Attitudes toward xenotransplantation-patients waiting for transplantation versus the general public

Exploring attitudes toward xenotransplantation: A scoping review of healthcare workers, healthcare students, and kidney patients

BACKGROUND

Recent advances mean that formal clinical trials of solid organ xenotransplantation are increasingly likely to begin and patients requiring a kidney transplant could be the first participants. Healthcare workers and healthcare students constitute the current and future workforce that will influence public opinion of xenotransplantation. The attitudes of these populations are important to consider before recruitment for formal clinical trials begins.

METHODS

This scoping review was reported according to the PRISMA extensions for scoping reviews checklist and the Joanna Briggs Institute methodology for scoping reviews. The Scopus, PubMed, and ScienceDirect databases were searched to identify articles that studied the attitudes of healthcare workers, healthcare students, or kidney patients toward xenotransplantation.

RESULTS

The search generated 816 articles, of which 27 met the eligibility criteria. The studies were conducted in 14 different countries on five different continents. Participants from the 27 studies totaled 29,836-this was constituted of 6,223 (21%) healthcare workers, 21,067 (71%) healthcare students, and 2,546 (8%) kidney patients. All three groups had an overall positive attitude toward xenotransplantation. However, in studies where participants were asked to consider xenotransplantation when the risks and results were not equal to allotransplantation-the overall attitude switched from positive to negative. The results also found that Spanish-speaking populations expressed more favorable views toward xenotransplantation compared to English-speaking populations.

CONCLUSION

The results of this review suggest that while attitudes of the three groups toward xenotransplantation are-on the face of it-positive, this positivity deteriorates when the risks and outcomes are framed in more clinically realistic terms. Only formal clinical trials can determine how the risks and outcomes of xenotransplantation compare to allotransplantation.

Should you need an organ… Flemish secondary school students' attitudes toward xenotransplantation and transgenetic organ donation

BACKGROUND

The supply of human organs available for transplantation remains grossly inadequate globally. Animal-to-human transplantation, and even more so humanized organ grown in animals, holds promising results for the start of clinical trials in humans. Very little is known about the public's willingness to accept different xenotransplantation techniques. This study aims to determine attitudes toward human-to-human transplantation, animal-to-human transplantation, and chimera-to-human transplantation in the Belgium context.

METHODS

Secondary school students from Flanders, Belgium, were surveyed between January and June 2019. Socio-demographic details likely to influence participants' attitudes were gathered. Participants were presented with three hypothetical cases (human-to-human transplantation, animal-to-human transplantation, and chimera-to-human transplantation) and asked about their willingness to accept the particular organ. Their risk appetite to accept organs with potentially worse outcomes than the status quo was also evaluated.

RESULTS

Seven hundred forty-one complete questionnaires were analyzed. It can be concluded that Flemish secondary school students favored the techniques of xenotransplantation to a lesser extent than allotransplantation; however, most of them did consider it a good solution for organ shortage. Compared to animal-to-human transplantation, chimera-to-human transplantation showed a more positive attitude among the respondents when considered a good organ transplantation solution.

CONCLUSION

Flemish secondary school students favored the techniques of xenotransplantation to a lesser extent than allotransplantation; however, most of them did consider it a good solution for organ shortage. In comparison to animal-to-human transplantation, chimera-to-human transplantation showed a more positive attitude among the respondents when considered a good solution for organ transplantation.

Student nurses at Spanish universities and their attitude toward xenotransplantation

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.

Reluctance of French patients with type 1 diabetes to undergo pig pancreatic islet xenotransplantation

INTRODUCTION

Type 1 diabetes could possibly be treated by transplantation of pig pancreatic islets. In addition to medical difficulties and ethical problems, social hurdles may need to be overcome. We have evaluated the attitude of patients with type 1 diabetes to the xenotransplantation of pig pancreatic islets and to the potential risks associated with such treatment.

METHODS

A survey of 214 patients with type 1 diabetes was carried out in France based on a multiple-choice questionnaire.

RESULTS

At first, 52.0% of these patients indicated that they would agree to receive pig islet xenografts. The main sources of reluctance were the ''risk of disease transmission'' (55.5%) and ''risks not yet identified'' (48.7%). After they were told of the risk of cancer or infection associated with immunosuppression, 74.9% of the respondents chose to refuse the transplant, compared with 48.0% before they heard of such risks. A 68.1% would refuse the xenotransplant if it would not exempt them completely from being treated by insulin injections. Discontinuing insulin injections was the most important priority for diabetic patients (73.5%), rather than limitation of diabetes-related complications (52.5%) or increase in life expectancy (44.0%). After they were informed of all of the risks associated with the procedure, 70.5% of the respondents decided they would rather not take any risks, and said they would refuse pig islet transplantation.

CONCLUSION

When diabetic patients learned about potential infectious risks and other risks associated with immunosuppression, reluctance to undergo xenotransplantation gained in significance or even led to refusal of the procedure.