The Transfusion Free Surgery and Patient Blood Management Program (TFS-PBM) started initially as “the Bloodless Medicine & Surgery Program at USC University Hospital and USC Norris Cancer Hospital ” in 1997 to serve the specific needs of the Jehovah’s Witness (JW) community. Basically this meant surgical and medical care of JW patients without transfusion of any major blood components, conservation of blood through limiting blood draws and in some cases augmentation of blood counts with iron, vitamins and hormonal products (growth factors) prior to surgical procedures. What started at Keck USC as a narrowly focused initiative has expanded into a much broader mainstream program in Patient Blood Management that serves non-JW patients using many of the same techniques and processes that were so effective in the “Bloodless Medicine & Surgery Program.”
Many factors and pressures have contributed to the convergence in management strategy of Transfusion-Free Surgery with Patient Blood Management. Some of these drivers include:
- Blood product availability
- Cost of blood products
- Potential disease transmissions through blood products
- Decreased hospital reimbursements for resource utilization
- Lower patient complications (such as infections & cancer recurrences) in non-transfused patients related to the immune suppressing properties of
- Shorter lengths of hospital stay and costs that relate to #4.
Around successful clinical programs a critical mass of people develops that are dedicated to the success of that program. In pioneering a “USC Bloodless Surgery Program” many frontiers had to be faced by champions of this program on behalf of the institution. Not just clinical changes but cultural and administrative changes were required as well. Old perceptions about the threshold and safety of transfusion and the safety of anemia were examined while new technologies were implemented that allowed surgeons and anesthesiologists to create a margin of safety when performing difficult surgical procedures. In the service of the JW community we have built a program that allows effective system-wide tracking of JW patients to avoid inadvertent violation of their beliefs as well as cultural, CME, and QAPI programs that promote clinical efficacy and encourage cultural sensitivity for the JW position.
Over the years we have seen an exponential increase in the number of JW visits to our institution. Because of this growth and our early successes we have expanded our ability to do some of the most difficult tertiary surgical procedures without transfusion. We have published widely in the field of transfusion-free surgery. Not surprisingly, this clinical expansion to the level of tertiary level surgical procedures offers a similar opportunity to non-JW patients. Derived from the experience of the “Bloodless Surgery Program” we commenced the Keck USC Transfusion-Free Surgery and Patient Blood Management” program. The two components of the program share many clinical, administrative, data-tracking, and quality features. Although both JW and non-JW desire to have procedures done as transfusion-free, the conviction of the JW patients is more binding than for those patients in the Patient Blood Management program. Nevertheless the commitment on behalf of Keck USC Hospital’s TFS-PBM program is to strive for a transfusion-free environment for those patients in the mainstream program as well. Leading the way are Rick Selby, M.D., the Program’s Medical Director and Professor of Surgery at USC Keck School of Medicine, and Randy Henderson the administrative Program Director.
“There is no question that it would be advantageous for more surgeons and hospitals nationwide to adopt transfusion-free surgery techniques,” says Rick Selby, M.D. ” There is true value in avoiding transfusions — value that can be realized by all patients.”
Since its inception in June 1997, thousands of patients have been treated in the USC Transfusion-Free Surgery and Patient Blood Management Program. The physicians in our program have amassed expertise in treating patients using the transfusion-free approach in many clinical specialties.
In addition to its success in patient care, our academically-based program has gained significant national recognition for its clinical research. In 1999, after our transplantation team performed the first two successful transfusion-free live donor liver transplantations in the United States, these cases were reported at the 1999 National Bloodless Medicine and Surgery Association meeting and published on the Internet, where they have been accessed by thousands of people all over the world. We also have published numerous studies documenting the feasibility of transfusion-free techniques in major surgical procedures. These studies consistently show faster healing and recovery times in transfusion-free elective surgery. For abstracts of these studies, please visit our Publications and Clinical Research page.
Liver surgery is only one area in which our team has become proficient and well recognized. At USC, transfusion-free techniques have been used successfully in:
- Bariatric Surgery
- Cardiothoracic Surgery
- Colorectal Surgery
- General Surgery
- Hepatobiliary and Pancreatic Surgery
- Minimally Invasive Surgery
- Oncologic Surgery
- Otolaryngology (Head and Neck Surgery)
- Spine Surgery
- Urologic surgery
- Vascular surgery
The Administrative Program Director is Mr. Randy Henderson and the Medical Director of the Program is Dr. Rick Selby. Program organization is through a hospital-based committee termed the Steering Committee for Transfusion-Free Surgery and Patient Blood Management. It meets regularly and reports up through the Blood Utilization & Management Committee (BUMC) which reports to the Medical Staff Committee. The purpose of our committee is to work towards improving the quality of care and patient outcomes within the specialized field of transfusion-free surgery and blood management. The committee is heavily invested in policy development and quality measures for the purposes of improving patient outcomes in a transfusion free environment. Other functions of the committee include nurse and physician education, data tracking, and critical pathways. We are in the process of developing a credentialing mechanism for faculty certification.