16 Jun 2007

Doctor defends 'bloodless surgery' for babies

Jehovah's Witnesses prefer technique that requires no transfusions, overcomes ethical concerns


Globe and Mail

With a report from Canadian Press

May 25, 2007

VANCOUVER -- One of the leading practitioners of "bloodless surgery" says that when Jehovah's Witnesses demand to be treated without transfusions - as parents of premature babies in Quebec City and Vancouver have done recently - they are not relying on junk science.

Rather, they are pushing the medical establishment to provide them with a form of treatment that is increasingly available, but still relatively obscure, in the United States and Canada, says Aryeh Shander, chief of anesthesiology and critical care medicine at Englewood Hospital and Medical Center in New Jersey.

Dr. Shander, interviewed yesterday in the wake of a Quebec court decision that ordered transfusions for premature twins despite objections from their Jehovah's Witnesses parents, said that even tiny babies can be treated safely with techniques commonly called bloodless surgery, or more correctly, blood conservation.

"Bloodless is sort of a misnomer because essentially what we do is we treat patients without the use of banked blood products," said Dr. Shander, who is also a professor at Mount Sinai school of medicine in New York.

He was recently profiled by Time magazine in a report titled Heroes of Medicine, because of his pioneering work in bloodless surgery.

"What we do is try to approach the patient from a different scenario. ... we will make sure that their blood level is brought up before surgery," he said. "We will collect every drop of blood during surgery ... and we can return all the products back to them later on."

Machines that recycle a patient's own blood and drugs that reduce the need for transfusions are among the techniques used.

Dr. Shander said he's used the approach on a wide variety of patients - including premature babies born to parents who are Jehovah's Witnesses, a religion that forbids blood transfusions.

"To date, everything that has been performed from a surgical point of view ... on patients who take blood, can be performed on bloodless patients, or Jehovah's Witnesses," he said.


Dr. Shander has been at the forefront of bloodless surgery since the 1980s when AIDS and hepatitis C epidemics made him question the risks of transfusions.

He said his questioning of traditional methods was controversial at first, just as the questioning by Jehovah's Witnesses is now.

"There were arguments, no doubt about that ... I don't know if people actually viewed [what I was doing] as heresy, but this is how people view the Witnesses now, as heretics in the cathedral of medicine, because they are questioning even more than I did. They are questioning medicine to be able to deliver the same standard of care that everyone else gets - but without the use of blood."

Quebec Superior Court ruled on Wednesday that a Quebec City hospital caring for premature twins should proceed with blood transfusions after doctors treating the babies were able to demonstrate the severity of the situation.

Two doctors told the court blood transfusions were necessary to keep the twins alive and avoid brain damage. A doctor who is a Jehovah's Witness testified on the parents' behalf that alternatives to transfusion were available for the twins, who were born by cesarean section May 17 at 25 weeks.

In January, the B.C. government briefly seized four babies who had survived Canada's first sextuplet birth, and ordered transfusions, despite the objections of the parents, who are also Jehovah's Witnesses.

The parents have since taken the B.C. government to court, seeking a ruling that they should have had an opportunity to go before a judge and make an argument for bloodless treatment. That case is expected to be heard in July.

Dr. Shander said every case is different and he doesn't have medical details on the recent births in B.C. and Quebec. But he said in most instances, there is a good medical case to be made for bloodless treatment.

"We've had plenty of patients from all over the world who have come to our hospital to be treated without blood. All went home, yet they were refused by many, including Canada, to be cared for," he said.


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