Transfusion Ethics in a Pediatric Jehovah’s Witness Trauma Patient: Simulation Case

This simulation-based learning activity presents an urgent perioperative scenario involving a previously healthy 12-year-old trauma patient with suspected intra-abdominal hemorrhage requiring emergent surgery. The patient and family refuse blood transfusion due to religious beliefs as Jehovah’s Witnesses. During the procedure, the patient becomes hemodynamically unstable from ongoing blood loss. Learners must manage acute hypovolemic shock while navigating a complex ethical dilemma involving parental refusal of life-saving treatment for a minor.

The activity challenges participants to integrate clinical resuscitation skills with ethical reasoning and professional communication. Specifically, learners must determine when beneficence overrides parental autonomy in emergent situations and advocate for the patient’s best interest despite opposition from another healthcare provider (confederate surgeon). The scenario reinforces decision-making related to transfusion practices, pediatric consent, and interprofessional conflict management in time-critical environments.

Target Learners 

• Anesthesiology residents 

• Senior medical students (clinical years) 

• Pediatric anesthesia fellows 

• Emergency medicine residents 

• Surgical residents involved in perioperative care 

• Interprofessional learners participating in operative or trauma teams 

Recommended for trainees with foundational knowledge of: 

• Rapid sequence intubation 

• Hemodynamic monitoring 

• Pediatric Advanced Life Support (PALS) principles 

• Basic perioperative transfusion practices 

Equipment Needed 

• High-fidelity pediatric patient simulator (manikin) 

• Simulated operating room environment 

• Anesthesia workstation 

• Standard patient monitoring equipment: 

• • ECG 

• • Pulse oximetry 

• • Non-invasive blood pressure 

• • Arterial line setup 

• Airway management equipment: 

• • Endotracheal tubes 

• • Laryngoscope 

• • Rapid sequence induction medications 

• IV access supplies 

• Simulated crystalloid fluids 

• Simulated vasopressors 

• Simulated packed red blood cells (PRBCs) 

• Defibrillator/crash cart (for PEA arrest management) 

• Confederates: 

• • Surgeon role 

• • Patient voice (optional) 

Estimated Time to Complete Activity