Expert Opinions > Expert Medical Opinions > Dr Shigeyuki Kuratsu

Dr Shigeyuki Kuratsu

Asia | Japan

EXTRACTS FROM OPINION, DATED FEBRUARY 26 2024:

“In my career as a physician, I have treated many patients who do not accept blood transfusions. Most of them were Jehovah’s Witnesses. However, I have also seen an increasing number of non-Witness patients come to seek bloodless treatments.”

“When performing surgery on a Jehovah’s Witness patient, the surgeon should be well prepared for the bloodless surgery and have extensive knowledge about the surgical and medical procedures for it. That is the key. This approach is now widely known as Patient Blood Management. I have treated Witness patients and found that they can tolerate much lower hemoglobin levels than what is taught in textbooks (when I started my career in medicine, transfusions were encouraged when hemoglobin level dropped below 10 g/dl). I also found that in many cases, patients treated without blood transfusions had the same or better results than those treated with blood transfusions.

In addition, the costs of providing treatment without blood transfusions is generally no greater than providing treatment with blood transfusions. Some international studies show treatment without blood transfusions is considerably cheaper than treatment with blood transfusions. For example, the 2021 policy brief of the World Health Organization, “The Urgent Need to Implement Patient Blood Management”, reports that a large study in Western Australia on Patient Blood Management showed a savings of up to USD 100 million (https://www. who.int/publications/i/item/9789240035744, at page 5)

As I mentioned above, many patients, including non-Jehovah’s Witnesses, do not want blood transfusions and wish to avoid them if possible. I believe it is the physician’s responsibility to respond to such requests. Doctors may use procedures such as hypotensive anesthesia to control bleeding and intraoperative autologous blood transfusion, and various medical devices and drugs will be developed in the future. I believe that this will lead to future medical advances and will also enhance the careers of physicians (especially surgeons and anesthesiologists) in perioperative management, such as intraoperative and postoperative care.

In conclusion, it was a great experience to be able to treat Jehovah’s Witnesses without blood transfusions. … The relationship between the medical staff and Jehovah’s Witness patients at Kure Medical Center was good and cooperative. The medical staff, including the doctors, had no preconceived ideas about the patient’s wishes and intentions, and the medical staff and the individual patient had a thorough discussion before the surgery, so I believe that both sides were fully aware of the use of blood fractionation and autologous blood. This experience has helped me to become experienced in surgical and medical techniques to avoid or minimize use of blood transfusion which can be used for all patients.” (Original in Japanese.)