Former Jehovah’s Witnesses reflect on changes to blood transfusion bans

Lee Elder will never forget when a friend asked him to be one of her pallbearers. At 16 years old, he carried her casket.

Elder and his friends were members of the Tucson Mountain Congregation in Arizona. After Elder’s friend was diagnosed with leukemia, chemotherapy and radiation made her anemic; as a Witness, she refused the standard treatment of a blood transfusion. Combined with her cancer, she only got sicker until she died in 1976 as a teenager.

Elder, the executive director and founder of the Alliance for Jehovah’s Witness Research and Bioethics, stopped being an active Witness in the late 1990s after four decades when the death toll of the transfusion policy became too much to bear. The blood transfusion ban has affected his loved ones since childhood, he said. He’s lost family members, friends and neighbors who denied blood because of it.

In what former Witnesses have called an “erosion” of long-standing policy, Jehovah’s Witnesses are now able to accept component blood transfusions, or isolated forms of plasma, platelets, red blood cells and white blood cells, which are separated from whole blood through a process called apheresis. Bans on whole blood transfusions remain.

The Watch Tower Bible and Tract Society of Pennsylvania, which dictates policy for Jehovah’s Witnesses around the world, announced the change Sept. 18. This update and earlier changes have reversed decades-old policy regarding one of the religion’s most controversial tenets. 

Florida is home to over 300,000 Witnesses, the second most in the U.S. in raw numbers and adjusted population rates according to the most recent U.S. Religion Census. The religion has long-standing ties in Gainesville, where the Stephen C. O’Connell Center was previously home to its Florida district conventions in the early 2010s. The conventions changed locations after 2012 due to rising costs, according to the Gainesville Sun. 

Today, members of the religion can be found across campus in high-traffic areas like The Hub and Turlington Plaza. Tabling Witnesses declined to offer comment for this story. 

Overnight changes to transfusion bans have been hard pills to swallow for current and ex-Witnesses, who frequently write in to the Alliance’s website to recount stories of lost or affected loved ones. Rules that may have contributed to deaths in the eight decades leading up to the overhaul are gone, but those mourning the deceased remain.

“We are talking tens of thousands of lives, and that’s being conservative,” Elder said. “It’s a human catastrophe.”

The policy change was a relief, he said, and will give Witnesses more authority in their healthcare moving forward. He remains hopeful that the remaining bans on whole blood transfusion will be lifted in the future.

However, the changes will disproportionately affect low-resource countries, where apheresis, advanced blood processing facilities and blood component transfusion are not readily available, he said. In low-income countries, just over half of blood collected is separated into components, while nearly all is separated in high-income countries, according to the World Health Organization.

“The burden of this is going to fall on some of the poorest Jehovah’s Witnesses in the world,” Elder said. 

The Watchtower’s transfusion bans trace back to Bible verses mentioning blood, like Acts 15:29, which command Gentile Christians to abstain from eating blood. Although not explicitly mentioned, the Watchtower has historically extended the interpretation of this verse to include receiving or donating blood through transfusions, according to its website. 

Blood transfusion bans, which began in 1945, have become less strict over time. Blood fractions — products further derived from major components, like albumin — were permitted in 1982 after decades of policy flip-flopping. In 2000, sweeping reforms allowed the use of all blood fractions. 

In March, a ban on a medical process known as preoperative autologous blood donation — the preventative collection, storage and transfusion of one’s own blood — was lifted. In September, the Watchtower lifted bans on major blood components entirely. 

Geoffrey W. Jackson, the Watchtower governing body member who announced the Sept. 18 update, cited a lack of scriptural justification for previous policy. Because the specific components of blood are not explicitly mentioned in the Bible, he said, the Watchtower lacks the authority to make policies about them. 

Lingering caution

With the exception of whole blood, the decision to pursue a blood transfusion or donate blood is now up to the individual.

Some Witnesses may continue refusing component transfusions out of tradition or personal concerns related to the practice. 

But others may do so out of fear, said Lee Marsh, a former Jehovah’s Witness who directs patient and family support at the Alliance.

The Watchtower has rolled back changes in the past, she said, making it hard to tell which ones will stick.

“Right now, Witnesses are in this no-man's-land,” Marsh said. “Are they going to change it again and make it more strict tomorrow? They don’t know. So, to be careful, most of them will refuse.”

Going against the Watchtower policies and prohibitions comes with heavy consequences, most notably shunning by other church members, including friends and family. Removal of a Witness — formerly known as “disfellowshipping” — is the loss of a Witness’ community, identity and way of life, Marsh said.

“They’ll say, ‘Sorry, I can’t talk to you,’” she said, recalling her own experience running into a church member at a bank after leaving the religion. The man she saw, the husband of Marsh’s former best friend, left the building as soon as he saw her. 

“They’re afraid that if they are caught talking to me, then they’re going to be thrown out,” she said.

Bloodless medicine

Modern advancements in medicine have made bloodless medicine more viable. 

“To me, whether they’re whole blood or component products, they’re still blood,” said Bruce Spiess, a UF professor emeritus in the Department of Anesthesiology. 

When he was still practicing medicine at UF Health, Spiess said, Witnesses would travel to Florida specifically to see him, an expert in bloodless medicine.

One technology he used — and argues is still underutilized — is cell salvage. Cell salvage is used during surgery to filter lost blood and reintroduce it to a patient, avoiding the need for a transfusion. Because it uses a patient’s own blood, a majority of Witnesses approve of the practice.

When working with Witnesses, he used patient blood management strategies, which focus on treating conditions like anemia before operations, minimizing blood loss and reducing the demand for blood, which is constantly in short supply. 

“[Jehovah’s Witnesses] have a lower mortality rate than do patients who we transfuse,” Spiess said, pointing to the added time physicians take when patient blood management strategies are used. 

Patient blood management occurs before, during and after operations, he said, putting a patient’s health at the center.

“Frankly, those are the kinds of discussions somebody should have with every patient,” he said.

Updated blood policies extend the discussion around patient treatment options and informed consent for Witnesses. It remains to be seen whether new transfusion policies become the new normal, get repealed or expand to allow whole blood.

Elder and other members of the Alliance continue to document the transfusion policy, as an updated official health directive for Witnesses has not yet been released.