Shawnetta Parker lost much of the past few years to a lung disease that left her short of breath, in and out of the hospital and, eventually, barely able to walk from her car to the house.
The diagnosis last fall of pulmonary fibrosis, and the recommendation that she seek a lung transplant, suggested a solution but also posed an untenable choice - her life or her faith.
Parker, 27, and other Jehovah's Witnesses follow the biblical injunction to "abstain from … blood," a belief that for years put organ transplants out of reach because surgeons routinely required patients to agree to a blood transfusion if they decided it was needed.
Parker never considered that, even knowing the surgery was her only chance for a normal life and that no hospital in her home state of North Carolina would agree to a transplant without a transfusion.
"It was kind of scary," she said.
But she received a transplant at Methodist Hospital in Houston earlier this year, the fifth patient in a program offering lung transplants with the promise of no transfusion. A sixth transplant was performed March 4.
"The thing about Jehovah's Witnesses, people are always trying to talk them out of it," said surgeon Scott Scheinin, who started the transplant program here in 2010. "You can't talk them out of it."
Heart surgery in 1960s
The program is just a small part of the lung transplant service at Methodist, which reported 113 lung transplants in 2011. But Scheinin said techniques to minimize blood loss for Jehovah's Witness patients are becoming common practice, helping to protect patients against blood-borne diseases and reducing dependence on donated blood. About 5 million Americans have a blood transfusion every year, mostly to replace blood lost through surgery or injury, according to the National Institutes of Health.
Although the blood supply is screened for diseases, including HIV and Hepatitis C, transfusions can still lead to complications. Dr. Luca Cicalese, director of the Texas Transplant Center at the University of Texas Medical Branch in Galveston, said certain infections and viruses could be transmitted by a transfusion, despite the increased screening.
"We can't screen for what we don't know," he said.
Jessica Varisco, former director of blood management and conservation at St. Joseph Medical Center and a longtime advocate for people seeking so-called bloodless surgery, said interest among patients is increasing.
'Organs are precious'
Most are Jehovah's Witnesses, as is Varisco, but others simply want to avoid the risks of transfusion.
Houston surgeon Denton Cooley was among the first to perform a bloodless open-heart surgery in the 1960s, and the practice gradually caught on. But organ transplants carry an additional risk, due to worries the donor organ will be damaged.
"These organs are precious, and we want to be very careful," Scheinin said.
Laura Frnka, a spokeswoman for the Lifegift Organ Recovery Network, said the organization has not taken a position on bloodless organ transplants.
Blood, like organs, is a resource in limited supply.
"The donor population is getting smaller, and the need for blood is going up," Varisco said. "At some point, there's going to be a situation where there's not blood available."
Special techniques help
Bloodless kidney and liver transplants are offered more widely, including at UTMB, but Varisco said relatively few surgeons perform heart and lung transplants without transfusions.
"These patients, they're treated very badly," said Scheinin. "Medical personnel haven't adapted. They expect the patients to adapt."
So far, the six lung transplant patients at Methodist have done well, although one did accumulate fluid around the heart after surgery. That was treated and not related to the lack of a transfusion, Scheinin said.
Jehovah's Witnesses generally don't accept transfusions of donated blood, nor do they bank their own blood prior to surgery.
But Scheinin said most allow some blood to be withdrawn at the start of a procedure, to be used as needed. He also requires patients to agree to "cell salvage," in which blood shed during the surgery is collected, cleansed and reused.
Cicalese said attention to surgical technique can reduce the risk of bleeding and improve results.
"Surgery goes smoother, the patient will go home faster, with fewer problems," he said.
Decreased anemia risks
After surgery, limiting blood drawn for testing lowers the risk of anemia, which Scheinin said was first considered for Jehovah's Witness patients but is now done more widely.
For Parker, the past few months have been an acknowledgment that following her faith did not mean she had to give up on medical care.
Last month, she left Houston for a brief visit home. And after pulmonologist Harish Seethamraju pronounced himself "really impressed" with her improving lung function when she returned earlier this month, she was allowed to leave again, this time for six weeks.
Now, she is thinking of the future. She hopes to return to her job as a food stamp caseworker.
And she has another goal, this one involving Anthony Tune, the man she met as her health began to fail.
"Marriage," she said with a laugh. "I almost forgot."