Integrated and structured care in lung transplantation for a Jehovah's Witness patient

A 63-year-old female Jehovah's Witness with familial idiopathic pulmonary fibrosis underwent elective bilateral lung transplantation at a private quaternary hospital in southeastern Brazil. Intraoperatively, Cell Saver technology was used to minimize blood loss. Postoperatively, she developed severe anemia (Hb < 7 g/dL), primary graft dysfunction (grade 2), and septic shock. Due to her religious beliefs, she refused allogeneic blood transfusion, creating unique challenges for the intensive care team.

Nursing diagnoses included risk of ineffective tissue perfusion related to severe anemia and transfusion refusal; impaired gas exchange secondary to graft dysfunction; risk of infection and sepsis due to immunosuppression; and potential spiritual distress associated with religious restrictions in the context of critical illness.

The care plan focused on pharmacological stimulation of erythropoiesis, continuous hemodynamic and respiratory monitoring, renal replacement therapy, infection control, and individualized rehabilitation strategies. Ethical principles-particularly autonomy-guided all shared decision-making and documentation.

Despite comprehensive interdisciplinary interventions, the patient developed progressive clinical deterioration and died. This case emphasizes the importance of structured nursing care, integration of bioethical principles, and institutional preparedness in managing complex postoperative scenarios when transfusion is not an option. It highlights the nurse's central role in coordinating technical, psychosocial, and spiritual care needs, ensuring that patient-centered values remain at the core of critical care.