Reconsidering blood refusal: Implications of updated Jehovah’s Witness acceptance of autologous transfusion

Refusal of blood transfusion has historically been associated with members of the Jehovah’s Witness (JW) faith. As such, a range of transfusion-sparing strategies have been developed for these individuals and others who refuse standard blood transfusion. Techniques that maintain blood in continuous circuit with the patient are often acceptable and have been used in operative settings, including cell salvage and acute normovolemic hemodilution. By contrast, blood that has been collected and stored for later use has traditionally been considered unacceptable, which has limited the use of both allogeneic and autologous blood products. A March 2026 update by the governing body of Jehovah’s Witnesses, The Watch Tower Bible and Tract Society of Pennsylvania, moves decisions about the storage and reinfusion of a patient’s own blood into the realm of individual conscience, which may expand the use of autologous transfusion. Given this change, requests for autologous transfusion from JW patients may increase. In this letter, we offer practical guidance on balancing respect for patient autonomy and religious belief with the medical and logistical challenges of autologous blood transfusion.