Background: A Jehovah's Witness is a member of a religious group that forbids the transfusion of any blood component. Major surgery on a Jehovah's Witness is challenging for both the surgeon performing it and the interdisciplinary team caring for the patient. Case Report: In this case, a 56-year-old Brazilian man with lung adenocarcinoma was due for a lower left lobectomy, but being a Jehovah's Witness patient, he refused a blood transfusion. While he refused allogenic blood transfusions, he consented to intra-operative cell salvage and the administration of blood coagulation agents. Discussion: The patient underwent a successful thoracic surgery despite refusing blood transfusions. Anesthetic management involves the maintenance of hemodynamic stability and the use of conservative blood management techniques.