Cardiac surgery in Jehovah's Witness children: Clinical characteristics and outcomes from a limited single-center cohort.

BACKGROUND

Jehovah's Witnesses (JWs), a religious group with over 9 million members globally, refuse allogeneic blood transfusions on religious grounds. Awareness of this population and their unique medical needs remains limited in India, particularly within the pediatric cardiac surgical context. Managing such patients poses legal, ethical, and clinical challenges. This study aims to describe the clinical profile, perioperative management, and outcomes of JW children undergoing cardiac surgery at a tertiary center.

METHODOLOGY: A retrospective cohort study was conducted at a tertiary care hospital in Bangalore, India, including all pediatric JW patients who underwent cardiac surgery between 2019 and 2024. Data were collected on demographics, diagnoses, perioperative hemoglobin levels, blood-conservation strategies, postoperative complications, and outcomes.

RESULTS

Ten JW pediatric patients underwent cardiac surgery during the study period, including six infants. Seven had acyanotic congenital heart disease, whereas three had cyanotic defects. The mean preoperative hemoglobin and hematocrit were 13.1 ± 2.3 g/dL and 36.7% ± 5.2%, respectively; postoperative values were 10.3 ± 1.2 g/dL and 28.6% ± 3.9%. Blood conservation measures included postoperative recombinant erythropoietin in five patients and tranexamic acid in seven. There were no mortalities, and most patients had an uneventful recovery.

CONCLUSIONS

Pediatric cardiac surgery in JW patients can be performed safely and effectively when a structured, multimodal blood conservation strategy is meticulously applied. Increased awareness and preparedness among clinicians are essential for optimizing outcomes in this unique population.