A 51 year old Jehovah's witness undergoing an elective AAA repair. He stated pre-operatively that he did not wish to undergo allogenic or autologous transfusion and this was appropriately documented during the consenting process. However, during the procedure there is significant back-bleeding from some large lumbar vessels and then is further massive bleeding from the top end anastomosis which necessitates re-clamping. The patient will not survive without a transfusion.