Attitudes to Clinical Pig Kidney Xenotransplantation among Medical Providers and Patients

Abstract

BackgroundIn addition to governmental regulation and scientific advancements, the World Health Organization requires extensive review of local opinions before initiating clinical trials of xenotransplantation (XTx). The purpose of this study was to assess the attitudes of health care providers and patients regarding XTx.MethodsAn anonymous Likert-scale survey regarding attitudes toward XTx was distributed to pre- and post-kidney transplant patients, nephrologists, transplant surgeons, and nurses (“providers”). Patient and provider responses were described and compared. Regression analysis using patients’ responses was performed to identify factors associated with XTx acceptance.ResultsEighty percent (32/40) of providers and 69% (113/163) of patients were agreeable to clinical XTx if the risks and results were likely to be similar to kidney allotransplantation (P<0.05). Kidney providers rated the influence of religious beliefs in medical decisions (45% versus 15%) and genetic engineering (43% versus 25%) as being more important than did patients (P<0.05). A small proportion in both groups (<15%) reported concerns about (1) potential personality changes, (2) how others would interact, (3) a perception of being “less human,” or (4) morals or ethics. Logistic regression found that the odds of patients accepting XTx were greater if they had no religious concerns (OR, 25.10; 95% CI, 2.59 to 243.00), but acceptance was less likely if they were not willing to use XTx as a bridge to allotransplantation (OR, 0.18; 95% CI, 0.51 to 0.70).Conclusions(1) If outcomes were similar to allotransplantation, XTx support was strong among both providers and patients; (2) providers overestimated the influence of religious beliefs and genetic engineering on patient medical decisions, although religious beliefs are associated with XTx acceptance; (3) XTx use as a bridge to allotransplant was associated with XTx acceptance; and (4) psychosocial concerns were low for either group. Future studies among other communities are warranted to assess if similar attitudes exist.

Factors influencing attitudes toward xenotransplantation clinical trials: A report of focus group studies

“…However, the Islamic religious leader, the Jewish rabbi we consulted, and a Jewish participant in the organ procurement staff/administrators group, viewed XTx as a life‐saving procedure and, as the life of the human being always takes precedence in their views, is permissible. Projecting views on other groups that may not necessarily be true aligns with prior research conducted among a sample of pre‐ and post‐transplant kidney patients, nephrologists, transplant surgeons, and nurses in which “providers over‐estimated the influence of religious beliefs and genetic engineering on patient medical decisions, although religious beliefs are associated with XTx acceptance.” 5 …”

“…While clinical considerations, including further immunological and safety‐related aspects of XTx, must be overcome, ethical and social aspects also need to be considered before clinical trials can be initiated. To date, there have been a number of quantitative survey‐based studies assessing attitudes of various persons toward XTx, with much of the research showing that potential acceptance of XTx is high 4‐7 . However, the use of qualitative methodology, which is designed to elicit viewpoints that may not be present in surveys, has been limited and not with a broad array of stakeholders 8 …”

Racial differences in attitudes to clinical pig organ Xenotransplantation

“…Attitudes to XTx among groups who were/or may be faced with the need for an organ transplant were measured using a five point Likert‐scale survey at the (University to be added after peer review) in 2019. The full questionnaire and other cohorts surveyed have been described elsewhere 15 . After our Institutional Review Board approved this study, parents of children with congenital heart disease (CHD) and patients with kidney disease or a kidney transplant were approached at our institution's outpatient clinics during their follow‐up visits.…”

“You cannot stay in the laboratory forever”*: Taking pig kidney xenotransplantation from the laboratory to the clinic

“…The opinions of patients, health care professionals, and members of the public need to be sought. A number of surveys and focus groups have been organized by Paris and his colleagues during the past three years, which indicate that the public is largely supportive of xenotransplantation [80] , [81] , [82] , [83] , [84] , [85] , [86] . The influence of religious beliefs has also been explored [ 87 , 88 ].…”