Estado actual del xenotrasplante de órganos

Population Study about the Attitude toward Organ Xenotransplantation in the Population from Eastern Europe Resident in Southeast Spain

Background

The objective of this paper is to analyze the attitude toward xenotransplantation and to determine the variables that influence this attitude in the population of southeast Spain who were born in Eastern European countries.

Methods

A random sample was taken of natives from Eastern Europe residing in southeast Spain (n=320). The sample was obtained randomly between November 2005 and April 2006 and stratified according to the respondents' nationality. Attitude was evaluated using a validated questionnaire which was self-administered and completed anonymously. The control group was a random sample of the native Spanish population (n=250). The statistical analysis used included Student's t-test, the chi-square test, Fisher's exact test, and a logistic regression analysis.

Results

The questionnaire completion rate was 83% (n=267). Regarding the use of animal organs for transplantation in humans, if the outcome were similar to that achieved when using human organs, 43% (n=114) would be in favor, 32% (n=86) undecided, and the remaining 25% (n=67) would be against it. This attitude is less favorable than in the control group (43% versus 74%, p<0.001). The attitude was related to the following factors: 1) the country of origin (p<0.001); 2) participation in social help activities (p<0.001); 3) discussion on organ donation and transplantation within the family (p=0.005); 4) previous experience of organ donation and transplantation (p=0.002); 5) the respondent's religion (p=0.002); 6) knowing that one's partner had a favorable attitude toward transplantation (p<0.001); 7) the respondent's belief that he or she might need a transplant in the future (p<0.001); 8) the attitude toward human donation, both from cadaver (p<0.001) and living (p<0.001) donors. The following were also independent variables in the subsequent multivariate analysis: 1) favorable attitude toward cadaver organ donation (OR=4.998); 2) previous experience of donation (OR=2.857); 3) partner's attitude against transplantation (OR=0.079); and 4) attitude toward living donation (OR=12.703).

Conclusions

The attitude toward xenotransplantation is less positive among Eastern Europeans living in Spain than in the native Spanish population and is influenced by many psychosocial factors that are mainly related to human organ donation.

Clinical xenotransplantation, a closer reality: Literature review

Xenotransplantation could provide an unlimited supply of organs and solve the current shortage of organs for transplantation. To become a reality in clinical practice, the immunological and physiological barriers and the risk of xenozoonosis that they possess should be resolved. From the immunological point of view, in the last 30 years a significant progress in the production of transgenic pigs has prevented the hyperacute rejection. About xenozoonosis, attention has been focused on the risk of transmission of porcine endogenous retroviruses; however, today, it is considered that the risk is very low and the inevitable transmission should not prevent the clinical xenotransplantation. Regarding the physiological barriers, encouraging results have been obtained and it's expected that the barriers that still need to be corrected can be solved in the future through genetic modifications.

British citizens in a regional community of southeastern Spain with a pre-clinical organ xenotransplantation program. A study of attitude toward xenotransplantation

BACKGROUND

It is important to find out about the social acceptance of xenotransplantation, especially in populations where there are pre-clinical xenotransplantation projects, and therefore the possibility of xenotransplantation to humans. In the native population of southeastern Spain this situation is well-known, but in recent years there has been an important social change because of a considerable migrational flow into Spain, especially from the British Isles.

OBJECTIVE

To analyze the attitude toward xenotransplantation among the population living in southeastern Spain born in the British Isles and to determine the variables that affect this attitude.

METHOD

A random sample was taken of British and Irish citizens resident in southeast Spain and stratified according to a respondent's nationality (n = 1700). The data were obtained between November 2005 and April 2006. Attitude was evaluated using a validated questionnaire that was completed anonymously and self-administered. The control group comprised a random sample (n = 250) of the native population. Student's t-test, the chi-squared test, Fischer's exact test and a logistic regression analysis were used in the statistical analysis.

RESULTS

The questionnaire completion rate was 91% (n = 1546), with 69% of respondents in favor of xenotransplantation, 8% against and 23% unsure, an attitude that is similar to that of the control group (P = 0.1616). These attitudes were based on the assumption that transplanted animal organs had the same outcomes and involved the same risks as human ones. This attitude is related to the following factors: (i) being of male sex (P = 0.0477); (ii) level of education (P = 0.012); (iii) being natives from England or Wales (P = 0.016); (iv) participation in voluntary pro-social activities (P = 0.035); (v) the respondent's religion (P < 0.001); (vi) knowing that one's religion has a favorable attitude toward transplantation (P < 0.001); (vii) having discussed the subject of organ donation and transplantation within the family (P < 0.001); (viii) a partner's favorable attitude toward transplantation (P < 0.001); (ix) previous experience of donation or transplantation (P = 0.024); (x) the belief that in the future one might need a transplant (P = 0.007) and (xi) a favorable attitude toward human donation, both deceased and living (P < 0.001). In the multivariate analysis, the following are significant independent variables: sex [odds ratio (OR) = 2.206], a favorable attitude toward deceased donation (OR = 1.977), and attitude toward living donation (OR = 2.097).

CONCLUSIONS

Attitude toward xenotransplantation among British residents who usually live in the southeast of Spain is similar to that of the native Spanish population, and is determined by many psychosocial factors, mainly related to previous attitude toward the different types of human organ donation and the respondent's sex.

Hospital personnel faced with organ xenotransplantation: an attitudinal survey in a hospital with a pre-clinical liver xenotransplantation program

BACKGROUND

In situations of extreme urgency when there is a need for vital organs, xenotransplantation could provide a bridge until the arrival of a human organ. However, it is important to find out the level of acceptance of this potential therapy among the health care workers who would be involved in its implementation. The objective of this study is to analyze attitude among personnel in a hospital with a pre-clinical xenotransplantation program toward xenotransplantation and to determine the variables that influence this attitude.

MATERIALS AND METHODS

A random sample (n=1168) was taken and stratified according to job category and service. Attitude toward xenotransplantation was evaluated using a validated questionnaire. Contact was made with the head of each service who was given an explanation of the project. This person was made responsible for the distribution and collection of the survey in each service in randomly selected work shifts. Such a survey was completed anonymously and was self-administered. A random sample of 250 individuals from our regional community was used as a control group.

RESULTS

The survey completion rate was 98% (n=1148). Most respondents are in favor (67%), 7% are against and 26% undecided. Such an attitude is more favorable in the control group (74% vs. 67%; P=0.0378). The following factors are positively related to such an attitude: (1) male sex (P<0.0005); (2) a younger age (P=0.013); (3) participation in prosocial voluntary activities (P=0.002); (4) knowing that the church has a positive attitude toward donation and transplantation (P<0.0005); (5) a partner's favorable attitude toward transplantation (P<0.0005); (6) a physician's job category (P<0.0005); (7) a resident physician's job contract situation (P=0.017); (8) a respondent's belief that he or she may need a transplant in the future (P<0.0005); and (9) a favorable attitude toward human donation, whether this be cadaveric or living (P<0.0005). In the multivariate analysis, the following persist as independent variables: (1) sex (odds ratio=1.6); (2) participation in prosocial voluntary activities (odds ratio=2.2); (3) a partner's unfavorable attitude toward transplantation (odds ratio=0.3); (4) a favorable attitude toward cadaveric donation (odds ratio=2); and (5) attitude toward living liver donation (odds ratio=3.8).

CONCLUSIONS

Attitude toward xenotransplantation is not as favorable among hospital personnel as it is in the general public and this is determined by many factors. It will be necessary for research groups to periodically carry out awareness-raising activities about our findings in our own centers, to avoid the rejection that could be generated by a lack of awareness.

Attitudes of Primary Care Professionals in Spain Toward Xenotransplantation

OBJECTIVE

The deficit in transplantable organs is making it necessary to find alternative sources. One possibility is xenotransplantation. However, the use of animal organs may be rejected by society and among health professionals. Primary Care is fundamental for promoting matters of health; in Spain it has access to nearly 100% of the population. Our objective was to analyze the acceptance of this therapy, although it is experimental, among Primary Care professionals, given that they are the ones most involved in spreading information about this therapy if it was confirmed to be useful.

MATERIALS AND METHODS

A random sample was stratified by sex, job category, and geographical location among Primary Care personnel, including 428 professionals in 32 health centers among population of 2851 professionals. Attitudes toward xenotransplantation were evaluated using a questionnaire on psychosocial attitudes validated in our geographical area. Contact was made in each center with the Doctor Coordinator for doctors, the Nursing Coordinator for nurses, and an Administrative Officer for ancillary personnel. The chi-square test and Student t test were applied to evaluate categorical and continuous data, respectively.

RESULTS

Attitudes toward xenotransplantation were similar to those obtained in human organs: favorable in 79% (n = 325), whereas 19% (n = 78) had doubts and 2% (n = 10) were against. The attitude was more favorable in men (89% vs 72%; P < .000), those who had cared for transplant patients (84% vs 71%; P = .009), those with previous experience in organ donation and transplantation (84% vs 75%; P = .033), those with an attitude in favor of cadaveric organ donation (83% vs 66%; P < .0001), and those in favor of living donation of the kidney (P < .000) or the liver (P < .000), as well as those who believed that they may need a transplant at some time in the future (84% vs 74%; P = .045). There was a clear difference in attitude according to job category (P = .018): approval rates were 89% for doctors, 76% for nurses, and 70% for ancillary personnel.

CONCLUSIONS

Attitudes toward future application of xenotransplantation were quite positive among doctors. However, the attitudes of nursing and ancillary personnel were similar to those of the general population. The main factors related to such an attitude depended mainly on the previous relationship and attitude of the respondent toward human organ donation and transplantation.

Attitudes Toward Xenotransplantation Among Nonhealth Service Workers in a Hospital With a Preclinical Xenotransplantation Program

INTRODUCTION

Our hypothesis was that nonhealth workers (NHW) in our hospital should have a more favorable opinion toward xenotransplantation than the general population, given that this group is in closer contact with a preclinical xenotransplantation program. Therefore, our objective was to determine the attitude of NHW in a hospital with a preclinical liver xenotransplantation program and to determine the factors that influenced this attitude.

MATERIALS AND METHODS

A random sample of 276 subjects in nonhealth services was used. For the distribution of the questionnaire, we contacted the head of each of the services and explained the project. They became responsible for the distribution and collection of the questionnaires in randomly selected work shifts. A random sample of 250 individuals from our community was used as a control group.

RESULTS

As for animal organ donation for humans, if the results could be superimposed on those achieved by human donors, 63% would be in favor, 30% undecided, and the remaining 7% against. The attitude toward xenotransplantation was more favorable in the control group (74% versus 63%, P < .05). On analyzing the variables that influence attitudes toward xenotransplantation, we found that there is no significant relationship to the classical psychosocial variables (P > .05). However, there is a relationship to prior attitudes toward different types of human organ donation and the possibility of needing a transplant oneself.

CONCLUSIONS

The attitudes toward xenotransplantation among NHW are not as favorable as in the general population.

Attitude Toward Xenotransplantation Among Residents

INTRODUCTION

The deficit in transplant organs has made it necessary to search for alternatives, among them research into xenotransplantation. However, the use of animal organs may cause rejection in society and among health professionals. The objective was to analyze the acceptance of this therapy among Residents, given that they would be the professionals most involved in its application if such a therapy proves to be useful.

MATERIALS AND METHODS

A random sample stratified by the services of the Residents in a third-level hospital with an organ transplant program and accredited for teaching at undergraduate and postgraduate levels (n = 171). The attitude toward xenotransplantation was evaluated using a questionnaire that analyzes different pychosocial variables that may influence such attitude.(5)

RESULTS

The sample consisted of 171 residents (mean age 28 +/- 4 years; 56% women). Attitudes toward xenotransplantation, whether the results were similar to those obtained with human organs, were positive in 81% (n = 138) of cases, with 16% (n = 27) having doubts and 3% (n = 6) being against. The attitude was more favorable among residents in favor of cadaveric donation (83% vs 57%; P < .05) and of living donation either of the kidney (90% vs 55%; P < .001) or of the liver (88% vs 56%; P < .001), and among those who consider that they might need a transplant at a given point in the future (88% vs 73%; P < .05).

CONCLUSION

Residents have a positive attitude toward the application of a possible xenotransplantation in safe conditions similar to those that currently exist in human organ donation. Such a favorable attitude was greatly influenced by a positive attitude toward human organ donation, in cadaveric as well as in living donation, and when considering oneself to be a possible candidate for a transplant.

Attitude Toward Xenotransplantation in Kidney and Liver Patients on the Transplant Waiting List

INTRODUCTION

The deficit in transplant organs is encouraging research into stem cells and xenotransplantation. However, many studies have shown that using animals for human transplantation could be rejected by society. The objective here was to analyze the attitude of patients on the waiting list toward a possible transplant of an organ of animal origin.

MATERIALS AND METHODS

Patients on the waiting list for kidney and liver transplants including last year (n = 96) underwent a direct interview by an independent health professional from the transplant unit. Using a psychosocial survey, an evaluation was made of attitudes toward donation of organs of animal origin and its various options. Student t test and the chi-square test were used for analysis.

RESULTS

If results from xenotransplantation could be superimposed onto those of human transplantation, 71% would accept such an organ. In the case of the kidney, 83% would accept, 4% would not, and 13% have doubts; as opposed to 60%, 12%, and 28%, respectively, of liver cases (P < .05). Supposing that the results were worse than in human organs, only 26% would accept an animal organ. Thus, for kidney, 33% would accept it, 48% would not, and 20% would have doubts; and for liver, it would be 20%, 50%, and 30%, respectively. In a life-threatening situation 98% would accept an animal organ as a bridge of hope in the wait for a human organ. In addition, if the organ functioned correctly, 98% would keep the animal organ, thus avoiding an intervention to substitute a human organ.

CONCLUSION

If xenotransplantation became a clinical reality, acceptance of an animal organ by patients on the waiting list would be low, especially if the results could not be superimposed onto human ones. Only its use as a bridge until the arrival of a human organ would increase its acceptance.

Public attitude toward xenotransplantation: Opinion survey

BACKGROUND

Although xenotransplantation is still in an experimental phase, it is presented herein as a possible solution to the organ shortage. However, there are few data concerning how the general public would accept treatment with animal organs, especially after recent incidents of infections of animal origin, such as "avian influenza" or "SARS disease." The aim of this study was to determine the attitude of the general public toward xenotransplantation of organs.

MATERIALS AND METHODS

Using an opinion survey, a study was performed on a random sample of 250 subjects in an urban setting. The questionnaire was administered by personnel from the regional transplant coordination center. Completion of the form was self-directed and anonymous for each respondent. The attitude toward donation of human and animal organs was evaluated by analyzing different psychosocial variables that may influence this attitude. A descriptive statistical study was performed using Student's t test and the chi-square test.

RESULTS

Ninety-eight percent of respondents completed the survey (n=245). As for human donation, 60% are in favor of cadaveric donation with 21% are in favor of living donation, a rate that increases to 74% if it is for a living partner. As for animal donation, if the results were similar to those obtained with human organs, 74% (n=181) would accept an animal organ if they needed it, as opposed to 18% (n=45) who were undecided and 8% (n=19) against (P <.005). Analysis of variables that influence attitudes toward xenotransplantation showed that this attitude was more positive among those having had a previous experience with transplantation (P=.028) and those having a positive attitude toward cadaveric donation (P=.007). Factors traditionally related to cadaveric donation, such as manipulation of the body or pro-social activities, showed no influence.

CONCLUSIONS

In the population studied, a positive attitude toward xenotransplantation was greater than toward cadaveric donation, assuming the results of these two types of transplants were comparable. Such an attitude is related to human donation, although it is not influenced by many traditional factors.