Much routine cardiovascular surgery can be performed without blood tra
nsfusion, Complex cardiac surgical procedures, however, especially reo
perations, are often associated with heavy blood loss and large transf
usion requirements. Anaesthetists and surgeons caring for patients who
are Jehovah's Witnesses may be unwilling to offer such high risk surg
ery without recourse to blood transfusion. We report six such cases wh
ich were successfully performed without the use of blood or blood prod
ucts and discuss the techniques used Three of the patients described h
ad been refused surgery, on their terms, at other centres. We believe
that no patient should be denied potentially life saving surgery on th
e grounds of excessive risk without blood transfusion.