Resection of Metastatic Liver Cancer in a Jehovah's Witness Patient: A Case Report

Masaki Kaibori, Kosuke Matsui, Takamichi Saito, Shigeyoshi Iwamoto, Kazuhiko Yoshioka and Yasuo Kamiyama

Department of Surgery, Hirakata Hospital, Kansai Medical University

A 53-year-old woman admitted in March 2006 with multiple metastatic tumors involving both hepatic lobes following after colorectal cancer surgery. Refused allogeneic blood transfusion or the use of albumin due to her beliefs as a Jehovah's Witness. After being informed of acceptable methods of diluted and salvaged autologous blood transfusion, she signed a liability waiver. She signed a liability waiver involving a preoperative contract between the patient, surgeon, and anesthetist for conducting transfusion-free surgery. During hepatectomy to remove five metastatic tumors, she underwent transfusion of 650 mL of preoperatively diluted autologous blood and 500 mL of intraoperatively salvaged autologous blood. Surgery took 8 hours 43 minutes and the volume of blood lost was 1,015 mL. Her preoperative hemoglobin level decreased from 12.2 g/dL to 8.9 g/dL and serum albumin from 4.1 mg/dL to 2.0 mg/dL immediately after surgery, and shewas discharged on postoperative day 13 in good condition. Cautions should be exercised in determining the suitability of special patients such as ours for hepatectomy, but full informed consent and careful perioperative management should, as we found enable hepatectomy designed to effect a complete cure.

Key words
Jehovah's Witness, hepatic resection, transfusion-free

Reprint requests
Masaki Kaibori Department of Surgery, Hirakata Hospital, Kansai Medical University
2-3-1 Shinmachi, Hirakata, 573-1191 JAPAN

Accepted
January 30, 2008

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