 313 results, 10 studies met inclusion criteria. Primary outcomes included 30-day mortality, kidney injury, and blood loss. Where possible, statistical comparison of binary outcomes was performed using two-proportion z-tests on pooled data across studies. For variables not uniformly defined or not reported in a comparable format (e.g., AKI criteria, median-only values), trends were summarized descriptively.


Results/Findings:

Across studies, JW sample sizes ranged from 27 to 113 patients. JW patients had significantly lower diabetes prevalence (25.7% vs 33.2%, p = 0.0086). No significant differences were found in pooled rates of hypertension (p = 0.198), prior cardiac surgery (p = 0.409), or sex (p = 0.343). Post-operatively, no significant difference in 30-day mortality was observed between JW and control groups in most studies (3.6% vs 3.4%, p = 0.873). Kidney injury rates were comparable or lower in JW groups. Although quantitative blood loss was inconsistently reported, qualitative data did not suggest worse bleeding outcomes. JWs commonly received preoperative anemia optimization with EPO and IV iron, as well as intraoperative cell salvage.


Conclusions:

Bloodless cardiac surgery in JW patients is associated with outcomes comparable to those of patients receiving transfusions, provided appropriate perioperative strategies are used. These findings support the safety and efficacy of blood conservation techniques, not only for JWs but potentially for broader cardiac surgical populations.