Human donor organs (living and cadaveric) continue to be in short supply, and many potential transplant recipients die while waiting for an allograft to become available.¹ Because the organ supply is so limited and the offering of organs is based on the generosity of patients and families, proper stewardship of these organs is an ethical obligation for transplant teams, as well as organ recipients. Preventable graft loss must be protected against, and factors that foster preventable graft loss—for example, non-compliance must be proactively contemplated when patients are reviewed as potential transplant candidates. Post-transplant treatment refusal is one example of behaviour that can compromise transplant success.

JEHOVAH’S WITNESSES AS TRANSPLANT RECIPIENTS

It is widely known that one of the most significant teachings of the Jehovah’s Witness church is abstinence from receiving blood transfusions.² Believers derive this tenet from the Bible verse: “You are to abstain from …blood”.³ While blood loss is a risk of transplant surgery, some centres do not view patient refusal of blood transfusion as a transplant exclusion criterion. The first published case of transplantation of a Jehovah’s Witness appeared in 1986 from the University of California Los Angeles heart transplant team.⁴ Since then, numerous other cases (cadaveric and living donor) have been published, including liver,⁵ kidney,⁶ pancreas,⁶ and lung.⁷ For experienced centres with superior blood management skills, transplant can indeed be a surgical success; however, optimal blood management before and during surgery are only two thirds of the patient’s clinical time clock. In the remaining third, the post-transplant period, the patient has received his/her organ, yet the potential for clinical need of blood transfusion remains.

THE DILEMMA

Whether due to postoperative complication, or future illness or trauma, all transplant recipients have …