Attitudes of Swedes to marginal donors and xenotransplantation

A study of knowledge and acceptance of kidney xenotransplantation among Chinese kidney transplant recipients and candidates

BACKGROUND

In recent years, the implementation of the first case of pig-to-human heart xenotransplantation and the report of three cases of pig-to-brain-dead human recipient kidney transplantation indicate that xenotransplantation is getting closer to clinical application. In the near future, China may also launch clinical trials of kidney xenotransplantation. Therefore, it is necessary to investigate the level of knowledge and acceptance of xenotransplantation among kidney transplant recipients and candidates in China. This study aims to investigate the level of comprehension and acceptance of kidney xenotransplantation in kidney transplant recipients and explore related factors, providing a reference for promoting the application and clinical trials of xenotransplantation in the near future.

METHODS

A questionnaire was completed by 211 kidney transplant recipients and 21 candidates. Answers to the questionnaires were self-administered by the respondents. Scores were compared using nonparametric tests, as well as using Chi-square test or Fisher's exact test to compare differences in answers.

RESULTS

Respondents demonstrated a high score of 75 (out of 100) on knowledge and acceptance of kidney xenotransplantation. The sector "Knowledge and Attitude" received the overall highest score from respondents (85.0 out of 100), while "Risks and Concerns" received the lowest score (50 out of 100). Interestingly, respondents paid more attention to infection risks but showed less concern about rejection or unknown risks. Furthermore, 191 respondents (82.3%) expected that pig kidney xenografts could function for at least 5 years or more. The scores were statistically significant in terms of age, gender, level of education, level of knowledge on the case of xenotransplantation clinical trial, and willingness to donate organs. cognition CONCLUSIONS: The awareness rates of xenotransplantation are high among kidney transplant recipients and candidates, for which the majority showed a generally favorable attitude towards this procedure. Respondents did not have a comprehensive understanding of the specific knowledge of xenotransplantation and expressed more concern about the risk of infection compared to the risk of rejection and other unknown risks, while also expecting long-term survival similar to allograft transplantation for pig kidney xenografts.

Attitudes of patients with renal disease on xenotransplantation: A systematic review

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.

Xenotransplantation: A historical-ethical account of viewpoints

Formal clinical trials of pig-to-human organ transplant-known asxenotransplantation-may begin this decade, with the first trials likely to consist of either adult renal transplants or pediatric cardiac transplant patients. Xenotransplantation as a systematic scientific study only reaches back to the latter half of the 20th century, with episodic xenotransplantation events occurring prior to that. As the science of xenotransplantation has progressed in the 20th and 21st centuries, the public's knowledge of the potential therapy has also increased. With this, there have been shifting ethical stances toward xenotransplantation in key areas, such as religious and public viewpoints towards xenotransplantation, animal rights, and public health concerns. This review provides a historical-ethical account of xenotransplantation and details if or how viewpoints have shifted over time.

'Dirty pigs' and the xenotransplantation paradox

For almost the last 300 years human beings have sought to use organs from non-human animals to repair or replace their own failing organs. This procedure of intraspecies transplant is called xenotransplantation, and despite the continued attempts by researchers, it is yet to be successful. Experiments in xenotransplantation persist, however, partly based on the perceived biological similarities that exist between humans and non-human animals despite the success of xenotransplantation being hampered by the ability of the human body's immune system to attack and therefore reject foreign material. In this article, I explore the sociocultural reactions to xenotransplantation which demonstrates that it is based on a paradox; although non-human animals and humans are thought to be biologically compatible or similar, many assume and emphasise just how different we are from non-human animals. These two positions of 'same but different' are arguably incompatible. I begin by reviewing social science research that demonstrates, despite some variation, a range of persistent concerns towards xenotransplantation including the consequences for personal identity should a person receive a non-human animal organ. I add to this body of work, findings from a mixed-method study involving focus groups and a representative survey with young adults to show that most people prefer to have their organs replaced by materials from their own body and non-human animals the least. These reactions sit within a broader context of a 'wisdom of repugnance' that is brought into existence when our classifications of what is thought to be natural or not is threatened.

3D bioprint me: a socioethical view of bioprinting human organs and tissues

In this article, we review the extant social science and ethical literature on three-dimensional (3D) bioprinting. 3D bioprinting has the potential to be a 'game-changer', printing human organs on demand, no longer necessitating the need for living or deceased human donation or animal transplantation. Although the technology is not yet at the level required to bioprint an entire organ, 3D bioprinting may have a variety of other mid-term and short-term benefits that also have positive ethical consequences, for example, creating alternatives to animal testing, filling a therapeutic need for minors and avoiding species boundary crossing. Despite a lack of current socioethical engagement with the consequences of the technology, we outline what we see as some preliminary practical, ethical and regulatory issues that need tackling. These relate to managing public expectations and the continuing reliance on technoscientific solutions to diseases that affect high-income countries. Avoiding prescribing a course of action for the way forward in terms of research agendas, we do briefly outline one possible ethical framework 'Responsible Research Innovation' as an oversight model should 3D bioprinting promises are ever realised. 3D bioprinting has a lot to offer in the course of time should it move beyond a conceptual therapy, but is an area that requires ethical oversight and regulation and debate, in the here and now. The purpose of this article is to begin that discussion.

Korean attitudes to Xenotransplantation: a survey conducted in 2009

BACKGROUND

Xenotransplantation research has been being actively conducted in Korea. However, there are numbers of socio-ethical issues involved in this research, and it is necessary to know public attitudes toward the research, inducing "public consensus" for the sound development of the technology.

MATERIALS AND METHODS

A telephone survey consisting of 10 questionnaire items was conducted to investigate the attitudes of Koreans on social and ethical issues related to xenotransplantation. Participants were randomly selected in proportion to the 2009 Korean population census. The response rate was 22.3%. Finally, 500 sets of data were collected and analyzed with SPSS® 12. A statistical analysis was performed using the chi-square test.

RESULTS

In the first phase of the study, 69.8% of the respondents were positive about xenotransplantation while 29.0% were negative. However, after being informed of the specific benefit and risk, 58.4% of the respondents stated that xenotransplantation research should be continued, while 38.6% of them indicated that these studies should be prohibited; 63.0% of the respondents agreed with lifelong surveillance after xenotransplantation, while 34.0% disagreed. To avoid triggering immune response in the transplantees, 63.0% of the respondents also approved of the necessity of genetic modification of pigs. If xenotransplantation proves to be safe, 56.8% of the respondents said that they would accept it if necessary; 69.8% of the respondents would recommend it for their family members and friends as a therapeutic option if they are in need. Men were more positive than women about the necessity of animal experimentation for xenotransplantation research, the necessity of lifelong surveillance, and the necessity of genetic modification of pigs. There was no significant difference between the religious and non-religious group except about the issue of lifelong surveillance.

CONCLUSION

Korean people have relatively positive attitudes toward xenotransplantation research and animal experiments regarding xenotransplantation.

Communicating about xenotransplantation: models and scenarios

Xenotransplantation entails using organs from genetically modified animals as a way to solve the shortage of human organs for transplantation. As with other novel technologies, if xenotransplantation is to be judged fairly, proponents must explain its complex, uncertain, and unfamiliar risks and benefits. Xenotransplantation's risks include the possibility of a recombinant virus infecting human transplant recipients, potentially causing an epidemic of an unfamiliar disease. Using materials vetted by scientific experts, we communicated the variables and relationships determining this risk in three formally equivalent formats: (a) a graphic model, (b) scenarios structured by the graphic model, and (c) both the model and the scenarios. Participants were randomly assigned to receiving one set of materials. They rated them as equally clear and studied them equally long, suggesting similar ease of cognitive processing. Compared to participants receiving the scenarios, those who received the graphic model better identified causes and effects of the risk, and saw less risk of xenotransplantation. Participants who received both the model and the scenarios generally showed intermediate responses. The study demonstrates a general procedure for developing and evaluating formally equivalent graphic and scenario communications regarding highly uncertain risks. In this application to xenotransplantation, presenting a graphic representation improved people's understanding of the risk.

The xenotransplantation narratives of nine type 1 diabetic patients with renal failure

Within the research project ''Treatment of Diabetes by Transplantation of Porcine Islets'' that was run by the Swedish Xenoislet Transplantation Network between 1998 and 2003, a partner project called ''Cultural Perspectives on Xenotransplantation'' investigated attitudes toward xenotransplantation development among the patients and their relatives as well as the medical personnel at a transplantation clinic in Sweden. In-depth interviews were done with 37 individuals: nurses, doctors, researchers, patients, and relatives. All interviews were taped and transcribed verbatim. In this presentation the interviews with the nine type 1 diabetic patients with renal failure that took part in the project are focused. The personal and embodied narratives of these nine patients illustrate the ambivalent situation of individuals who are both patients and (potential) experimental subjects simultaneously. Both as actual practice and as biomedical information xenotransplantation research triggers a certain kind of cultural identity of the chronically ill patients--an identity related to how the patients ''translate'' scientific information and, at the same time, counter risk and uncertainty as well as promises of remedy. A central dimension in this cultural identity is a positive but still reluctant embodied attitude toward what spearhead science can bring about.

Understanding of and attitude to xenotransplantation among Italian university students: impact of a 3-yr university course

BACKGROUND

Young people, and students in particular, generally have a positive attitude to xenotransplantation. We reported previously that university students attending their first year approved of the idea of transplanting animal organs into humans. The aim of this study was to evaluate the impact of a 3-yr course at various faculties on the university students' understanding of and attitude to xenotransplantation.

METHODS

University students in their fourth year at five different faculties of Padua University (Italy), who had previously been surveyed in exactly the same way 3 yr earlier, were re-administered an anonymous 19-item questionnaire on their attitude to xenotransplantation.

RESULTS

A total of 453 students completed the fourth year questionnaire (84 males, 369 females; mean age 24.6 yr, range 21-36 yr). Students were attending courses in Medicine (22.1%), Veterinary Science (16.5%), Agriculture (10.4%), Educational Sciences (22.1%) and Psychology (28.9%). In their fourth year, 85% of the students knew that animal organs could, at some stage, be transplanted into humans, 81.5% approved of this idea and 84% would accept an animal organ to save their life if necessary (these percentages were 88%, 78% and 76%, respectively 3 yr earlier). A significantly larger proportion of the students who approved of xenotransplantation were attending science courses rather than art courses, while no differences emerged as regards gender. Those who refused xenotransplantation justified their position mainly on ethical-moral (41.7%) and immunological (35.7%) grounds.

CONCLUSION

As in their first year, so too in their fourth, University students were well informed about the feasibility of transplanting animal organs into human beings and those attending science courses were more likely to accept this idea than art students. Approval of xenotransplantation was much the same among fourth year males and females, whereas in the first year, male students had approved more than female students.

The ethics of xenotransplantation: a survey of student attitudes

Xenotransplantation is a burgeoning technology that could provide a solution to the shortage of organs and tissue for transplantation. It does, however, raise many moral and ethical dilemmas. The aim of this study was to evaluate undergraduate university students' knowledge and opinions on the controversial practice. Choice of science or arts subjects and gender were also assessed to establish if they were influencing factors. A total of 100 students, 50 science students and 50 arts students, answered a questionnaire. Seventy-seven percent of the students had heard of xenotransplantation, 66% believed it would be beneficial to society and only 45% believed it to be ethically and morally acceptable. The medical need for organs was highlighted as the most important argument in favour, and the risk of infection was revealed to be the most important argument against xenotransplantation. The students would significantly prefer a human to non-human animal organ, and did not believe the genetic modification of animals for transplantation was ethically acceptable. This study, in general, did not find that knowledge and acceptance of xenotransplantation was associated with subject background (i.e., science or arts courses) or gender.

Reluctant acceptance of xenotransplantation in kidney patients on the waiting list for transplantation

Previous research has shown contradictory results regarding the acceptance of xenotransplantation (XT) by kidney patients. This variance in attitude towards XT could be explained by differences in knowledge of XT, the availability of alternative treatment options, specific beliefs and cognitions of the patient, and differences in the health status of the patients. We studied 61 patients in this contention in the Netherlands waiting for a kidney transplant. All took part in in-depth interviews and filled out questionnaires on two occasions, once before and once after an information brochure on XT had been read. We found that a better health status is correlated with a greater acceptance of XT, but only before information was given. After information had been given, the acceptance of XT decreased significantly. However, if XT is the only possibility in a life-threatening situation, almost all patients are willing to accept XT, except for a small group (approximately 10-15%) with fundamental religious and/or spiritual objections against such treatment. When alternative treatment options such as a human cadaver donor, a living related donor or commercial donor are offered, the majority of patients would prefer those to XT. The main reason for reluctance is uncertainty about the risks of XT to personal health. Because alternatives are currently available, we expect that XT will become more popular only if future results of this procedure have proved to be comparable to transplantation with a human donor kidney.

Focus group data as a tool in assessing effectiveness of a hand hygiene campaign

BACKGROUND

Routine handwashing has been proven to decrease incidence of health care-associated infections, including methicillin-resistant Staphylococcus aureus (MRSA), spawning numerous attempts to "advertise" its importance. However, most control measures fail to evaluate systematically the efficacy of handwashing initiatives. The purpose of this study was to implement a hand hygiene program in an academic medical center, utilizing visual cues developed with periodic input from hospital personnel.

METHODS

After estimation of baseline compliance (20%), visual cues in the form of 11'' x 17'' posters were developed in a sequential fashion, based on suggestions from participants. The stepwise approach was supported by data collected via focus groups. These data were used to design target-specific messages and to understand better the benefits of utilizing participant input.

RESULTS

Postexposure compliance rates indicated a modest improvement over baseline, increasing to 37% during the 12-month study. In addition, the stepwise design proved to be highly useful in guiding the intervention process. Analysis of qualitative data also elucidated numerous routes through which effective hand hygiene campaigns could be implemented.

CONCLUSIONS

Through diligent observation and participant feedback, the research team was able to develop and market educational cues to meet service demands of health care professionals in a unified effort to control health care-associated infections. Future interventions should employ incremental evaluation designs supported by participant input to develop effective hand hygiene initiatives.

Psychosocial aspects of xenotransplantation: Survey in adolescent recipients of porcine islet cells

INTRODUCTION

Transplantation is a process with several psychosocial challenges. Regarding the case of xenotransplantation, the perceived similarity between humans and pigs may be stressful. Adjustment disorders have been reported among transplantation recipients. We sought to assess the psychosocial aspects of xenotransplantation among porcine islet-cell recipients and their efforts to adapt themselves to this condition.

MATERIAL AND METHODS

Ten insulin-dependent diabetes mellitus patients aged 14.58 +/- 7.93 who received porcine islet-cells were included. The bioartificial steel/fibrous tissue chamber method was used. All patients and their relatives were interviewed about their expectations, overall functioning, and experiences. The quality of life, enjoyment, and satisfaction scale and the hospital anxiety and depression scales were used. A 1-year follow-up was done.

RESULTS

Their motivation was centered on autonomy; there were no troubles regarding the graft origin. Xenotransplantation was perceived with pragmatism, seeing pigs as an unlimited resource. The patients with best outcomes also had the greatest improvements in several quality of life areas (QOL) while the medium responders had fewer QOL improvements. The nonresponders experienced mainly frustration. Parents' concerns were not related to their children's health but to their recently gained autonomy.

CONCLUSIONS

In addition to enthusiasm, the perception of animals as an unlimited source of organs may affect patient compliance; in this group, xenotransplantation was seen as using as a long-lasting drug, with chamber walls considered as a physical, immunologic, and, in certain manner, a psychological barrier.

Public opinion surveys about xenotransplantation

BACKGROUND

Xenotransplantation may eventually provide a solution to the worldwide shortage of human organs for transplantation. Xenotransplantation is surrounded by profound ethical issues, both for the potential recipients and for the society as a whole. Concurrent with increased scientific interest, there has been an increasing number of quantitative public opinion surveys conducted about xenotransplantation in the last decade. The aim of the present study was to elucidate these surveys, and to assess some factors that may affect the outcome of them.

MATERIALS AND METHODS

Surveys were identified by web and literature searches using key words in Medline and ISI Web of Knowledge. Reference lists of identified surveys were checked. Data was obtained from Inter-University Consortium for Political and Social Research (ICPSR) and directly from authors whose data were presented in another way than percentages. In total, the present material covered surveys from 35 sources, including 23 countries.

RESULTS AND DISCUSSION

Results showed that almost half of the respondents accept xenotransplantation, whereas the remaining half did either not accept or did not have/state an opinion. Over time, the proportions of acceptance seemed unchanged. The proportion of those who did not accept decreased and the remaining proportion increased. This pattern was evident in Europe and the US, but not in Japan. Gender and education were found to be associated with opinions to xenotransplantation. The influence of religion was not as straightforward. This may partly depend on how religiosity was measured in the polls. Wording of items influenced levels of acceptance. If a xenotransplant was the ''only choice'' proportions of acceptance increased, and if a ''risk for zoonotic diseases'' was stated proportions of acceptance decreased. When wording of survey items was somewhat comparable, there were often, but not always, minor differences in proportions of acceptance between surveys from different sources. Trends in opinions are best measured by the use of the same items. It is however difficult to phrase items that will not be affected by external events.