Are we ready for pig-to-human clinical xenotransplantation trials? / Estamos prontos para ensaios clínicos de xenotransplante porco-para-humanos? / ¿Estamos listos para ensayos clínicos de xenotrasplante del cerdo al humano?

Abstract: The invention and widely use of organ allotransplantation provides effective treatment of some originally fetal diseases such as liver/kidney failure and has saved million of lives around the globe. However, the scarcity of human organs has caused many patients, who could have been treated, to die while waiting for suitable organs around the world. Pig-to human xenotransplantation provides a potential solution to solve this tough problem. Pig organs have been considered as major sources of xenotransplantation because of the sufficient number of donors, the sizes of organs, and physiologically structural similarities. However, xenotransplantation also has some problems, such as the possibility of spreading animal diseases to human, the interspecies immunological barrier, organs of animal origin challenging human nature, and potential informed consent issues. This article will discuss these potential issues and to see whether it is the suitable time to conduct clinical xenotransplantation trials in humans.

Resumen: La invención y el amplio uso de trasplantes alógenos proporciona tratamiento efectivo de algunas enfermedades de origen fetal, como la insuficiencia renal y hepática, y ha salvado a millones de pacientes en el mundo. Sin embargo, la escasez de órganos humanos ha causado que muchos pacientes en el mundo, que podrían haber sido tratados, murieran por esperar un órgano adecuado. El xenotrasplante del cerdo al humano proporciona una solución potencial para resolver este difícil problema. Los órganos de cerdo han sido considerados como fuentes mayores para xenotrasplantes debido al suficiente número de donantes, el tamaño de los órganos y estructuras fisiológicas similares. No obstante, el xenotrasplante también tiene algunos problemas, como la posibilidad de expandir enfermedades animales a humanos, la barrera inmunológica entre especies, el desafío para la naturaleza humana de tener órganos de origen animal y problemas potenciales de consentimiento informado. Este artículo discute estos temas potenciales y plantea si estamos en un momento apropiado para realizar ensayos clínicos de xenotrasplantes en humanos.

Resumo: A invenção e amplo uso de alotransplante de órgãos propicia tratamento efetivo para algumas doenças originalmente fetais tais como falência hepática/renal e tem salvo milhões de vidas em todo o globo. Entretanto, a escassez de órgãos humanos tem causado a morte de muitos pacientes que poderiam ter sido tratados - aguardando por órgãos apropriados em todo o globo. Xenotransplante porco-para-humanos propicia uma solução potencial para resolver este difícil problema. Órgãos de porco tem sido considerados como as principais fontes de xenotransplante por causa do número suficiente de doadores, do tamanho dos órgãos e de similaridades estruturais fisiológicas. Entretanto, xenotransplante também tem alguns problemas, tais como a possibilidade de disseminar doenças animais aos humanos, a barreira imunológica entre espécies, órgão de origem animal desafiando a natureza humana e aspectos potenciais de consentimento informado. Esse artigo discutirá esses aspectos potenciais e verificará se é o momento adequado para conduzir ensaios clínicos de xenotransplante em humanos.

French People's Views Regarding Xenotransplantation.

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.

Attitudes toward xenotransplantation: A survey of parents and pediatric cardiac providers.

BACKGROUND: Scientific advancements are occurring in cardiac xenotransplantation (XTx). However, there have been religious and social concerns surrounding this allotransplantation alternative. The purpose of this study was to explore the acceptance of XTx among stakeholders of the congenital heart disease (CHD) community. METHODS: A Likert-scale anonymous survey was distributed to physicians and nurses who care for children with CHD and parents of children with CHD. Psychosocial and clinical attitudes were compared across all groups to identify differences, and regression analysis was performed to identify factors associated with XTx acceptance. RESULTS: A total of 297 responded to the survey: 134 physicians, 62 nurses, and 101 parents. Potential acceptance of XTx if outcomes were similar to allotransplantation was high overall (75.3%), but different between the groups (physicians 86%; nurses 71%, parents 64%; P < .0001). Regression analysis showed respondents who reported religion would influence medical decision making (OR 0.48; 95%CI 0.24-0.97) and those who would not use a pig heart transplant as a bridge until a human heart became available were less likely to accept XTx (OR 0.09; 95%CI 0.04-0.21). Psychosocial concerns to XTx were minimal but were also associated with XTx acceptance particularly among parents (OR 0.17; 95%CI 0.03-0.80). CONCLUSIONS: Potential acceptance of XTx is high, assuming results are similar to allotransplantation. Religious beliefs and attitudes toward the use of XTx as a bridge to allotransplant may present barriers to XTx acceptance. Future research is needed to assess potential attitude differences in light of ethical, psychosocial, and religious objections to XTx.

The role of religious beliefs for the acceptance of xenotransplantation. Exploring dimensions of xenotransplantation in the field of hospital chaplaincy.

BACKGROUND: The Changsha Communiqué (2008) calls for a greater account to be taken of the ethical aspects of xenotransplantation as well as of public perception. This also applies to the field of hospital chaplaincy. So far, there has been no empirical exploration of the assessment and acceptance of xenotransplantation by pastoral workers in German-speaking countries. In view of the prospect of clinical trials, in-depth research is both sensible and necessary, since both xeno- and allotransplantation can have far-reaching consequences for patients, their relatives, and the social environment. In addition to the tasks of health monitoring, questions of the individual handling with and integration of a xenotransplant must also be considered. They can affect one's own identity and self-image and thus also affect religious dimensions. Hence, they make a comprehensive range of accompaniment necessary. METHODS: This paper presents the first explorative results of a Dialogue Board with Christian, Jewish, and Muslim hospital chaplains. It explores pastoral challenges of xenotransplantation for the German-speaking countries, in particular (a) self-image and tasks of hospital pastoral care, (b) religious aspects of transplantation, and (c) religious aspects of xenotransplantation as anticipated by the hospital pastors. RESULTS: Depending on their religious background, hospital chaplains see different pastoral challenges when xenotransplantation reaches clinical stage. In particular, the effects on the identity and religious self-image of those affected must be taken into account. Three desiderata or recommendations for action emerged from the Dialogue Board: (a) initial, advanced and further training for hospital pastoral workers, (b) contact points for patients, and (c) interreligious cooperation and a joint statement. All participants of the Dialogue Board emphasized the chances of xenotransplantation and expressed their hope that xenogenic transplants could save patients or improve the quality of their life substantially. CONCLUSIONS: Xenotransplantation can affect the identity work of patients and relatives also in religious terms. In order to provide better pastoral and psychosocial support for these persons within the framework of the hospital, it is important to reflect on such challenges at an early stage and to develop concepts for pastoral further training and pastoral care in xenotransplantation.

Population of Senegal Residents in Spain: Acceptance of Organ Xenotransplantation.

INTRODUCTION: Spain is a great receptor of immigration from sub-Saharan people like the Senegalese. This population is not very familiar with the process of organ donation and transplantation, and even less toward new therapies related to transplantation, such as xenotransplantation (XenoTx). OBJECTIVE: Analyze the attitude toward XenoTx among the Senegalese population living in Spain. MATERIAL AND METHODS: Population under study. Population born in Senegal and resident in Spain. INCLUSION CRITERIA: Sample of population over 15 years stratified by age and sex, according to census data and immigrant assistance associations. INSTRUMENT: Validated questionnaire of attitude toward donation and organ transplantation "PCID-XenoTx-Ríos." Field work. Random selection of respondents based on stratification. The support of immigration support associations was required to obtain sample locations. The completion was anonymous and self-administered. RESULTS: A sample of 468 Senegalese was obtained. Twenty percent (n = 92) would accept a solid organ xenotransplant if the results were similar to human organs, 40% (n = 188) have doubts, and 40% (n = 188) would not accept it. If the results were worse than with human organs, only 8% would accept it (n = 38). Respondents with a favorable attitude toward XenoTx presented a more favorable attitude toward cadaveric donation (70.5% vs 31.3%; P < .001). The attitude toward acceptance of XenoTx is related to socio-personal factors (P < .05), knowledge about the process of organ donation and transplantation (P < .05), social interaction factors (P < .001), and religious factors (P < .05). CONCLUSIONS: Senegalese residing in Spain do not have a favorable attitude toward XenoTx. A direct relationship between the attitude toward XenoTx and organ donation is observed.

Is the Population of Santiago de Cuba Sensitized to Xenotransplantation? A Multivariate Analysis.

INTRODUCTION: New transplant-related therapies such as xenotransplantation of solid cells, tissues, and organs are still poorly understood, especially in countries without preclinical xenotransplantation programs. OBJECTIVE: Analyze the attitude toward xenotransplantation among the population of Santiago de Cuba. METHOD: Type of study. Cross-sectional observational study. SAMPLE: Random sampling of 455 individuals residing in Santiago de Cuba. Assessment instrument. Validated questionnaire of attitude toward the xenotransplant, "PCID-XenoTx-Ríos." Field work. Random selection based on stratification. Anonymous and self-administered completion. RESULTS: A total of 49.9% would accept a solid organ xenotransplant if they needed it and the results were similar to those currently obtained with human organs, 27.5% have doubts, and the remaining 22.6% would not accept it. They are presented as statistically significant variables (P < .05): level of studies; comment with the family about the donation; opinion of a partner; religion; opinion of religion; performing prosocial activities; attitude toward donation; previous relationship with the organ donation and transplant; favorable attitude toward live kidney donation. In the multivariate analysis, the following persist: 1. level of university studies: odds ratio (OR) = 5.076; 2. not having a partner: OR = 5.154; 3. belonging to another religion: OR = 2.061; 4. favorable attitude toward organ donation: OR = 5; and 5. favorable attitude toward living donation: OR = 3.759. CONCLUSIONS: The population of Santiago de Cuba is less sensitized toward xenotransplantation, possibly due to ignorance of the issue due to lack of preclinical trials in their countries.

Acceptance of the Xenotransplantation of Organs Among the Population of the Spanish Gypsy Ethnic Group.

INTRODUCTION: Organ refusal rates among Gypsies is much higher than that of any other social group in Spain. However, their attitude toward new therapies related to transplantation, such as the xenotransplantation, is not known. This is especially important in countries such as Spain, where there are research and development units for xenotransplantation. OBJECTIVE: To analyze the attitude toward xenotransplantation among the Gypsy population living in Spain. METHOD: Type of study: Observational sociological study. Population under study: Adult Gypsy population currently residing in Spain. SAMPLE: A random sampling of 230 adult Gypsies. Assessment instrument: A validated attitude questionnaire for xenotransplantation-PCID-XenoTx Ríos. Fieldwork: Random selection based on stratification. Anonymity and self-administered fulfillment. STATISTICS: Student t test, χ2, Fisher, and a logistic regression analysis. RESULTS: A sample of 206 Gypsies was obtained. Forty-five percent (n = 93) would accept a solid organ xenotransplantation if they needed it, and the results were similar to those currently obtained with human organs; 24% (n = 49) have doubts, and 31% (n = 64) would not accept the xenotransplantation. If the results were worse than with human organs, only 9% would accept the xenotransplantation (n = 19). Respondents with a favorable attitude toward xenotransplantation presented a more favorable attitude toward cadaveric organ donation (55% vs 34%, P = .01). CONCLUSIONS: Gypsies do not present a very favorable attitude toward xenotransplantation, especially compared with other Spanish population groups. A favorable sensitivity is presented by the population group in favor of it to cadaveric organ donation, which could be used to sensitize this social group and promote donation campaigns with the aim of increasing donation rates.

Impact of 2009 Pandemic H1N1 Influenza A Virus on Veterinary Students' Perception of Xenotransplantation.

The pandemic influenza virus A (H1N1) in 2009, which was initially associated with pigs (swine flu), could have had a negative influence on attitudes toward xenotransplantation (XT), particularly after the social alarm it caused. The objective of this study was to analyze the impact of this pandemic on the acceptance of XT among veterinary science students. METHODS: A control group sample was taken of students registered in the veterinary degree course (academic year 2007-2008). For the study group, the study was repeated on the same students (year 2008-2009) after the pandemic (April 2009). Pair-matching was carried out between both groups taking into account that (1) the questionnaire was anonymous but included the student's initials and (2) when the study was repeated, the students were in the next academic year. Attitude was assessed using a validated questionnaire. RESULTS: After comparing the surveys from the control group (n = 515) and study group (n = 465), 287 matched pairs were obtained. Acceptance of organ XT did not differ significantly before and after the outbreak, assuming similar results to those using human organs (89% vs 89%; P = .10) or with a greater risk than human donation (10% vs 13%; P = .37). There was no difference between the attitude toward tissue XT before and after (94% vs 93%; P = .69) and toward cell XT (97% vs 98%; P = .30); 82% (n = 236) believed that the pandemic had not changed their perception of XT, although 43% (n = 124) considered that it had negatively affected society's perception. CONCLUSION: The pandemic influenza virus A (H1N1) did not change the attitude of veterinary science students toward XT.

Are Dominicans in Favor of Xenotransplantation? A Study of the Attitude of Dominican Immigrants Residing in Spain and the United States.

Xenotransplantation carries many social and cultural implications. The immigrant population in countries with xenotransplantation programs, such as Spain and the United States, will play an important role in accepting such therapy. The objective of the study is to analyze the attitude toward xenotransplantation among the Dominican population residing in the United States and Spain. METHODS: The study population was born in the Dominican Republic and resides in the southeastern United States and Spain. A sample population older than 15 years was obtained randomly and stratified by age and sex. Attitude was assessed using a validated questionnaire on psychosocial aspects toward xenotransplantation (PCID-XENOTx-Ríos). A random selection of people to be surveyed was carried out. Assistance from immigration support associations was needed to advise on the location of potential respondents. RESULTS: A total of 123 respondents were included in the study: A sample was taken of residents of the population from the Dominican Republic residing in Florida, United States (n = 66), and in Spain (n = 57). If it was assumed that xenotransplanted organs functioned as well as human ones, 30% would be in favor. If the results were worse, only 7% would be in favor. This favorable attitude was related to the following variables (P < .05): level of education, an attitude in favor of deceased and living organ donation, and having spoken about donation and transplantation within the family. CONCLUSIONS: The attitude toward xenotransplantation among the population from the Dominican Republic who are residing in the southeastern United States and Spain is unfavorable.

Level of Acceptance of Solid Organ and Tissue Xenotransplantation Among the Bolivian Population Residing in Spain.

The Bolivian population is growing in Spain. Xenotransplantation of organs and/or tissues carries many social and cultural implications. It is important to find out the level of acceptance of xenotransplantation in immigrant populations, especially in populations where there are preclinical trials. The objective of the study is to analyze the attitude toward xenotransplantation of organs and tissues in the Bolivian population residing in Spain and the variables that influence their attitude. METHODS: We selected a sample of the Bolivian population living in Spain. A sample of the population older than 15 years was obtained randomly and stratified by age and sex. Attitude was assessed using a validated questionnaire on psychosocial aspects toward xenotransplantation (PCID-XENOTX-Ríos). RESULTS: Of the 206 respondents, 26% of respondents are in favor of xenotransplantation of organs if it was assumed that xenotransplanted organs functioned as well as human ones. If the results were worse, only 6% would be in favor. The following factors were associated with this attitude: (1) level of education (P = .008), (2) a favorable attitude toward human donation (P = .004), (3) a partner's favorable attitude toward transplantation (P < .001), and (4) a belief that one might need a transplant in the future (P = .01). The following were associated with attitude in the multivariate analysis: (1) having secondary education (odds ratio, 3.690; P = .004) and (2) a partner's favorable attitude toward transplantation (odds ratio, 6.024; P = .003). CONCLUSIONS: The attitude of Bolivian residents in Spain toward xenotransplantation is negative and is determined by educational and family factors.

Attitude Toward Organ and Tissue Xenotransplantation Questionnaire (PCID-XENOTx-Ríos): Characteristics and Psychometric Properties of the Validation in Spanish-Speaking Populations.

INTRODUCTION: Making xenotransplantation socially acceptable is the first step in working toward the promotion of this potential therapy option for providing transplant organs. However, most of the questionnaires used for this task are not validated. OBJECTIVE: To analyze the psychometric characteristics of the questionnaire of attitud toward xenotransplantation PCID-XENOTx-Ríos (Questionnaire of Proyecto Colaborativo Internacional Donante about Xenotransplantation developed by Dr. Ríos) to validate the questionnaire in the Spanish speaking population. METHODS: The study population was the native Spanish population living in southeast Spain. A sample of the population was obtained randomly and stratified by age and sex (N = 600), using the following inclusion criteria: 1. being older than 18 years; 2. being Spanish; and 3. living in Spain. Instrument valuation. Attitude was assessed using the validated PCID-XENOTx-Ríos questionnaire to gauge attitudes toward organ and tissue xenotransplantation. The statistical analysis included an initial description of the data, an exploratory factor analysis, an items analysis, and an internal consistency analysis. RESULTS: The questionnaire consists of a total of 30 items, distributed in 4 subscales: 1. Factor 1: consequences (11 items); 2. Factor 2: associated risks (7 items); 3. Factor 3: transmission of infections (6 items); and 4. Factor 4: origins of transplantation (6 items). This structure presents a total explained variance of 61.18%. The internal consistency of each factor was as follows: α1 = 0.91; α2 = 0.92; α3 = 0.89; and α4 = 0.72. The analysis of items and internal consistency supported the 4 factors' composition. CONCLUSIONS: Dimensions analyzed in the PCID-XENOTx-Ríos questionnaire of attitudes toward organ and tissue xenotransplantation show a good fit in relation to their factorial validity and internal consistency values.

Teenagers and Their Future Role in Transplantation: An Analysis of Their Attitudes Toward Solid Organ Xenotransplantation.

INTRODUCTION: It is important to determine the level of social acceptance of xenotransplantation, especially in places where there are preclinical xenotransplantation projects. In this sense, it is important to know the attitude of teenagers, given that their attitude could have an influence on this kind of donation in the future. OBJECTIVES: The aim of this study is to analyze the attitudes of teenagers toward xenotransplantation and to determine the variables affecting their attitudes. MATERIAL AND METHODS: A random simple was obtained of students who were between 12 and 16 years of age in secondary schools in the southeast of Spain (n = 3633). Their attitudes were assessed with the use of a validated psychosocial questionnaire about xenotransplantation (PCID-XenoTx Ríos). The questionnaire was completed anonymously and was self-administered. Descriptive statistical analysis, Student t, and χ2 tests were used. RESULTS: The completion rate was 97% (n = 3531). With regard to animal organ donation for humans, 44% (n = 1569) would be in favor, 22% (n = 784) against, and 34% (n = 1178) undecided. Attitude was related to knowing a transplantation patient (P = .02), believing that transplant organ needs are not covered (P = .004), having received information about organ donation and transplantation (ODT) on television and from schools (P = .001), family discussion about ODT (P < .001), attitude of the respondent's parents (P < .001), and attitude toward human donation (P < .001). CONCLUSIONS: More than half of the teenagers had unfavorable attitudes toward xenotransplantation as this was determined by factors related to knowledge of and previous information about ODT, the attitude of one's family, and attitudes toward the different types of human organ donation.

Looking for New Alternatives: What Nursing Students of Lodz's Medical University in Poland Think About the Use of Organs Coming From Animals?

BACKGROUND: The shortage of organs has made it necessary to look for new alternatives as xenotransplantation. The objective of this study was to analyze the attitudes of Polish nursing students toward organ donation of nonhuman origin, and to determine the factors that affect them. METHODS: Year 2011-2012. Nursing students of the University of Poland. Sampling points in 5 compulsory-attendance nursing courses with a completion rate of fulfillment of 80%. Validated questionnaire (PCID-XenoTx Rios) filled out anonymously and self-administered. RESULTS: The completion rate was 81% (325/402): 55% in favor (n = 179), 7% (n = 24) against, and 38% (n = 122) do not know. There were significant associations between: 1) the academic year, with 1st-year students presenting the more favorable attitude than those in the 3rd year (68% vs 41%; P = .039); 2) discuss the topic with friends (59% vs 41%; P = .043); 3) being in favor of cadaver organ donation (64% vs 41%; P < .001); and 4) consider the option of needing a transplant in the future (63%) compared with those who do not consider this option (40%; P = .040). In multivariate analysis, the relationship with being in favor of cadaver organ donation remained (odds ratio, 2.577; 95% confidence interval, 4.081-1.631; P < .001). CONCLUSIONS: Almost one-half of the nursing students had an unfavorable attitude toward xenotransplantation.

Attitude of Nursing Students at the University of Lublin in Poland Toward Xenotransplantation of Organs.

OBJECTIVE: Because of the shortage of organs, it has become necessary to look for alternative sources of organs, such as xenotransplantation. The aim of this study was to analyze the attitude of nursing students at a university in the Eastern Poland toward xenotransplantation, to determine factors that affect their acceptance. MATERIAL AND METHOD: During the 2011-2012 academic year, nursing students at the University of the Eastern Poland enrolled the 5 nursing courses self-administered a validated questionnaire (the PCID-XenoTx Rios) anonymously. We undertook a descriptive statistical analysis using the Student t test, χ(2) test, and logistic regression analysis. RESULTS: The completion rate was 90% (608 of 672). When asked about the acceptability of organ donation from humans, 62% (n = 379) were in favor, 9% (n = 54) against, and 29% (n = 175) undecided. We found a significant association between the acceptability of transplantation and the university course and the respondents' religion (P ≤ .05). Fourth-year students have a more favorable attitude toward xenotransplantation than third-year students (75% vs 54%; P = .018). Catholics accept this type of donation more readily than those belonging to other faith traditions (63% vs 37%; P = .053). In the multivariate analysis, academic course is a significant influence on attitude toward xenotransplantation (odds ratio, 2.421; 95% CI, 4.347-1.345; P = .003). CONCLUSIONS: Nursing students have an unfavorable attitude toward xenotransplantation. This attitude is influenced by the religious beliefs and their academic year.

A study of the attitude of Latin-American residents in Spain toward organ xenotransplantation.

BACKGROUND: It is important to find out what would be the level of acceptance of xenotransplantation in society, especially in populations where there are preclinical trials. The Latin-American population is growing in Spain, given the cultural, religious, and language similarities. OBJECTIVES: (i) to analyze attitude toward xenotransplantation in the population born in Latin America and now residing in Spain; and (ii) to establish the variables that affect this attitude. METHOD: A sample of Latin-American residents in Spain was obtained randomly in 2010 and stratified by the respondent's nationality (n = 1.314). Attitude was evaluated using a validated questionnaire (PCID-XenoTx Rios), which was completed anonymously and self-administered. STATISTICAL ANALYSIS: Student's t-test, the Chi-squared test, Fisher's exact test, and logistic regression analysis. RESULTS: The questionnaire completion rate was 89% (n = 1.165). If it was assumed that xenotransplanted organs functioned as well as human ones, 40% were in favor, 19% against, and 41% undecided. This attitude is related to: age (P = 0.003); sex (P = 0.002); level of education (P < 0.001); descendents (P = 0.003); country of origin (P < 0.001); participation in voluntary prosocial activities (P = 0.006); having spoken about donation and transplantation within the family (P < 0.001); a partner's favorable attitude toward transplantation (P < 0.001); previous experience of donation and/or transplantation (P < 0.001); a belief that one might need a transplant in the future (P < 0.001); and a favorable attitude toward human donation, both deceased as well as living (P < 0.001). In the multivariate analysis, the following variables continue to feature as independent variables: age (older: Odds Ratio = 1.041); sex (male: OR = 1.579); level of education (university: OR = 2.770); descendents (none: OR = 2.386); a partner's attitude toward transplantation (favorable: OR = 2.262); attitude toward deceased organ donation (favorable: OR = 1.587); previous experience of donation and/or transplantation (OR = 1.519); a belief that one might need a transplant in the future (OR = 1.675); and attitude toward related living donation (in favor: OR = 4.405). CONCLUSIONS: Latin Americans who usually reside in Spain have a more negative attitude toward xenotransplantation than the native Spanish population, and their attitude is affected by many psychosocial factors, mainly related to previous attitude toward the different types of human organ donation.

Irish citizens resident in the southeast of Spain and xenotransplantation.

BACKGROUND: It is fundamental to find out the level of social acceptance of xenotransplantation (XT), especially in areas where there are preclinical projects. In the native population in the southeast of Spain this situation is well known, but in recent years there has been a considerable social change due to large migratory flows, especially concerning Ireland. The aim of this study was to analyze the attitude toward XT among the population in the southeast of Spain born in Ireland and to determine the variables affecting this attitude. METHODS: Within the "International Collaborative Donor Project," a random sample was taken (n = 325) of the population from the southeast of Spain born in Ireland. Attitude was evaluated using a validated questionnaire, which was self-administered and completed anonymously. RESULTS: The questionnaire completion rate was 82% (266 respondents of the 325 selected). Regarding animal organ donation for humans, if the results were similar to those achieved using human donors, 62% (n = 165) would be in favor, 30% (n = 79) undecided, and the remaining 8% (n = 22) against. If the results were worse than those achieved using human donors, 20% (n = 50) would be in favor, 59% (n = 150) undecided, and the remaining 21% (n = 54) against. Attitude toward XT is related to religion (P = .003), knowing the favorable attitude of one's religion toward transplantation (P = .037), having spoken about donation and transplantation within the family (P = .001), a partner's favorable attitude toward transplantation (P = .001), and a favorable attitude toward both deceased (P = .001) and living (P = .023) human donation. CONCLUSIONS: Attitude toward XT among Irish citizens who are resident in the southeast of Spain is worse than that of the native Spanish population and is mainly determined by factors related to prior attitude toward the different types of human organ donation, family attitude, and religious motives.

Attitudinal study of organ xenotransplantation in patients on the kidney and liver transplant waiting list in a country with a high rate of deceased donation.

BACKGROUND: The organ transplant deficit is leading to an increase in the importance of solid organ xenotransplantation. However, the use of animals for human transplantation causes a certain amount of opposition in patients and the general public. The objective of this study was to analyze the attitude of patients on the kidney and liver waiting list toward xenotransplantation and the variables affecting this attitude. METHODS: Patients on the kidney and liver waiting list (January 2003 - December 2005) were surveyed. Attitude toward xenotransplantation was assessed using a psychosocial questionnaire about the donation of organs of animal origin administered by a healthcare professional from the Transplant Unit. RESULTS: A total of 373 patients were interviewed (kidney [n=214] and liver patients [n=158]). In the case of kidney patients, if the results of xenotransplantation were as effective as those attained using human organs, 76% (n=162) would be in favor. If the results were worse, only 8% (n=17) would be in favor. Two factors affected this attitude: a high level of education (P=0.007) and a positive attitude toward organ donation upon death (P< 0.001). In the case of liver patients, 67% (n=106) would be in favor if the results of xenotransplantation were as effective as those attained using human organs, decreasing to 16% (n=25) if the results were worse. Attitude toward deceased organ donation also affected the attitude of these patients (P<0.043). CONCLUSIONS: The attitude toward xenotransplantation of patients on the kidney and liver transplant waiting list was favorable and associated with a positive attitude toward human organ donation.

Attitude toward xenotransplantation of patients prior and after human organ transplantation.

Xenotransplantation is a potential strategy to overcome the shortage of human donor organs. As this technique has a major medical and psychological impact on patients and their family and friends, the attitude of patients currently waiting for organ transplantation is important. Therefore, we conducted a survey on the attitude toward xenotransplantation of patients on the waiting list and already transplanted patients. Patients received detailed information before being asked to fill in the questionnaire. We found that 65% would accept xenotransplantation, irrespective of gender, education level or if the patients were on the waiting list or already transplanted. The most common concern was transmission of diseases or genetic material, followed by psychological concerns and ethical issues. More patients had a positive attitude toward accepting cell or tissue transplantation when compared to whole organs. Pig pancreas islet cell transplantation is generally well accepted, patients with diabetes mellitus show even higher acceptance rates than patients without diabetes. In conclusion, xenotransplantation seems to be well accepted in patients who are potential future candidates for organ transplantation. Informing patients about the current status of research tended to decrease acceptance rates slightly.