Publisher Summary This chapter focuses on the management of patients who refuse blood transfusion usually based on religious beliefs. A minority of patients for example, Jehovah's Witnesses, refuse blood transfusion as they believe that the Bible prohibits the consumption, storage, and transfusion of human blood. While standard transfusions are unacceptable to these patients, there are some related procedures that are not prohibited but not promoted including plasma exchange, dialysis, intraoperative blood salvage, hemodilution and blood donation strictly for the purpose of further fractionation of components. The right of a competent adult to refuse consent for medical treatment is accepted and documentation of refusal for transfusion should be placed in medical record. Some specific circumstances that require additional consideration are mentioned and include, trauma, pregnant women and children and blood management. A table is presented that illustrated the Jehovah's Witness religious position on medical therapy including the acceptable and unacceptable treatments and personal decision.