Author(s): Yorozu T
There are still legal and ethical problems relating to the refusal of blood transfusion due to religious belief of Jehovah's Witness patients. Since general consensus about the anesthetic management of these patients has not been established, the "Guidelines for refusal of blood transfusion on religious grounds" was proposed by the joint committee including Japanese Society of Anesthesiologists in February 2008. The principle of the guideline is that if a patient, who refuses blood transfusion even at cost of life, is 18 years old or above and competent to understand the medical treatment and the adverse effects due to bloodless medicine, doctors may plan and complete bloodless surgery. The same policy is allowed if the patient is 15 years old or above and he/she as well as all the parental authorities refuse blood transfusion. In other cases, the policy of life-saving blood transfusion should be explained to the patients. If a bloodless surgery is planned, precise perioperative strategies to avoid blood loss have to be carried out with the cooperation of all the physicians who care the patient. Anesthesiologists should be carefully prepared for the possible law suits that might lead to unexpected outcomes.