Here, we report 77 cases where blood alternatives and surgery were performed in Jehovah's Witness patients, of whom 18 had gastric cancers, 25 had colorectal cancers, and 30 had malignant diseases in hepato-biliary-pancreatic areas. During pancreatoduodenectomy and lobectomy and/or more extended liver resection, the average bleeding exceeded 1,000 ml. From 57 cases of where autologous transfusion was performed, a combination of hemodilution transfusion and salvage transfusion was performed in 15 cases. Twenty-five patients with anemia were treated with preoperative blood augmentation, which enabled planned elective resection. Complications were observed in 7 cases, of which 3 involved anastomosis failure, 3 involved a pancreatic juice fistula, and 1 involved disseminated intravascular coagulation. Two patients died after surgery because of hepatic failure and intestinal perforation. Thus, multidisciplinary management involving autologous blood transfusion for surgery enabled medical treatment of Jehovah's Witness patients.