Questions & Answers regarding Cell Salvage machinery

What is a cell salvage machine?

It is a machine enabling the salvage of blood during an operation.

How does a cell salvage machine work?

Operations will generally involve some blood loss. Using a blood processing device, the physician can utilise the patient's own blood (autologous blood), which is shed and collected during the operation.

What does the machine do for the patient and doctor?

It infuses the patients blood, and other fluids, rapidly during surgery, helping to keep patients alive while giving surgeons the time to complete surgery.

What are the benefits to Jehovah's people?

More machines will be available for use by medical teams treating our brothers and sisters, thus it will be easier for the medical teams to carry out surgery and yet still respect our conscientious determination regarding non-blood medical management. In other areas where machines have been donated a fine witness to Jehovah's name has been given.

What does the cell salvage machine do to my blood?

As soon as an operation has begun, shed blood can be suctioned off the surgical field, collected, and then processed with the cell salvage machine, after which it can be returned to the patient. The red blood cells are first separated from other blood components then washed with a saline solution. The washed and concentrated red blood cells are returned to the patient on immediate demand.

While washing the red blood cells, the cell salvage machine removes any undesirable components, heparin, coagulation factors, and fat.

Does this procedure fall into the category of 'autologous blood' (auto transfusion)?

Yes. The procedure is briefly described in "Questions from Readers" in the Watchtower, March 1, 1989, and October 15, 2000.

Is the use of autologous blood a matter of conscience?

Some uses are clearly out of line with Jehovah's law.

One common use of autologous blood is preoperative collection, storage, and later infusion of a patient's own blood. In layman's terms: Prior to you having surgery, some of your blood is banked, frozen, and stored. Then if you need blood during the operation it can be returned to you. Jehovah's Witnesses DO NOT accept this procedure.

In a somewhat different process, autologous blood can be diverted from a patient, through a machine and then returned to a patient's circulatory system, now becoming a matter of conscience. Cell salvage machinery is used in this use of autologous blood.

We recommend that "Questions from Readers" in the Watchtower, March 1, 1989, and October 15, 2000 are considered by each individual when making a conscientious decision regarding this matter.

Is a cell salvage machine a closed circuit system?

Yes. The patient's blood moves from the body, through the cell saver machine, returning to the patient. The phrase 'continuous circuit' is not necessarily a 'loop'. Whilst the giving set end is 'continuously' connected to the patient from the start, the other end, the wand with the vacuum suction, is in and out of the body cavity during the operation. Sometimes it is necessary for the surgeon to remove the suction device to perform operative movements and then when blood has built up again the assistant will lower the wand to remove the blood. From that description it can be seen that there is not a continuous circuit maintained at all times. In other words, both ends of the tubing might not be in contact with the body all the time but one end is, so there is a closed circuit between the patient and their blood. It would be possible for the giving set end to be connected up at all times and when the operation was over, all the machinery removed and the patient left with the same bag of blood hanging on a stand still in the 'closed' circuit, which might be rather a shock to some.

As with any medical or surgical procedure, the patient should discuss the precise use of the machinery with the doctor to ensure the patient is content that all aspects of the procedure to be undertaken will fall within the bounds of conscience of the patient.

Does the fact that the blood has flowed from my circulatory system into the wound mean it should be 'poured out', like the blood mentioned at Leviticus 17:13?

If an individual believes so he would probably refuse to permit such blood salvage. Yet another Christian might conclude that a circuit with recovery from a surgical site and ongoing reinfusion would not violate his trained conscience.

Are you promoting the use of these machines as acceptable for all of Jehovah's people?

NO. Each one of us is responsible to obtain details from medical personnel and then make a PERSONAL decision. What should predominate our resolve is that we respect God's command to 'abstain from blood' and maintain a good conscience.

Without pre-judging any issue, the committee have noted that a number of brothers would decide to use this equipment if it were available. They have further noted the fine publicity that has arisen when this equipment is donated to local hospitals. The committee have thus felt moved to supervise the collection of funds for this purpose.

In what areas of surgery are cell salvage machines most likely to be used?

Orthopaedic (hip replacement - especially revision hips, knee replacements, other prosthesis surgery); Urological (radical prostatectomy, urological procedures, kidney operations) Vascular surgery related to circulatory system (varicose veins, aortic valve repair or aneurysms, liver and other major organ resections). The machinery can also be used in emergency procedures. With more machines now in use further areas of use are being explored.

How can we be sure the hospitals use the equipment?

The H.L.C. have not been pro active (promoting the use in hospitals) but re active (showing interest in hospitals already using machines or hospitals who are wanting to use cell salvage machines) The H.L.C. have advised the committee of these hospitals.

Who owns the machinery once it is donated?

The equipment is donated to the hospital without conditions. The appropriate NHS hospital trust will become the owner of the equipment.

Who selects the precise model of equipment for the hospital?

Once a hospital has been identified as a suitable recipient for the equipment, the doctors at that hospital will determine the precise make and model to be purchased and donated. We are not promoting any particular make, and feel the doctors are best qualified to decide as to the most appropriate model for their use.

What about training and other on-going costs?

The remit of the North West Group is for the donation of the machinery only. The costs of training staff and other on-going costs will be met by the hospitals that receive the equipment.

Can the machines be moved between hospitals?

The machinery is small enough to be transported in a car or light van, so could be transferred between hospitals. However, the appropriate NHS trust will be responsible for determining its use, and whether or not it will be transferred between hospitals.

Are the machines for use of brothers only?

No, the equipment is donated to the local hospital for them to use at their discretion.

What are the benefits of the hospital using machines on non-witnesses?

Cost: 1 unit of blood cost approx. £100 (soon to rise to £200 and higher) often much more than one unit is used per operation.

Use of a cell salvage costs approx. £60 per operation.

Safety: Many surgeons admit blood is not safe. (New fear over B.S.E.)