When his acid reflux became intolerable and an endoscopy confirmed a diagnosis of Barrett’s esophagus, Peter Velarde knew surgery was inevitable. So Peter, a retiree from Frederick, Md., began a very methodical search for just the right surgeon. Of course, he wanted a skilled and experienced practitioner with a solid track record of success. But finding a surgeon who also respected his religious beliefs was just as critical.
Peter is a Jehovah’s Witness, and he follows an important tenet of his faith forbidding blood transfusions. “I spoke with the D.C. area’s Witness Hospital Liaison Committee for the names of surgeons who understood my position on bloodless surgery—and I did research myself,” Peter explains. "I made appointments with three area surgeons, but after my second meeting, I canceled the third."
Peter had found MedStar Georgetown surgeon Stephen Evans, MD. "When I asked him if he was agreeable with the Jehovah’s Witness stand on blood, he told me he had just toured the center for bloodless surgery in New York," says Peter. "You could see the glow in my eyes when he said, ‘It’s a good thing.'"
That "good thing" is now a new initiative at MedStar Georgetown’s Bloodless Medicine and Surgery Program, made possible by a generous grant from the New York Community Trust. It is the first center of its kind in Washington, D.C.
What is Bloodless Surgery?
Bloodless surgery is designed for people whose religious beliefs or personal preferences exclude the use of blood transfusions. It employs:
- Procedures focused on reducing blood loss and eliminating the use of allogeneic blood transfusions—those using donated blood.
- Techniques to reduce the need for blood transfusion:
- Medications that increase the production of red blood cells and blood volume
- Medications to decrease bleeding and promote clotting
- Autologous blood salvage, a medical procedure in which a patient’s blood is recovered and reinfused during surgery
- Autologous blood donation, in which the patient’s blood is collected before a scheduled surgery
- Minimally invasive surgical techniques, such as laparoscopic procedures that use a miniature video camera and surgical instruments inserted through small incisions
- Surgical techniques such as lasers and electrocautery to promote blood clotting and seal vessels at a surgical site
Dr. Evans explains that many patients request bloodless procedures. “This reflects a shift in medicine today. We are more sharply focused on reducing blood loss and eliminating the need for blood transfusions across the board. It’s simply good medicine since it addresses concerns about blood-borne diseases.
“Most surgeries do not result in blood loss that requires transfusions, Dr. Evans explains. “But there is a small subset of procedures that can result in serious blood loss, such as surgery of the gastrointestinal tract and organ transplantation. We have developed many techniques to minimize blood loss, as well as alternatives to transfusions. In fact, a number of these innovations have come out of research conducted by the Jehovah’s Witness community,” Dr. Evans notes.
There are medications that increase the production of red blood cells and blood volume, as well as drugs to decrease bleeding and promote clotting. A patient’s own blood can be collected and recycled during surgery. And surgical techniques can be used to coagulate blood and seal vessels at a surgical site, eliminating the need for transfusion, explains orthopaedic surgeon Mark Zawadsky, MD, medical director of MedStar Georgetown’s program.
"This really is about treating the whole patient—physically and spiritually,” Dr. Evans adds. “And while there is a large group of people in the area who request blood conservation methods for religious reasons, no one wants to have a blood transfusion. We know that blood conserving techniques help shorten hospital stays, reduce the risk of contamination and decrease the cost of care. They are a win-win for everyone."
It proved a win for Peter, whose February surgery was very successful—with no need for blood transfusion. “I’m feeling great,” he says. “Techniques that resulted from our spiritual needs are now helping to advance medicine. I’m delighted to know that Georgetown is taking the lead in this important work.”