Blood Product Transfusion for Jehovah's Witnesses

 

Reviewed by Clinical Practice Committee
July
2016
Clinical Guidelines Back Newborn Services Home Page
Urgent Transfusions Less Urgent Transfusions The Law in NZ Court Wardship

Jehovah's witnesses do not agree with blood transfusions. Our policy is to try to avoid transfusion, but always to have the best interests of the infant as the foremost aim. Blood tests should be kept to the safe minimum. Erythropoietin use should be considered on an individual basis and in discussion with the specialist neonatologist.

Transfusion needs to be discussed with the parents. Consider inviting a Jehovah's Witness Elder to such meetings, with the parent's consent. We have had a lot of contact with Elders of the Church over the years and, although they disagree with transfusion, these discussions have been helpful, particularly for the Witness parents.

Link to Witness's Hospital Liaison Committee (intranet only)

For Urgent Transfusions

For Less Urgent Transfusions (or if the need for transfusion is anticipated)

Anticipated transfusion need: Unwell ELBW infants, babies <26 weeks, anaemic VLBW infants, significant haemolytic disease, very sick term infants (although many of these would fit the urgent transfusion criteria).

The law in New Zealand

The law in New Zealand covering transfusion to minors is as follows:

'Section 126B of the Health Act 1956: This section protects medical practitioners from civil or criminal proceedings for administering blood transfusions without consent to any person under the age of 20 years as long as the judge is satisfied that:

  1. The transfusion was (in the reasonable opinion of the person administering the transfusion) necessary to save life, or to prevent permanent injury or prolonged and avoidable pain and suffering; and
  2. There were reasonable attempts to obtain consent, or it was impracticable to obtain consent  given urgency; and
  3. In all the circumstances, administering the transfusion is reasonable

Note: 16 to 19 year olds have the right to consent to medical treatment and their informed refusal of blood products should be respected.

Court Wardship

In Re J [1996] 2 NZLR 134 Ellis J had made a three-year-old boy, whom doctors considered in need of a blood transfusion after a severe nose bleed, a ward of the Court and appointed a medical specialist to act as agent of the court to consent to any medical treatment involving blood transfusion, over the objection of the boy's Jehovah’s Witness parents. The Court of Appeal dismissed the parents’ appeal, noting that the parents’ right to practise their religion cannot extend to imperil the life or health of the child.

The Court confirmed that S126B of the Health Act 1956 does not provide an exclusive statutory mechanism, and that an application to place the child under the guardianship of the Court and seek prior consent to a blood transfusion, may be brought where time and circumstances permit. Before the Court, as guardian, authorises a transfusion to a child in the face of parental opposition: there must be real or substantial risk that the patient's condition will in the course of medical care be such as, on accepted medical practice, would call for blood transfusion and that in the event that condition develops a blood transfusion will be necessary.