Cows and Pigs, by Rob Purvis, WikiCommons
In this issue of General Surgery from November 2009, a doctor tried to answer a question he had never received before. A female patient, a Jehovah’s Witness, wanted to know if she could have a biologic mesh for a hernia repair implanted without violating a religious conviction?
A research fellow at Washington University in St. Louis realized that there were no guidelines for surgeons on which religions might accept or reject biologic or animal meshes, so he launched a research project into religious preferences over biologic meshes. There was no inclusion of plastic, petroleum-based mesh which is often the first choice for hernia repair.
It turns out that The Church of Jesus Christ of Latter-Day Saints and Jehovah’s Witnesses gave broad responses to the inquiry, and had no opinion on the matter.
Catholics and Methodists are opposed to any medical product if aborted fetus tissue or embryonic stem cells are used but consider porcine and bovine acceptable.
Under Jewish law, the consumption of pork is prohibited but there are no laws regarding the use of non-kosher products. And there is no restriction on any products for Muslims even though they have restrictions on consuming beef and pork, as do Islamic principles.
What should surgeons say to their patients about race and religion and the use of biologic mesh in surgery?
“Absolutely, yes, you should tell patients everything. Not only are you legally and ethically obligated, but you also are medically obligated because some patients have allergies,” said Mary H. McGrath, MD, a professor of surgery at the University of California, San Francisco, and editor of Ethical Issues in Clinical Surgery, a publication of the American College of Surgeons.
Biologic meshes include AlloDerm, Flex HD, AlloMax Surgical Graft which all contain cadaver-harvested dermis.
CollaMend, FortaGen, Permacol, Strattice, Surgisis and XenMatriX come from porcine or pig dermis and submucosa. SurgiMend, Veritas Collagen Matrix contains bovine or cow-derived parts.
Other meshes are a composite such as Parietex Composite and C-Qur made with fatty acids from fish.
General Surgery, November 2009: