PREFACE
Bloodless or transfusion-free surgery was introduced to serve the Jehovah’s Witness community, who for religious reasons, refused transfusion of blood products even at the risk of their own lives. The above-mentioned technique is relatively new and unknown in the medical community. Historically, the issues related to transfusion focused on ethical, legal, and religious topics and not on the real problem, which is, the liberal use of blood products. The medical community perceives blood as plentiful, safe, and inexpensive, and thus little effort is paid to conservation, improvement, or development of alternatives. This view of blood is somewhat analogous to the view of energy: Oil is seen by the public as plentiful, safe, and inexpensive; however, like blood, oil is a limited resource, is expensive, and carries significant health risks from pollution and cancer.

As far as blood is concerned, ...

... our lack of interest is no longer an option given that the discovery of hepatitis C and HIV as viruses potentially transmitted by blood and the anxiety surrounding potential pathogens such as West Nile virus, mad cow disease, and SARS, have increased the awareness of the risks of transfusion.

Principles of transfusion-free surgery were originally driven by the Jehovah’s Witness community; but it should be a nidus for a wide change in the practice of medicine and surgery. Despite the stringent criteria for ever-safe blood donor screening, collection, and administration, blood will never be absolutely safe, and even a small percentage of risk will translate into major healthcare problems.

Since 50% of blood transfusions are prescribed by surgeons, physicians in general and surgeons specifically have the responsibility of objectively assessing the risks, availability, and cost of blood products. We have the responsibility to be at the forefront of adopting strategies to limit blood loss, to decrease the risk of transfusion, and to develop alternatives to blood products. Wide adoption of these innovations will yield higher standards of patient care.

I hope this manuscript will serve as a guide for blood conservation in medical and surgical practices. If every physician adopts part or all of these principles, less blood would be needed, and despite the ongoing shortage of potential blood donors, no elective surgery should ever need to be canceled due to the lack of blood.

Nicolas Jabbour