Rationing Organs for Religious Refuseniks

Since new medical advances always catch my attention, I read with interest this article about “bloodless” lung transplants being pioneered at some hospitals – that is, salvaging and re-infusing the patient’s own blood, rather than relying on transfusions from donors. It’s being sold as a cost-saving technique and a way to lessen the risk of allergic reactions or other rare side effects, plus it conserves donated blood so that more is available for emergencies. But the technique was developed for a different reason, which I bet you can guess:

Ms. Tomczak, who was baptized at age 12 as a Jehovah’s Witness, insisted for religious reasons that her transplant be performed without a blood transfusion. The Witnesses believe that Scripture prohibits the transfusion of blood, even one’s own, at the risk of forfeiting eternal life.

I must be jaded, because the idea of a Jehovah’s Witness refusing blood and dying because of it doesn’t shock me any more. But this story had a gut-wrenching twist: Rebecca Tomczak, the Witness who’s the subject of the article, was adamant that she wanted the lung transplant, but not a blood transfusion, even at the cost of her own life. She forced her surgeon to agree that if there was a disaster, if she started to hemorrhage on the operating table, he had to stand back and let her die:

Unlike other patients, Ms. Tomczak would have no backstop. Explicit in her understanding with Dr. Scheinin was that if something went terribly wrong, he would allow her to bleed to death. He had watched Witness patients die before, with a lifesaving elixir at hand.

In most cases, this would be a tragedy, but not an outrage. People have the autonomy to consent or refuse treatment as they wish, and if an adult of sound mind wants to throw their life away, that’s their choice to make. But this isn’t just any surgery; this is a transplant, which brings a very different set of criteria into the picture.

I don’t want to sound uncompassionate, because I want all people to live and to flourish regardless of their religious beliefs. But organ transplants are a triage situation, which means we have to make coldly logical choices. Maybe in a few decades, when tissue engineering is more advanced and we can manufacture new lungs or hearts on demand, this won’t be an issue. But for the foreseeable future, human organs are a scarce and precious resource, and that means that when one becomes available for transplant, priority has to be given to people who have the best chance to survive. Giving an organ to someone who’s likely to die anyway not only means their death, but the death of another person who might have lived if they’d gotten it instead.

And the “likely to die anyway” criterion weighs against Jehovah’s Witnesses who insist that if they start bleeding to death, their doctor is forbidden to intervene. By refusing potentially lifesaving care in the event of an emergency, they make themselves poor candidates for transplant surgery. (Just the same way, I’d argue that a person with a history of not following doctors’ orders is also a poor candidate for a transplant, since it’s less likely that they’ll stick to the regimen of anti-rejection drugs.)

I’m not saying that the medical profession doesn’t recognize this. As the article says, hardly any surgeons will even consider performing a bloodless transplant, and Dr. Scheinin, one of the few who will, carefully screens patients for those with the fewest risk factors. Combined with the blood refusal, JWs who are in poor health will probably exclude themselves. But even for those whose prognosis is good, it does strike me as unfair that people who willfully reject lifesaving care for irrational reasons should get to be in line ahead of people who want to live and are willing to follow their doctors’ orders. What do you think – should a person’s stated willingness to accept medical intervention (or their stated consent or refusal to donate themselves) be a factor in deciding their priority for receiving organ transplants?

Image: The May 1994 issue of Awake!, the Watchtower’s magazine, which was devoted to celebrating children who died after refusing blood transfusion. Yes, really. Via.

About Adam Lee

Adam Lee is an atheist writer and speaker living in New York City. His new novel, Broken Ring, is available in paperback and e-book. Read his full bio, or follow him on Twitter.

  • http://www.dannyhaszard.com Danny Haszard

    Jehovah’s Witnesses fare better with bloodless surgeries that are elective non emergency.Tens of thousands have died in the emergency room from traumatic blood loss.Jehovah’s Witnesses blood transfusion ban against “whole* blood is a deadly church dogma that confuses the ER staff and patient victims causing many deaths.
    When someone has lost a lot of blood giving IV fluids will not replace blood loss.
    –Danny Haszard Bangor Maine

  • L.Long

    OK! I will be the heartless one! Especially with transplants which are limited and could be used on another who isn’t so delusional. We have as a society decided when we consider a kid is now an adult, at that point when this delusional wackjob says ‘I refuse to have a doctor do what is best’ is when it is wheeled out of the hospital and left on the street, go ahead an pray – see how that works out! At the very least -if I was a doc- the patient would have to sign away on 25 different forms that me and the hospital are not responsible for ANY complications that may happen because of its stupid decisions.
    Now if the patient is below that certain age then I would be screaming for a judge! But even so in the long run I would be wasting my time because the kid survives to be persecuted as a lost contemned soul till it dies.
    Adult JWs and “Xtian scientist” (there’s a oxymoron!) and the like deserve all they get from their delusions, their kids are a sad story with no good solution.
    Despite what religion claims, there is only one sin – to cause physical harm to others – to cause harm to yourself is not a sin, just plain stupid.

  • David Hart

    How about this: JWs are entitled to receive transplants like everyone else, but if they insist on refusing lifesaving treatment in the process, they have to sign a waiver making them (or rather, whoever inherits their estate if they die as a result of them refusing the lifesaving treatment) liable to a legal claim for damages from the family of the next person in the queue to die because they didn’t get the transplant in question. This would of course require a change in the law, but that shouldn’t be too hard to engineer. Sound fair?

  • ctcss

    Perhaps I am missing something here, but if the procedure fails and the patient dies, isn’t that lung now available for someone else? Granted, there is a limited lifetime for organs, but I assume that it wasn’t ripped out of a living person (unless they were comatose and simply waiting to have their tissue matched with a possible recipient.) So if the lung was on ice, why couldn’t it be put back on ice and rolled down to the operating room down the hall, so to speak? (Yes, I realize that a logistical nightmare might ensue, but how often is the scenario depicted above likely to take place?)

    Just curious.

  • Marc Smith

    These Watchtower “no blood transfusion” dogmas all have their roots in old testament Jewish Bible laws, to not eat blood. Ironically, even Orthodox Jews see no conflict with their laws and life saving blood transfusions. Those transfusions aren’t a religious problem for Jews, Rabbis or Jewish doctors. Simply put, this JW should go into a Jewish hospital for surgery and can be assured that their old testament god, Jehovah, is not being offended by a blood transfusion.
    JWs won’t find any mention in their publications about how Jews have come to decide that blood transfusions don’t violate their 613 laws from G-d. If they allowed JWs to see this, they would realize they have been bamboozled by some old men at WT headquarters who call themselves, the governing body. They might as well be listening to Jim Jones-I order you to drink the koolaid!
    Will a blood transfusion save the life of a starving man? NO!- and this is why blood transfusions have nothing to do with eating blood. Transfused blood is not food for the body unless it is eaten and that is what early Christians were abtaining from- eating blood, nothing more. It’s that simple, JWs. Back in 1980 the WT changed it’s rules banning organ transplants. So in 1979 the JW who needed a kidney transplant just had to go ahead and die, but in 1980 they could receive a kidney transplant with the blessing of the old men in Bethel.

  • allein

    ctss: Similar thoughts crossed my mind, and in a perfect world that would be feasible. But the odds of the next eligible match being in the same hospital, or even the same city, are probably fairly small, and having taken the organ out once to start the operation, possibly having gotten as far as putting it in the person, and then having the person go downhill, removing and putting the organ back on ice and transporting it to the next eligible recipient…the odds of that organ still being viable by the time it gets there are probably very low (granted I’m not a doctor but I watch fake ones on TV ;)).

    I gotta say, I knew where Adam was going with this by the second paragraph, and as cold as it sounds, I have to agree. Someone who drastically cuts the odds of a successful operation because of purely emotional reasons should not be considered a good candidate for a transplant. If an operation can reasonably be expected to come with a high possibility of needing certain procedures along with it, vetoing those attendant procedures from the start should veto the operation. There are lots of people out there who are willing and able to follow the medical protocols prescribed and we shouldn’t be wasting limited resources on those who aren’t. Is it really any different from refusing an active alcoholic a liver if it can be expected the person will just keep drinking?

  • Vinny

    JW’s (including our own little children) are told they cannot take blood transfusions in situations where they might need one, such as through accidents or complications with surgery, pregnancy or child birth etc.

    So, naturally, more JW’s will DIE.

    Just like this mother died unnecessarily!

    http://news.bbc.co.uk/2/hi/uk_news/england/shropshire/7078455.stm

    And now her husband has no wife and her two new twins have no mother.

    And all for what?

    Or this teenager that also DIED:

    http://news.bbc.co.uk/2/hi/uk_news/england/west_midlands/8690785.stm

    This is very simple. JW’s NEEDLESSLY die for this sorry blood policy today.

    From the same organization that has an entire 100 + year history of similar bad and embarrasing policies.

    Please read my own detailed examinations about the JW blood policy. As a 15 year active and Zealous person for Jehovah (and elder) here is my own story:

    http://exjehovahswitnessforum.yuku.com/topic/922#.USEl4aWhDHh

    And an even more comprehensive list of reasons why the JW blood policy is just plain wrong, written afterwards:

    http://www.jehovahs-witness.net/watchtower/medical/150613/1/WT-SOCIETY-IS-WRONG-ON-BLOOD

    So in summary then, when I add up all of the facts:

    That blood transfusions are not the same as eating blood.

    That Jesus himself clearly emphasized the value and importance of “MERCY” and “LIFE” over the unnecessary “Sacrifice of Life” at Matthew 12:1-14

    That the scriptures themselves are always referring to the “Eating or Drinking” of ANIMAL blood that is forbidden (not transfusions).

    How Paul shows at 1 Corinthians. 8:4-8 that the Acts 15:29 command is not all encompassing command but had a particular purpose.

    That Saul’s men were not killed after eating blood.

    How the Strictest of Jews today (not allowing ANY BLOOD in their foods, demanding Kosher instead), DO Allow blood transfusions to be taken.

    That no other religion on earth forbids blood transfusions based on what the bible actually says.

    That Jesus clearly demonstrated how life (even that of an animal) was more important than a narrow, strict interpretation of the law, with the “animal that fell into a pit on the Sabbath” illustration he used, and the “Woman with a flow of blood” real-life example.

    How the one donating blood is a LIVE donor (not a dead animal) and offering this blood to another person that is ALSO alive and in need.

    That the Watchtower Society was COMPLETELY WRONG before about forbidding vaccinations and organ transplants for many years, and then actually REVERSED these decisions now allowing BOTH. Many loyal Witnesses nonetheless died from such stands coming down as ‘FOOD FROM GOD’. They were clearly wrong then and are wrong again.

    This is the SAME Watchtower Society that also predicted and announced IN WRITING that the end of the world would come on 1914, again 1925, would probably come in 1975, and also promised the end would come before the generation of 1914 passed away (even had it quoted in each Awake masthead before dropping it in 1995), stated it would come within the 20th century and even MORE. Jehovah’s Witnesses truly are know the world over for their false predictions.

    And, the Society has now changed its position on Blood ONCE AGAIN, instead of saying no to all blood, to now say “fractions” of blood are acceptable, even though the particular fractions approved and disapproved seem to have no particular rhyme or reason and we are still not allowed to donate blood nor store their own. Though they can use cow’s blood (Hemopure).

    It seems fairly easy for me then (and most open-minded think people), to come to the conclusion that they simply cannot support the JW position on blood transfusions.

    Did ((( GOD ))) make all of these terrible decisions to force on all the JW’s as “food at the proper time”, and then change his mind later on?

    Or was is just a bunch of MEN, that make up the Governing Body of Jehovah’s Witnesses (sitting up in some Brooklyn office somewhere) making these poor decisions, FORCING them on all JW’s and then afterwards conveniently change their mind?

    Which is why I simply left the religion.

    And now, because I walked away, they all are demanded to shun you for life (including your own family) or they too will end up being cut-off and shunned.

    Which is why sharing my own story and experience on sites like this is a worthwhile thing to do.

    To anyone who is a JW or thinking about becoming one: Please examine, examine, examine and ask as many questions as you can!
    Vinny

  • GCT

    Perhaps I am missing something here, but if the procedure fails and the patient dies, isn’t that lung now available for someone else?

    Not a doctor, but it appears that the answer is no.
    http://www.transweb.org/faq/q24.shtml

    There would not be sufficient time for most organs to get another recipient on the table and ready to receive this organ that someone couldn’t take because of their irrationality and superstitions.

  • Danny Haszard

    Jehovah’s Witnesses *blood transfusion confusion*.

    In 2013 God’s will and scripture has little to do with the Jehovah’s Witnesses position on use of blood products.
    The JW leadership is foremost concerned what will play out in a secular court of law as to the parent Watchtower being held liable for wrongful deaths.
    Most Jehovah’s Witnesses rushed to the ER with massive blood loss will cry NO BLOOD right up to their last breath.

    The shocker is they can now have most of the blood components that will pull them through,but they are so indoctrinated that blood is forbidden that they can’t comprehend the loopholes.
    The Watchtower has drilled and grilled us that our stand on blood is NON NEGOTIABLE.
    The loopholes that allow blood usage is to save the Watchtower corporation money from blood death liability suits.
    This is a truly evil organization that would sacrifice tens of thousands of men,women,children for the almighty dollar.
    The blood products ban has been in force since 1945 the buzz today about it being a *personal conscience matter* and the hope of new medical advances like artificial blood don’t undo all those who have past perished.
    The New York city based Watchtower sect is concerned foremost with liability lawsuits for wrongful death.They know that if they repeal the ban on *whole* blood transfusion,that it will open the door for legal examination of all the thousands who have died since 1945.

    Cults do get people killed!
    50-100 times as many men,women,children have been killed by the Watchtower society ban on *whole* blood transfusions than at Jonestown kool-aid mass murders.
    *tell the truth don’t be afraid*

    Danny Haszard Bangor Maine FMI
    http://www.ajwrb.org/articles/articles/really_abstain.php

  • Keith Collyer

    @ctcss: Unless the other patient was already prepped, there probably wouldn’t be enough time. Organs don’t stay viable for that long once removed, even when they have been put on ice

  • Tak

    I am of the firm opinion that organ transplants should be denied to ANYONE who jeopardizes the successful outcome of their transplant by refusing medically necessary care or not following their doctors advice.
    That we’re even discussing whether or not someone who abuses the gift of a donated organ should be given a transplant makes me consider revoking my organ donor status*. I don’t want my perfectly good liver going to someone who will just waste it.

    -Tak

    *rhetoric people, I still want them to harvest my organs. I just wish there were some way I could ensure that my donated remains are not wasted.

  • http://rickdalbert@me.com Rick

    Wow. It’s 2014, a dozen guys walked on the moon, Stephen Hawking is still alive and working and these nitwits are running on about a Misreading of 2500 year old fairy tales. Truly lethal stupidity.

  • RR

    Obviously, it is so strange that some one would accept an organ transplant but not a blood transfusion.

    But I doubt this is much of an issue in the organ transplant world. I attended a lecture by a leading nephrologist. He is an advocate of a regulated kidney market, but I digress. The surgeons and social workers involved put a LOT of effort and thought into choosing candidates for a transplant. Qualifying candidates remains a very subjective task. But in the vast majority of cases, any refusal by the patient to accept additional care to preserve life (and the organ) would surely disqualify him/her from consideration.

  • Bdole

    If blood transfusion = ingestion, how are they able to accept organ transplants? Isn’t that cannibalism?

  • Rike

    I don’t know much about Jehovah’s Witnesses, but I assume that, like most other christian religions, they are against medical euthanasia or “Choice in Dying”. I wonder, then, why they would be allowed to choose to die even if they could have a long and healthy life by accepting a blood transfusion, when a person in critical condition and maybe in crucial pain who only might have a few weeks or days to live, is not allowed to cut their suffering?

  • Michael

    I’ve heard about people with inoperable cancer. Clearly the doctors have assessed the patient’s condition, decided an operation will probably be unsuccessful, and ruled against it. If a JW is not prepared to accept a blood transfusion then could not the doctor declare that the operation will probably be unsuccessful, and rule against it?

  • Slane

    Why not tell the JW that if they die on your operating table you will be harvesting their organs? It might be worth losing one viable lung for a couple of kidneys, a liver, etc?

  • http://www.patheos.com/blogs/daylightatheism/2013/01/breaking-the-surface/ J. James

    Had I been a Jehovah’s Witness, I would be dead by now. I can only imagine the trauma the poor doctors have to live with. They’re dead, they obviously don’t care anymore; but how dare they cause surgeons to shoulder such immense guilt?

  • matt

    Everyone here seems to think that blood transfusions are ‘medically necessary’. If you read the original article and the many others about doctors and hospitals providing these techniques, you will find they feel they are better. If not for JW’s refusal of blood how long would doctors have continued to cause more truama than is absolutely necessary. How long would they have continued to put patients at risk of infection, immune suppression and mistakes associated with transfused blood? Doctors are beginning to avoid blood where they can, and if the people who farced medical personell to pioneer techniques that now make medecine and surgery safer seem a bit too zealous, maybe you should just accept it and stop insulting them.

  • Shoebutton

    A couple of good news on the transplant front:
    Livers being kept alive outside a body for 24 hours:
    http://www.guardian.co.uk/science/video/2013/mar/16/liver-kept-alive-transplant-video
    Can you imagine printing new parts? 3d Printing opening up doors:
    http://www.ted.com/talks/anthony_atala_printing_a_human_kidney.html
    Science never ceases to amaze me.

  • j

    Tell that to all dead jws or tell it to the ones who died because of refusing organ donation which wt gods later decided to drop that lie.wake up and grow up.


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