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Published on: July 18, 2014
Should Jehovah's Witness patients be listed for heart transplantation?
Elsayed Elmistekawy1, Thierry G Mesana, Marc Ruel
1Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada.
Insights
Heart transplantation is feasible for Jehovah's Witness patients with end-stage heart failure. A multidisciplinary approach ensures technical success without increased mortality risk in selected candidates.
Area of Science:
- Cardiovascular Surgery
- Transplantation Medicine
- Medical Ethics
Background:
- End-stage heart failure presents significant challenges for Jehovah's Witness patients due to their religious objection to blood transfusions.
- Assessing the safety and efficacy of heart transplantation in this specific patient population is crucial for expanding treatment options.
Purpose of the Study:
- To evaluate the outcomes of heart transplantation in Jehovah's Witness patients.
- To determine if heart transplantation can be performed without an increased mortality rate in this patient group.
Main Methods:
- A systematic review of best evidence was conducted, identifying 133 papers and focusing on 29 relevant studies.
- Five papers specifically addressed Jehovah's Witness patients with end-stage heart failure.
Main Results:
- Seven Jehovah's Witness patients underwent successful heart transplantation without mortality, re-exploration, or blood transfusion.
- Other organ transplantations (lung, liver, kidney, pancreas) in Jehovah's Witness patients showed comparable outcomes to non-JW patients.
- While publication bias is possible, individual cases demonstrate feasibility.
Conclusions:
- Heart transplantation is technically feasible and can be performed without increased mortality in selected Jehovah's Witness patients.
- A multidisciplinary team approach is essential for successful outcomes in these complex cases.
- Jehovah's Witness patients with end-stage heart failure may be considered for transplantation under favorable circumstances.
Abstract:
This best evidence topic in Cardiac Surgery was written according to a structured protocol. The question addressed was: for [Jehovah's Witness patients with end-stage heart failure] can these patients undergo a [heart transplantation] without an increased rate of mortality. Altogether, 133 papers were found using the reported search strategy. Of those, 29 papers represented the best evidence to answer the clinical question. Five papers focusing on patients of the Jehovah's Witness (JW) faith who had end-stage heart failure were published. Successful heart transplantation was performed in a total of seven patients without mortality, re-exploration or blood transfusion. One patient had left ventricular reduction surgery twice and another patient had bypass surgery several years after transplantation. Other successful organ transplantations were also reported, including lung, liver, kidney and pancreas in both adult and paediatric patients of the JW faith, with comparable mortality and morbidity to non-JW patients. A publication bias is likely; nevertheless, we conclude that although there are no large studies directly focused on heart transplantation in JW patients, a multidisciplinary team approach to such surgery can make it technically feasible and without an increased mortality risk in suitable candidates. Therefore, such patients may be considered for heart transplantation under selected and favourable circumstances.
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