A variety of bloodless surgical techniques have been developed for use on patients who refuse blood transfusions for reasons that include concern about AIDS, hepatitis, and other blood-borne infections, or immune system reactions.^[28] Many physicians have expressed a willingness to respect patients’ preferences and provide bloodless treatment^{[29][need quotation to verify]} and about 200 hospitals offer bloodless medicine and surgery programs for patients who wish to avoid or limit blood transfusions.^[29] Bloodless surgery has been successfully performed in significant procedures including open-heart surgeryand total hip replacements.^[30] A 2012 study in JAMA Internal Medicineconcluded that “Witnesses do not appear to be at increased risk for surgical complications or long-term mortality when comparisons are properly made by transfusion status. Thus, current extreme blood management strategies do not appear to place patients at heightened risk for reduced long-term survival.” The study also stated that “Survival estimates of Witnesses were 86%, 69%, 51%, and 34% at 5, 10, 15, and 20 years after surgery, respectively, vs 74%, 53%, 35%, and 23% among non-Witnesses who received transfusions.”^[31]

Bloodless medical and surgical techniques have limitations, and surgeons say the use of various allogeneic blood products and pre-operative autologous blood transfusion are appropriate standards of care for certain patient presentations.^[32][33] The Watch Tower Society states that in medical emergencies where blood transfusions seem to be the only available way to save a life, Jehovah’s Witnesses request that doctors provide the best alternative care possible under the circumstances with respect for their personal conviction.^[34] The Watch Tower Society has acknowledged that some members have died after refusing blood.^[35]

In some countries, including Canada and the United Kingdom, a parent or guardian’s decision can be legally overruled by medical staff. In this case, medical staff may act without consent, by obtaining a court order in a non-emergency situation, or without such in an emergency.^[36][37] In Japan, a doctor must respect the wish of an adult but can override the wishes of a child and their parents if the child is under 15. If a child is aged 15 to 17, a doctor will not perform a transfusion if the parents and the child refuse the transfusion. If a child aged from 15 to 17 objects to a transfusion but the parents demand the transfusion, then a doctor can override the child’s wish.^{[citation needed]} In the United States, the American Academy of Pediatrics recommends that in cases of “an imminent threat to a child’s life”, physicians in some cases may “intervene over parental objections”.^[38]

In 1988, the Watch Tower Society formed Hospital Information Services, a department to help locate doctors or surgical teams who are willing to perform medical procedures on Witnesses without blood transfusions.^[39] The department was given oversight of each branch office’s Hospital Information Desk,^[40][41][42] and of one hundred Hospital Liaison Committees established throughout the United States.^[43][44] As of 2003, about 200 hospitals worldwide provide bloodless medical programs.^[29] As of 2006, there are 1,535 Hospital Liaison Committees worldwide coordinating communication between 110,000 physicians.^[44][45]

Hospital Information Services researches medical journals to locate information on the availability and effectiveness of bloodless surgery methods.^[46] It disseminates information about treatment options to local Hospital Liaison Committees, and to doctors and hospitals.^[45]

Annually since 2004, Jehovah’s Witnesses in the United States have been informed that “with your consent, the law allows for the elders to learn of your admission [to hospital] and provide spiritual encouragement”,^[47] but that “elders serving on a Patient Visitation Group [could] have access to your name” only if patients made their wishes known according to the Health Insurance Portability and Accountability Act (HIPAA).^[48]

Jehovah’s Witnesses’ branch offices communicate directly with congregations regarding “ways to benefit from the activities of the Hospital Liaison Committee (HLC) and the Patient Visitation Group (PVG).”^[49] A Jehovah’s Witnesses publication in 2000 reported that Argentina had fewer than a hundred HLC committeemen “giving vital information to the medical community”, adding that “their work is complemented by hundreds of other self-sacrificing elders who make up Patient Visitation Groups that call on Witness patients to help and encourage them”.^[50] Each branch office appoints PVG committeemen, who serve as volunteers.^[51][52]