Health: The end of the blood transfusion is nigh

`Bloodless surgery' could revolutionise medical procedures, as well as freeing Jehovah's Witnesses from life-or-death dilemmas.
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WHEN HE booked in for a hip replacement operation, Phiroze Kapardia, a 67-year-old mathematical physicist, knew he risked losing several pints of blood. As one of Britain's 125,000 Jehovah's Witnesses, he also knew that, if a blood transfusion were necessary, he would have to refuse on religious grounds. So Mr Kapardia had his hip replacement done using so- called bloodless surgery, in which the blood spilt during surgery - normally sluiced away - is cleaned and returned to the body.

The technique is revolutionising surgery not only for Witnesses but for other patients, too, because it eliminates the risk of acquiring an infection from donor blood. It has already saved the lives of three people at one hospital who would have died as a result of massive blood loss following liver injuries.

One in 400 hospital patients in Britain is a Witness, and the issue of transfusions is one of the most fundamental they will ever face - for some the decision will mean the difference between life and death.

"Our belief is based on the clear biblical command, which goes right back to the time of Noah, that Christians should not allow blood to enter their bodies,'' says Paul Wade, the spokesman for UK Witnesses. For Mr Kapardia, who had his operation in Colchester using equipment from Basildon General Hospital - one of the few British units to have invested in the technology - there was no dilemma. "It is your own blood, and it is kept in a closed circuit. The spiritual view is that it should be discarded if it becomes detached from the body, and with this equipment it doesn't. This is equipment that every hospital should have. It's not a case of being a religious crank, because everyone would benefit.''

Technology is continually throwing up challenges to Witnesses. As well as the transfusion issue, there is kidney dialysis, where blood is taken out of the body and then returned, and the growing trend of people stockpiling their own blood.

But Wade says: "A situation where people go into hospital a few days ahead of time and store their blood is not acceptable to Witnesses. God's view is that blood is a sacred substance, and once shed it must be used for no other purpose."

However, most Witnesses find bloodless surgery acceptable.The equipment collects all the blood that haemorrhages during surgery, mixes it with a drug to ensure that it does not clot, washes it, filters and spins out extraneous material and delivers the blood back to the surgeon, all in five to 10 minutes.

Wade says that Witnesses have been told that they must make up their own minds on whether or not this technique conforms to their beliefs: "We don't feel it's right to make a ruling. It is down to the individual. Most Witnesses are happy to accept this equipment."

Dr Dafydd Thomas, a consultant at Swansea's Morriston Hospital, is another enthusiast. "We have had 25 people on whom we have used blood salvage," he said. "A number who had ruptured livers would probably have died because of the amount of blood loss involved. Take-up of this technology has been slow in Britain but there is no reason why every hospital should not be using this kind of equipment."

In the USA, a series of 100 open-heart operations carried out without blood transfusions at the Cornell University Medical Center has shown that even the most complex operations can be carried out without using blood transfusions. Dr Todd Rosengart, who led the Cornell work, says the technology means that the days of extensive use of blood transfusions are numbered. "In the old days, 20 years before Aids, surgeons were relatively cavalier about blood transfusions. Now, if you talk to heart surgery patients, their main concern is not the operation but the risk of having a transfusion."

Hospitals that use the technology have reported a drop in blood transfusions of up to 20 per cent. Some clinicians believe that the need for transfusions, which have been at the centre of infection scares involving Aids, hepatitis and CJD, will significantly decline with the increase of bloodless surgery.