Jehovah’s Witnesses, a Christian denomination with millions of members worldwide, decline transfusions of whole blood and its primary components on religious grounds. For nurses, this can raise strong emotions and difficult questions, especially when a patient is bleeding. Yet with good preparation, clear consent processes and modern blood conservation strategies, many Jehovah’s Witness patients undergo major surgery and complex treatment safely.
This guide explains what Jehovah’s Witnesses believe about blood, what they usually decline and what they may accept, consent and advance decisions, alternatives to transfusion, and how nurses can provide respectful care, including in emergencies and for children.
Imagine a pregnant woman admitted in labour who calmly tells you she is a Jehovah’s Witness and will not accept a blood transfusion, even if she bleeds heavily. She shows you a signed advance decision card. You feel anxious: what if she haemorrhages? Your role is not to persuade her, but to make sure the whole team knows, that every alternative is ready, and that her wishes are respected. That preparation may save her life.
The beliefs
Jehovah’s Witnesses base their position on their understanding of biblical passages that instruct believers to “abstain from blood”. For them, accepting a transfusion is a serious matter of conscience and faith, not a casual preference. Most Witnesses hold this belief sincerely, and its importance to their relationship with God should be respected.
What is usually declined and what may be accepted
| Usually declined | Individual decision (ask each patient) | Generally accepted |
|---|---|---|
| Whole blood | Blood fractions (e.g. albumin, clotting factors, immunoglobulins) | Non-blood volume expanders (crystalloids, some colloids) |
| Red cells | Cell salvage during surgery (if in continuous circuit) | Iron, erythropoietin (if not containing albumin, or as individual choice) |
| White cells | Haemodialysis, cardiac bypass | Tranexamic acid and other medicines to reduce bleeding |
| Platelets | Some organ transplants | Surgical techniques to minimise blood loss |
| Plasma | Fibrin glues | |
| Pre-donating and storing own blood |
Positions on fractions and procedures vary. Always ask the individual patient and document clearly.
Consent and advance decisions
- Adults with capacity have the right to refuse any treatment, including blood, even if refusal may lead to death. This principle is recognised in law in many countries.
- Many Witnesses carry an advance decision document (“No Blood” card) stating their wishes.
- Confirm the decision privately, away from family or congregation members, to ensure it is free from pressure.
- Use a specific consent or refusal form if your organisation has one, listing which products and procedures are acceptable.
- Record the decision prominently in the notes and inform the whole team.
Children
Laws on children differ by country. In many jurisdictions, when a child’s life is at risk, healthcare providers may seek legal authorisation to give blood despite parents’ refusal. Organisations should have clear policies, involve senior clinicians and legal teams early, and continue to treat families with respect.
Alternatives to transfusion: patient blood management
- Before surgery: detect and treat anaemia (iron, sometimes erythropoietin), stop medicines that increase bleeding where safe.
- During surgery: meticulous surgical technique, cell salvage if acceptable, tranexamic acid, controlled blood pressure.
- After surgery: minimise blood tests (paediatric tubes, fewer samples), early recognition of bleeding.
- In obstetrics: plan birth in a unit with senior staff and resources, active management of the third stage, rapid escalation protocols for postpartum haemorrhage. See our postpartum haemorrhage guide.
These strategies benefit all patients, not just Jehovah’s Witnesses, and are recommended by WHO as patient blood management.
Hospital Liaison Committees
Jehovah’s Witnesses have Hospital Liaison Committees in many countries, which can support patients and help healthcare teams identify clinicians experienced in bloodless approaches and transfer options. Contact details are often on the patient’s card.
The nurse’s role
- Respect the patient’s beliefs without judgement or pressure.
- Clarify exactly what they will and will not accept.
- Ensure documentation is clear and visible.
- Communicate the decision at every handover.
- Monitor closely for bleeding and anaemia; escalate early.
- Support the patient and family emotionally and spiritually.
- Seek support for yourself if you find the situation distressing.
Conscience and professional duty
Nurses may find it painful to watch a patient decline life-saving treatment. Nursing codes require respect for autonomy and person-centred care. Discussing feelings with colleagues or in debriefs is healthy. See our guide to spiritual care across faiths and nursing ethics.
Frequently asked questions
Why do Jehovah’s Witnesses refuse blood?
Because of their religious understanding of biblical instructions to abstain from blood.
Can a Jehovah’s Witness accept any blood products?
They usually decline whole blood and its four main components; acceptance of fractions and some procedures is an individual decision.
Can an adult be given blood against their wishes?
Generally no, if they have capacity and have refused. Laws vary, so follow local legal advice.
What about children?
Laws differ; in many countries courts may authorise transfusion for a child in a life-threatening situation.
But should nurses try to change the patient’s mind?
No. Nurses should ensure the patient has accurate information and is deciding freely, then respect their choice. Pressure damages trust and can make patients avoid healthcare altogether.
Your next step: Find out whether your organisation has a policy and consent form for patients who decline blood, and where it is kept. Read it before you need it.
Related: Blood transfusion nursing care · Spiritual care in nursing · Nursing ethics
Sources: World Health Organization guidance on patient blood management (2021); published clinical guidelines on management of Jehovah’s Witness patients (e.g. Royal College of Surgeons of England, Association of Anaesthetists); Watch Tower Society Hospital Information Services materials. Follow local law and policy.
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