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‘Bloodless’ Lung Transplants Offer Hint at Surgery’s Future (nytimes.com)
38 points by interconnector 1520 days ago | hide | past | web | 21 comments | favorite

As good of an idea as reducing transfusions is, I can't help but think that this is the wrong way to do it.

> He said his focus was intensified by the knowledge that if a patient died for lack of blood, a second life might hang in the balance — the wait-listed patient who would otherwise have received the organ.

Doctors should not be adrenaline junkies playing with other peoples' lives, especially those who aren't even their patient. This looks like a pretty clear breach of the ethics I expect from doctors.

There's nothing wrong with acknowledging the base motivations that drive people so long as clear ethical decision procedures are maintained. The typical neurosurgeons relishes pressure much more than the average human, and this is a contributor to them entering the specialty and to them being successful at it. (My father is a neurosurgeon.) Those kind of personality traits should be harnessed for good rather than eliminated.

This isn't to say that a doctor's decisions can't be colored. Evidence-backed, community accepted guidelines are very desirable, as are second opinions. But once the decision is made that someone needs surgery, I would want a guy who's excited to operate.

And yet, his behavior – whether driven by thrill-seeking or a desire to help an under-served population of Witnesses or some combination of both – is driving innovation that will soon benefit those with conventional appetites for risk and consensus treatments.

If your proposed standard of ethics were strongly enforced, such progress would stop.

The 'right-thinking' mainstream can easily become inbred and inflexible – especially so in medicine. The occasional surprise successes of nuts and daredevils are a necessary corrective, so their deviations from the norm should be respected (and perhaps even celebrated), not disciplined.

> By cherry-picking patients with low odds of complications, Dr. Scheinin felt he could operate almost as safely without blood as with it.

And what does he suppose the odds would be if he applied the same cherry-picking whilst operating with the option of a blood transfusion?

I'm not necessarily advocating for reliance on blood transfusions here, but the logic (and ethics) of this seem highly questionable.

I think the point is that if you have few complicating factor, then the risk of the bloodless (vs. normal) surgery is much reduced and possibly acceptable. On the other hand, if you have these factors, then the additional risk might be too high. I think you might just be responding to the loaded word "cherrypicked"; the poor wording is chosen by the NYTimes, not the doctor.

People willing to have a blood transfusion already have plenty of options, so factor them out of your analysis. (They are already 'cherry-picked' by every other doctor.)

Among those who would prefer not to receive blood, should the doctor be experimenting with this novel approach on all patients, without regard to a risk of complications? How would that be more ethical?

The transfusions carry their own risk. So if you cherry pick properly you can end up where using a transfusion gives more risk than not.

Also, when you start a new technology you always do the low hanging fruit first, so cherry picking is pretty normal and reasonable.

I don't really see what is so interesting about this. As I understand it those are just normal lung transplants, the difference is that you simply select patients so that complications that would require blood transfusions are minimal, to keep everyone concerned about the ethics of it happy.

It might be somewhat helpful to have doctors who are less trigger happy when it comes to giving blood transfusion but I don't see how that is particularly innovative or hinting in any way at the future. This only helps a couple of not too ill people who want to keep their imaginary friend happy.

You can think that this is insane, but because Jehovah's Witnesses being stubborn about blood transfusions, much progress has been made in bloodless procedures. Most of the time they cost less, and there are less complications after the procedures. Even the US army was interested lately [1] in how to incorporate these procedures.

Full disclosure: I'm a Jehovah's Witness.

[1] http://www.youtube.com/watch?v=JAWhRqCjT9w

It's not insane that progress is being made -- that's pretty sensible (because more guinea pigs = more data, and in normal circumstances patients don't volunteer for more dangerous paths). Deciding to be the guinea pigs is... well, not insane (people simply don't behave logically much at all, for religious as well as non-religious reasons), but sure, somewhat foolish.

In this case, JWs are presenting themselves as the control group for experimenting with blood transfusions... in a "study" that would be utterly unethical.

Imagine a doctor that refused a blood transfusion that would normally be called for in a serious surgery, because the patient was part of a study and fell into the "no transfusions even in dire need" group.

A randomized study like that is (still) impossible and unethical, but because we have this group of people who place themselves onto the higher-risk path, doctors can test out the actual boundaries of where transfusions are needed -- and indeed, seriously advance the science.

The Jehovah's Witnesses are at higher risk, and more of them will die because of this decision, but we're getting quite useful data in the meantime.

You mentioned the Army -- medicine is also advanced by the normally-unethical medical approaches to medicine that are required by battlefield medicine. There's some overlap with the real requirements there, and the self-imposed requirement of JWs refusing transfusions that actually are available -- so certainly they'd be interested.

Now we just need a new L Ron Hubbard to invent a religion that requires adherents to go all the way -- and always take the most-data-rich path through medical treatment -- then we'll be making progress in leaps & bounds (though of course more guinea pigs will die along the way).

> The Jehovah's Witnesses are at higher risk, and more of them will die because of this decision, but we're getting quite useful data in the meantime.

The article mentions that there's some evidence that transfusions carry their own risk. How closely has this been studied, and what are the risks? Without accurate knowledge of that, how can we make definitive statements as to the negative repercussions to people that opt out of transfusions?

Additionally, I fail to see how more Jehovah's Witnesses die because of this decision, which allows the operation to continue, when the alternative is that they don't get the procedure at all, which I believe results in death?

Because of their decision, certainly more will die that could have lived.

The grey area, where getting a transfusion might actually be riskier than not getting one, is what they're finding out more about. That's useful to know.

There are also cases that are not at all grey areas, where refusing transfusions means they will die. They're still refusing them (and unfortunately, that death doesn't provide any useful data, beyond "yes, what we were sure would happen, happened").

What's up JW buddy.

It should be noted that there's a lot of hospitals / medical centers that have bloodless surgery programs.


If this many are doing, it can't just be crazy person talk, there must be some real benefit.

>You can think that this is insane, but because Jehovah's Witnesses being stubborn about blood transfusions, much progress has been made in bloodless procedures. Most of the time they cost less, and there are less complications after the procedures

I feel I read that somewhere recently...

I don't know if you can register that your organs only go to people of a particular group (religious beliefs, for example), but if that is possible then it would solve the ethical issue of giving an organ to someone who is a less suitable candidate (due to them refusing other life-saving treatment in the case of complications). Just have the various religious groups put on their organ donation form that they are to be donated only to others with similar beliefs.

It seems bizarre that they would allow an organ transplant but not a blood transfusion.

They believe that the protestant canon of the bible is the inspired, inerrant word of god, and that it should be taken literally. All commandments given should be followed without question.

One such commandment is in acts 15:28-29:

    For it seemed good to the Holy Ghost, and to us, to lay 
    upon you no greater burden than these necessary things;

    That ye abstain from meats offered to idols, and from 
    blood, and from things strangled, and from fornication: 
    from which if ye keep yourselves, ye shall do well. 
    Fare ye well.
For them, that's enough. Since organs are not mentioned, they are A-OK.

If you really want to get technical, it's a dietary restriction rather than a medical one. They're not allowed to eat blood, and consider transfusions a form of "eating."

This is what the United States was founded on. Jumping through hoops to respect other peoples' beliefs even when they make no sense to you.


as it mentions in the article, there is " a growing body of research that transfusions often pose unnecessary risks and should be avoided when possible, even in complicated cases".

It is an interesting read, especially in terms of the surgeon's framing of the ethical question. I just wish medicine focused more on helping people keep their own organs functional. But that isn't heroic and headline-worthy. Sigh.

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