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Martínez-Alarcón L, Flores-Medina J, Ramis G, Gómez-Laguna J, Moll X, Falceto V, San Román-Ascaso F, San Román-Llorens F, Quereda JJ, Herrero JM, Mendonça L, Martin-Barrasa JL, Fernández OM, Muñoz A, Ramírez P, Gutiérrez P, López-Chicheri I, López-Navas A, Ríos A. Organ xenotransplantation acceptance in veterinary students: A multicentric opinion study in Spain. Xenotransplantation 2023; 30:e12823. [PMID: 37695105 DOI: 10.1111/xen.12823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/27/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND The shortage of available transplant organs has made it necessary to search for alternatives, one of which is xenotransplantation. However, the use of animal organs could face rejection from society and the personnel involved in its implementation. OBJECTIVES (a) to analyze the attitudes of Veterinary Degree students in six Spanish Universities towards xenotransplantation; and (b) to determine the factors that affect its acceptance. METHODS Of the 2815 students surveyed in the degree program, 2683 valid surveys were obtained. Attitudes towards organ xenotransplantation were evaluated using a validated questionnaire of organ donation. RESULTS If xenotransplantation was confirmed as a clinical reality, 93% (n = 2493) of those surveyed would accept a xenotransplanted organ, whilst 7% would not. If the results of xenotransplantation were worse than those obtained with human donors and it entailed more risk, 12% (n = 318) would be in favor. 56% (n = 1497) of the students would accept a xenotransplantation provisionally pending the arrival of a human organ. Attitudes towards xenotransplantation were affected by the academic year in which a student was studying, with more favorable attitudes among students in the last year (88% in first year vs. 95% in fifth year; p < .001). More favorable attitudes are also observed depending on the attitude they have towards organ transplantation, with those students being more in favor of donating their organs when they die (94% vs. 88%; p < .001). CONCLUSION Veterinary students would have a very favorable attitude toward xenotransplantation if these animal organs functioned as well as human organs. Therefore, these students could play an important role in the future promotion of this technique.
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Affiliation(s)
- Laura Martínez-Alarcón
- International Collaborative Donor Project, Murcia, Spain
- Surgery Service, Transplant Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Juan Flores-Medina
- Department of Psychology, Faculty of Medicine, Catholic University of Murcia (UCAM), Murcia, Spain
| | - Guillermo Ramis
- International Collaborative Donor Project, Murcia, Spain
- Surgery Service, Transplant Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
- Department of Surgery, Paediatrics, Obstetrics and Gynaecology, University of Murcia, Murcia, Spain
- Department of Animal Production, Faculty of Veterinary Medicine, University of Murcia, Murcia, Spain
| | - Jaime Gómez-Laguna
- Department of Anatomy and Comparative Pathology and Toxicology, University of Córdoba, Córdoba, Spain
| | - Xavier Moll
- Faculty of Veterinary Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Victoria Falceto
- Department of Animal Pathology, Faculty of Veterinary Medicine, University of Zaragoza, Zaragoza, Spain
| | - Fidel San Román-Ascaso
- Department of Animal Medicine and Surgery, Faculty of Veterinaria, Universidad Complutense de Madrid, Madrid, Spain
| | - Fidel San Román-Llorens
- Department of Animal Pathology, Faculty of Veterinary, University of Zaragoza, Zaragoza, Spain
| | - Juan José Quereda
- Department of Animal Production and Health, Veterinary Public Health and Food Science and Technology, Faculty of Veterinary, University Cardenal Herrera-CEU, Valencia, Spain
| | - Juan Manuel Herrero
- Department of Animal Production, Faculty of Veterinary Medicine, University of Murcia, Murcia, Spain
| | - Livia Mendonça
- Faculty of Veterinary, Universidade Federal de Goiás, Goiania, Brazil
| | - José Luis Martin-Barrasa
- Experimental Animal Facility, Research Unit, Hospital Universitario de Gran Canaria, Dr. Negrín, Las Palmas de Gran Canaria, Arucas, Spain
- Animal Infectious Diseases and Ictiopatology, University Institute of Animal Health (IUSA), University of Las Palmas de Gran Canaria, Arucas, Spain
| | - Olga María Fernández
- Animalario libre de Patógenos Arrixaca-Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Antonio Muñoz
- Department of Animal Production, Faculty of Veterinary Medicine, University of Murcia, Murcia, Spain
| | - Pablo Ramírez
- International Collaborative Donor Project, Murcia, Spain
- Surgery Service, Transplant Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
- Department of Surgery, Paediatrics, Obstetrics and Gynaecology, University of Murcia, Murcia, Spain
- Department of Animal Production, Faculty of Veterinary Medicine, University of Murcia, Murcia, Spain
| | - Pedro Gutiérrez
- Urology Service, Complejo Hospitalario Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
- Departmen of Surgery, University of La Laguna, San Cristóbal de la Laguna, Tenerife, Spain
| | - Isabel López-Chicheri
- Department of Psychology, Faculty of Medicine, Catholic University of Murcia (UCAM), Murcia, Spain
| | - Ana López-Navas
- International Collaborative Donor Project, Murcia, Spain
- Department of Psychology, Faculty of Medicine, Catholic University of Murcia (UCAM), Murcia, Spain
| | - Antonio Ríos
- International Collaborative Donor Project, Murcia, Spain
- Surgery Service, Transplant Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
- Department of Surgery, Paediatrics, Obstetrics and Gynaecology, University of Murcia, Murcia, Spain
- Department of Animal Production, Faculty of Veterinary Medicine, University of Murcia, Murcia, Spain
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DeLaura I, Anwar IJ, Ladowski J, Patino A, Cantrell S, Sanoff S. Attitudes of patients with renal disease on xenotransplantation: A systematic review. Xenotransplantation 2023; 30:e12794. [PMID: 36880602 DOI: 10.1111/xen.12794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/09/2022] [Accepted: 01/26/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Recent years have seen major advancements in xenotransplantation: the first pig-to-human heart transplant, the development of a brain-dead recipient model for kidney xenotransplantation, and the registration of the first xenokidney clinical trial. The attitudes of patients with kidney disease or transplants on xenotransplantation and an assessment of their reservations and considerations regarding the technology are crucial to successful clinical translation and eventual widespread implementation. METHODS This systematic review was registered through PROSPERO (CRD42022344581) prior to initiation of the study and reported using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. We included studies that evaluated attitudes towards and willingness to undergo xenotransplantation in patients with end-stage renal disease (ESRD), including those who had already undergone transplantation. MEDLINE (via Ovid), Embase (via Elsevier), and Web of Science (via Clarivate) were searched from database inception to July 15, 2022 by an experienced medical librarian for studies on xenotransplantation and attitudes. Abstracts and full text were screened using Covidence software and data items regarding study methodology, patient demographics, and attitudes regarding xenotransplantation were extracted using Microsoft Excel. Risk of bias assessments were performed using the Critical Appraisal Skills Programmed and National Institute of Health study quality assessment tools. RESULTS Of 1992 studies identified, 14 studies met the inclusion criteria. These studies were conducted across eight countries, four in the United States, for a total of 3114 patients on the kidney waitlist or with a kidney transplant. All patients were over 17 years old and 58% were male. Acceptance of a xenotransplant was assessed using surveys in 12 studies. Sixty-three percent (n = 1354) of kidney patients reported that they would accept a xenotransplant with function comparable to that of an allotransplant. Acceptance of xenografts with inferior function to allografts (15%) or as bridge organs (35%) to allotransplantation was lower. Specific concerns expressed by patients included graft function, infection, social stigma, and animal rights. Subgroup analyses showed higher acceptance in already transplanted compared to waitlist patients and white compared to Black Americans. CONCLUSION An understanding of patient attitudes and reservations is key to the successful execution of the first xenotransplantation clinical trials. This study compiles important factors to consider, such as patient concerns, attitudes regarding practical clinical scenarios for the use of xenotransplantation, and the impact of demographic factors on acceptance of this emerging technology.
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Affiliation(s)
- Isabel DeLaura
- Duke Transplant Center, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Imran J Anwar
- Duke Transplant Center, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Joseph Ladowski
- Duke Transplant Center, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Sarah Cantrell
- Duke University Medical Center Library & Archives, Duke University School of Medicine, Durham, North Carolina, USA
| | - Scott Sanoff
- Department of Medicine, Division of Nephrology, Duke University, Durham, North Carolina, USA
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Xenotransplantation and Risks: The Opinion of Veterinary Students at Spanish Universities. Transplant Proc 2022; 54:2411-2413. [DOI: 10.1016/j.transproceed.2022.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/01/2022] [Indexed: 11/13/2022]
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Fraux C, Muñoz Sastre MT, Kpanake L, Sorum PC, Mullet E. French People's Views Regarding Xenotransplantation. Transplant Proc 2020; 53:529-538. [PMID: 32988637 DOI: 10.1016/j.transproceed.2020.08.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/08/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND French laypeople's views on xenotransplantation were examined. METHODS A convenience sample of 224 adults (among them, 37 nurses) judged of the acceptability of xenotransplantation in 50 realistic scenarios composed of various combinations of 4 factors: 1. the type of graft (eg, pig cardiac valve), 2. the level of urgency (eg, critical condition with very high risk of death in the short term), 3. the patient's or the family's level of consent (eg, the members of the family are divided on the issue), and 4. whether the transplantation was temporary or definitive. The ratings were subjected to cluster analysis and analyses of variance. RESULTS Seven qualitatively different positions were found that were termed Never acceptable (12%), Urgency (4%), Family consent (33%), Religious concerns (15%), Family consent and urgency (10%), Depends on all circumstances (4%), and Always acceptable (11%). Vegans and vegetarians expressed the Never acceptable position more often than nonvegetarians. Health professionals expressed the Family consent position more often than the public. Regular church attendees expressed the Religious concerns position more often than atheists did. CONCLUSIONS Few participants, mostly vegetarians, were opposed to xenotransplantation on principle. About one-third expressed positive views regarding xenotransplantation, either irrespective of circumstances or at least in those cases in which the patient's death is imminent and the family is not opposed for religious reasons. About one-half expressed positive views but deferred to the wishes of the family. The type of xenograft proposed had practically no effect on participants' views.
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Affiliation(s)
- Cécile Fraux
- Department of Psychology, Jean-Jaurès University, Toulouse, France
| | | | - Lonzozou Kpanake
- Department of Social Sciences, University of Québec-TELUQ, Montréal, QC, Canada.
| | - Paul Clay Sorum
- Department of Pediatrics and Internal Medicine, Albany Medical College, Albany, New York
| | - Etienne Mullet
- Department of Ethics and Work, Institute of Advanced Studies (EPHE), Paris, France
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Knoll MF, Cooper DKC, Bottino R. How the COVID-19 pandemic may impact public support for clinical xenotransplantation in the United States? Xenotransplantation 2020; 27:e12623. [PMID: 32596829 PMCID: PMC7361153 DOI: 10.1111/xen.12623] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/06/2020] [Indexed: 12/11/2022]
Abstract
Many patients who would undergo organ transplantation cannot proceed due to the inability of human organ donation to satisfy medical needs. Xenotransplantation has the potential to offer unlimited availability of pig organs for transplantation, and pig-to-non-human primate models have demonstrated outcomes that may soon justify clinical trials. However, one of the unique ethical challenges faced by xenotransplantation is that the risk of introducing potential zoonotic disease into the community must be weighed along with the benefit to the patient. While most experts believe that zoonosis is manageable, apprehension over disease transmission from animal donors to human recipients remains a frequent concern of many who are undecided or opposed to clinical xenotransplantation. The COVID-19 pandemic represents a scenario (rapid worldwide spread of a highly contagious novel zoonotic disease with no natural defense in humans) that would seem to justify apprehension, especially in the United States, which has largely avoided previous pandemic outbreaks. However, there are many differences between zoonosis found in the wild or after xenotransplantation that favor the safety of the latter. Still, these differences, as well as the benefits of xenotransplantation, are not widely understood outside of the field. We must therefore ask what impact the COVID-19 pandemic will have on attitudes toward xenotransplantation.
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Affiliation(s)
- Michael F Knoll
- Institute of Cellular Therapeutics, Allegheny Health Network, Pittsburgh, PA, USA
| | - David K C Cooper
- Department of Surgery, Xenotransplantation Program, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rita Bottino
- Institute of Cellular Therapeutics, Allegheny Health Network, Pittsburgh, PA, USA.,Department of Biological Sciences, Carnegie Mellon University, Pittsburgh, PA, USA
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Martínez-Alarcón L, Ríos A, Santainés-Borredá E, Agras-Suarez MC, Cañadas-De la Fuente GA, Hurtado-Pardos B, Bárcena-Calvo C, Alorda-Terrasa C, Morillo-Velázquez JM, Martí-García C, Redin-Areta MD, Alconero-Camarero AR, Jiménez-Navascues ML, Gutierrez-Izquierdo MI, Chamorro-Rebollo E, de Las Nieves Merchán-Felipe M, Barandiaran-Lasa M, Martín-Espinosa N, Gala-León FJ, Oter-Quintana C, Benbunan-Bentata B, Tirado-Altamirano F, Fernández-Vallhonrat MB, Ramírez-Rodrigo J, Maciá-Soler L, Saez A, Sánchez Á, López-Navas A, Ramírez P, Parrilla P. Student nurses at Spanish universities and their attitude toward xenotransplantation. Xenotransplantation 2019; 26:e12507. [PMID: 30963648 DOI: 10.1111/xen.12507] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/27/2019] [Accepted: 03/07/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Recent immunological and transgenic advances are a promising alternative using limited materials of human origin for transplantation. However, it is essential to achieve social acceptance of this therapy. OBJECTIVE To analyze the attitude of nursing students from Spanish universities toward organ xenotransplantation (XTx) and to determine the factors affecting their attitude. MATERIALS AND METHODS Type of study: A sociological, multicentre, and observational study. STUDY POPULATION Nursing students enrolled in Spain (n = 28,000). SAMPLE SIZE A sample of 10 566 students estimating a proportion of 76% (99% confidence and precision of ±1%), stratified by geographical area and year of study. Instrument of measurement: A validated questionnaire (PCID-XenoTx-RIOS) was handed out to every student in a compulsory session. This survey was self-administered and self-completed voluntarily and anonymously by each student in a period of 5-10 min. STATISTICAL ANALYSIS descriptive analysis, Student's t test, the chi-square test, and a logistic regression analysis. RESULTS A completion rate: 84% (n = 8913) was obtained. If the results of XTx were as good as in human donation, 74% (n = 6564) would be in favor and 22% (n = 1946) would have doubts. The following variables affected this attitude: age (P < 0.001); sex (P < 0.001); geographical location (P < 0.001); academic year of study (P < 0.001); attitude toward organ donation (P < 0.001); belief in the possibility of needing a transplant (P < 0.001); discussion of transplantation with one's family (P < 0.001) and friends (P < 0.001); and the opinion of one's partner (P < 0.001). The following variables persisted in the multivariate analysis: being a male (OR = 1.436; P < 0.001); geographical location (OR = 1.937; P < 0.001); an attitude in favor of donation (OR = 1.519; P < 0.001); belief in the possibility of needing a transplant (OR = 1.497; P = 0.036); and having spoken about the issue with family (OR = 1.351; P < 0.001) or friends (OR = 1.240; P = 0.001). CONCLUSIONS The attitude of nursing students toward organ XTx is favorable and is associated with factors of general knowledge about organ donation and transplantation and social interaction.
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Affiliation(s)
- Laura Martínez-Alarcón
- Department of Surgery, Transplant Unit, Virgen de la Arrixaca Univeristy Hospital, El Palmar, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), El Palmar, Spain.,"International Collaborative Donor Project", El Palmar, Spain
| | - Antonio Ríos
- Department of Surgery, Transplant Unit, Virgen de la Arrixaca Univeristy Hospital, El Palmar, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), El Palmar, Spain.,"International Collaborative Donor Project", El Palmar, Spain
| | - Elena Santainés-Borredá
- Departamento de Enfermería, Facultad de Enfermeria, Universidad de Valencia, Valencia, Spain
| | | | | | | | - Carmen Bárcena-Calvo
- Departamento de Enfermería y Fisioterapia-Área de Enfermería, Facultad de Ciencias de la Salud, Universidad de León, León, Spain
| | - Carme Alorda-Terrasa
- Departamento de Enfermeria y Fisioterapia, Universidad de las Islas Baleares, Baleares, Spain
| | - Juan Manuel Morillo-Velázquez
- Departamento de Ciencias de la Salud, Escuela Universitaria de Enfermería y Fisioterapia "San Juan de Dios", Universidad Pontificia Comillas, Madrid, Spain
| | - Celia Martí-García
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, Spain
| | | | | | | | | | - Elena Chamorro-Rebollo
- Facultad de Enfermería y Fisioterapia Salus Infirmorum, Universidad Pontificia de Salamanca, Madrid, Spain
| | | | - Maite Barandiaran-Lasa
- Facultad de Medicina y Enfermería, Departamento de Enfermería II Donostia, Sección Donostia UPV/EHU, Gipuzkoa, Spain
| | - Noelia Martín-Espinosa
- Escuela Universitaria de Enfermería y Fisioterapia de Toledo, Universidad de Castilla la Mancha, Toledo, Spain
| | | | | | - Bibinha Benbunan-Bentata
- Departamento de Personalidad, evaluación y tratamiento psicológico, Universalidad de Granada, Melilla, Spain
| | | | | | - Jesús Ramírez-Rodrigo
- Departamento de Enfermería, Facultad de Ciencias de la Salud de Ceuta, Universidad de Granada, Ceuta, Spain
| | - Loreto Maciá-Soler
- Departamento de Enfermería, Facultad de Ciencias de la salud, Universidad de Alicante, Alicante, Spain
| | - Aida Saez
- Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), El Palmar, Spain
| | - Álvaro Sánchez
- "International Collaborative Donor Project", El Palmar, Spain
| | - Ana López-Navas
- Departmento de Psicología, Universidad Católica San Antonio Murcia, Murcia, Spain
| | - Pablo Ramírez
- Department of Surgery, Transplant Unit, Virgen de la Arrixaca Univeristy Hospital, El Palmar, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), El Palmar, Spain.,"International Collaborative Donor Project", El Palmar, Spain
| | - Pascual Parrilla
- Department of Surgery, Transplant Unit, Virgen de la Arrixaca Univeristy Hospital, El Palmar, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), El Palmar, Spain
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