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

Organ xenotransplantation acceptance in veterinary students: A multicentric opinion study in Spain

BACKGROUND

The shortage of available transplant organs has made it necessary to search for alternatives, one of which is xenotransplantation. However, the use of animal organs could face rejection from society and the personnel involved in its implementation.

OBJECTIVES

(a) to analyze the attitudes of Veterinary Degree students in six Spanish Universities towards xenotransplantation; and (b) to determine the factors that affect its acceptance.

METHODS

Of the 2815 students surveyed in the degree program, 2683 valid surveys were obtained. Attitudes towards organ xenotransplantation were evaluated using a validated questionnaire of organ donation.

RESULTS

If xenotransplantation was confirmed as a clinical reality, 93% (n = 2493) of those surveyed would accept a xenotransplanted organ, whilst 7% would not. If the results of xenotransplantation were worse than those obtained with human donors and it entailed more risk, 12% (n = 318) would be in favor. 56% (n = 1497) of the students would accept a xenotransplantation provisionally pending the arrival of a human organ. Attitudes towards xenotransplantation were affected by the academic year in which a student was studying, with more favorable attitudes among students in the last year (88% in first year vs. 95% in fifth year; p < .001). More favorable attitudes are also observed depending on the attitude they have towards organ transplantation, with those students being more in favor of donating their organs when they die (94% vs. 88%; p < .001).

CONCLUSION

Veterinary students would have a very favorable attitude toward xenotransplantation if these animal organs functioned as well as human organs. Therefore, these students could play an important role in the future promotion of this technique.

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.

Puerto Rican Population Residing in Florida: Attitude Towards Organ Xenotransplantation

INTRODUCTION

Puerto Ricans are one of the majority immigration groups in Florida. However, little is known about their attitudes toward xenotransplantation (XenoTx), a still experimental technique, which is making significant progress.

OBJECTIVE

To analyze the attitude toward XenoTx of organs among the population of Puerto Rican residents in Florida.

METHODS

Population under study. Sample taken from the International Collaborative Donor Project and formed by the population born in Puerto Rico and resident in Florida.

INCLUSION CRITERIA

Over 15 years stratified by age and sex. Instrument valuation. Validated questionnaire of attitude toward xenotransplantation "PCID-XenoTx-Ríos." Setting for the study. Random selection of people to survey based on stratification. Immigrant assistance associations in Florida were consulted to locate potential respondents.

RESULTS

Of the 259 respondents, 16% are in favor of XenoTx if the results are similar to those obtained with human organs, 74% are against, and 10% are doubtful. If the results are worse than with human organs, only 2% are in favor, 74% against, and 24% undecided. The variables that are associated with this attitude are the following: sex (P = .001); marital status (P < .001); have offspring (P = .004); level of education (P < .001), opinion of a partner toward donation (P = .008), religious beliefs (P < .001), knowing the opinion toward donation of religion (P < .001), prosocial activity (P < .001), attitude toward donation (P ≤ .001), previous relationship with donation (P < .001), possibility of receiving a transplant in the future (P = .001), and attitude toward donation to a relative (P < .001).

CONCLUSIONS

The Puerto Rican population residing in Florida does not hold a favorable attitude toward xenotransplantation.

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.

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.

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.

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.

Acceptance of organ xenotransplantation among Latin American immigrants resident in the United States

BACKGROUND

Making xenotransplantation socially acceptable is the first step in working toward the promotion of this potential therapy option for providing transplant organs.

OBJECTIVE

To analyze the attitude toward xenotransplantation among the Latin American population resident in Florida (the USA), and to determine the variables affecting this attitude.

METHODS

A sample of Latin American residents in the state of Florida was randomized and stratified according to nationality, age, and sex (n = 1524). Attitude was assessed using a validated questionnaire (PCID-XenoTx Rios) which was self-completed anonymously.

STATISTICAL ANALYSIS

descriptive analysis, Student's t-test, the chi-square test, and a logistic regression analysis.

RESULTS

The questionnaire completion rate was 95% (n = 1450). If it was assumed that xenotransplanted organs functioned as well as human ones, 10% (n = 147) would be in favor, 73% (n = 1092) against, and 17% (n = 246) undecided. If the results were worse, only 2% (n = 35) would be in favor. This favorable attitude was related to country of origin (Honduras and Guatemala; P < 0.001); age (P < 0.001); sex (women; P < 0.001); marital status (married; P < 0.001); descendents (yes; P < 0.001); level of formal education (secondary education and university; P < 0.001); participation in voluntary prosocial activities (yes; P < 0.001); having spoken about donation and transplantation within the family (yes; P < 0.001); a partner's favorable attitude toward transplantation (P = 0.040); religion (catholic; P < 0.001); knowing the attitude of one's religion toward donation (yes; P < 0.001); previous experience of donation and/or transplantation (yes; P < 0.001); a belief that one might need a transplant in the future (yes; P < 0.001); and a favorable attitude toward human donation (yes; P < 0.001). The following were associated with attitude in the multivariate analysis: age (≥40 yrs; OR = 1.152); marital status (married; OR = 500); prosocial activities (yes, I participate in them; OR = 9.196. No, but I would like to; OR = 332.538); religion (catholic; OR = 2000); attitude toward deceased organ donation (in favor; OR = 2000); and previous experience of donation and/or transplantation (yes; OR = 500).

CONCLUSIONS

The attitude of Latin Americans resident in Florida toward xenotransplantation is very negative, and is determined by many psychosocial factors, mainly related to their prior attitude toward the different kinds of human organ donation.

The level of acceptance of spanish medical students of the transplantation of solid organs from animals: a stratified and multicentre study

INTRODUCTION

Research into the transplantation of solid organs from animals (xenotransplantation) is generating interest and curiosity given that this could be a way of resolving the shortage in transplant organs. However, the fact is that currently xenotransplantation is far from becoming a clinical practice.

OBJECTIVE

To analyse the attitude of medical students from Spanish universities towards the donation of organs from animals and to determine the factors affecting their attitudes.

MATERIAL AND METHODS

TYPE OF STUDY

A sociological, interdisciplinary, observational and multicentre study in Spain.

STUDY POPULATION

Students enrolled on the medical degree in Spain (n = 34 000).

SAMPLE SIZE

A sample of 9598 students (a confidence level of 99% and precision of ± 1%) stratified by geographical area and academic year. Instrument of measurement: A validated questionnaire of attitude towards organ xenotransplantation (PCID-XenoTx RIOS) which was self-administered and completed anonymously.

RESULTS

A completion rate of 95.7% (n = 9275) was obtained. If the results of xenotransplantation were as good as in human donation, 81% (n = 7491) would be in favour, 3% (n = 308) against and 16% (n = 1476) undecided. The following variables affected this attitude: sex (P < 0.001); academic year (P < 0.001); discussion of transplantation with one's family (P < 0.001) and friends (P < 0.001); the opinion of one's partner (P < 0.001); the respondent's attitude towards organ donation (P < 0.001); religion (P < 0.001); and participation in altruistic activities (P < 0.001). The following variables persisted in the multivariate analysis: (1) being a female (OR = 1.794; P < 0.001); (2) academic year (OR = 2.487; P < 0.001); (3) having spoken about the issue with one's family (OR = 1.200; P = 0.019); (4) the favourable opinion of one's partner (OR = 1.526; P = 0.028); (5) an attitude in favour of donation (OR = 2.087; P < 0.001); (6) being an atheist/agnostic, (OR = 2.5; P < 0.001); and (7) a belief that one's religion is in favour of transplantation (OR = 1.317; P = 0.005).

CONCLUSIONS

Spanish medical students have a favourable attitude towards xenotransplantation. This willingness and interest could be a decisive platform for the development and strengthening of research, both for centres with a pre-clinical xenotransplantation programme and new healthcare centres.

Design of a real-time quantitative polymerase chain reaction to assess human complement regulatory protein gene expression in polytransgenic xenograft pigs

OBJECTIVE

To design a real-time quantitative polymerase chain reaction (q-PCR) to assess gene expression for hCD55, hCD59, and hCD46 in polytransgenic (PT) pigs used as xenograft donors for orthotopic liver xenotransplantation using a pig-to-baboon model.

MATERIALS AND METHODS

Three pairs of primers were designed using PrimerBlast and mRNA of hCD55, hCD59, and hCD46 sequences. Blood samples from five PT pigs (two males and three females) were used to isolated peripheral blood mononuclear cells (PBMCs) by means of Ficoll gradients. After DNAase digestion of isolated mRNA, we synthesized cDNA. Using SYBR-Green chemistry of q-PCR, we constructed a standard curve. Two wild-type (WT) pigs were used as negative controls, and PBMCs from two healthy human volunteers as positive controls. The amplicon length was assessed by means of agarose gel electrophoresis and PCR products, sequenced.

RESULTS

We observed amplification for hCD55, hCD59, and hCD46 in all samples from the five PT pigs except for hCD55 and hCD46 in one male PT pig. Neither the human samples nor the negative controls showed amplification. The expected amplicon length was confirmed; sequencing showed high homology with human mRNA for the three proteins and no match with any known pig sequence.

CONCLUSIONS

The q-PCR allowed detection of animals with the highest gene expression for hCD55, hCD59, and hCD46 for xenograft donors in transplantation experiments.

Pig islet xenotransplantation acceptance in a Latin-American diabetic population

Progress in porcine islet xenotransplantation has been accompanied by studies on acceptance of this new procedure by patients, health professionals or the general public. Such studies have not been done in the Latin-American population. We conducted a questionnaire in 108 diabetes patients (insulin-dependent, n = 53; insulin-independent, n = 55) in a public hospital in Argentina. The questions addressed the general perception of the xenotransplant procedure and specific items related to the outcome (achieving insulin independence, improvement in metabolic control, delay in emergence of diabetic complications, need for repeat procedures, potential of transfer of infectious viruses, association with psychological problems, and anticipated success in relation to achieving a cure). Eighty-six (79%) of the patients accepted islet xenotransplantation; this incidence was not different for insulin-dependent or insulin-independent patients, patients with or without complications, or patients with good or poor metabolic control. Also, over 75% of patients accepted the procedure if this is only associated with a reduction in insulin requirement, if the procedure just delays but not prevents the onset of complications, or if the procedure needs to be performed every 6 months. Fifty-seven percent of patients indicated acceptance even if the potential transmission of a virus infection cannot be completely ruled out: this outcome was not affected by the outbreak of the H1N1 flu epidemic during the conduct of this study. Forty percent of patients indicated that living with porcine cells in their body could give psychological problems. We conclude that this population of Latin-American diabetic patients shows a high acceptance rate of a porcine islet xenotransplantation product.

The attitude toward living liver donation among the hospital personnel in a northeast China center with a liver transplant program

China has the largest population of end-stage liver disease patients, but the acceptance of liver donation is really poor. Our objective was to analyze the attitudes toward living liver donation among hospital workers in a hospital with an authorized living donor liver transplant program in northeast China. A random sample stratified by department of service and job category (n = 800) evaluated attitudes using a modified psychosocial questionnaire, which was self-administered and completed anonymously. The factors were divided into subcategories of psychosocial variables, family variables, and attitudes toward other types of organ donation and willingness to accept an organ if needed. The results showed favorable attitudes toward living liver donation among hospital personnel. Family factors were closely related to this attitude as were altruistic activities and feelings of reciprocity.

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.

A Comparison of Two Distribution Methods on Response Rates to a Patient Safety Questionnaire in Nursing Homes

BACKGROUND

Survey research focusing on patient safety issues in the nursing home sector poses challenges owing to nursing staff turnover rates, and the adversarial and punitive nature of US nursing home regulation which may promote a negative culture of distrust. Using a patient safety questionnaire, we compared two methods of survey distribution on response rates, respondent sample characteristics, and resident safety ratings. We hypothesized that employees may provide overly positive perceptions when the surveys are distributed on-site as opposed to distribution to employees' homes, as has been reported by studies evaluating patient satisfaction in other settings.

METHODS

In August 2003, 26 nursing homes indicated their distribution method preference (mail directly to staff members' homes vs. distributed at work) for a survey determining perceptions of resident safety. Facilities provided lists of currently employed nurses (n=721) and nursing assistants (n=1,233). The survey process included an initial mailing of the survey packet, a reminder postcard, a re-mail of the survey packet to non-respondents to the initial survey, and a final reminder postcard. Return envelopes were addressed to the research team.

RESULTS

In nursing facilities where surveys were distributed at work, a greater proportion of respondents were identified as no longer currently employed. Response rates were similar regardless of distribution method, but with greater variability in the facility-specific response rate in surveys distributed at work. Regardless of staffing type, yield of the first mailing was lower and yield of the second mailing higher in homes with surveys distributed at work than those mailed directly to respondents' homes. While characteristics of nurses were similar regardless of wave, nursing assistant responders to second mailing were more likely to be black relative to responders to the first wave.

CONCLUSION

Distributing surveys at the workplace may not result in a reduction of response rate, but may provide overly positive perceptions of patient safety issues. Mailing directly to homes may result in less facility-level variability in response rates. Multiple mailings may increase the diversity of the respondent pool.

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.