Determinants of stakeholders' attitudes to xenotransplantation

Evaluation of knowledge, attitude, and awareness of liver transplant patients toward xenotransplantation

BACKGROUND

Xenotransplantation (XTx) is an alternative treatment for organ scarcity. Investigating the acceptance of XTx among patients from diverse cultural and religious backgrounds is essential. This study aimed to evaluate the knowledge, attitudes, and awareness of XTx among patients undergoing liver transplant (LT).

METHODS

This descriptive study was conducted between November 2022 and August 2023. The study population comprised LT patients aged ≥18 years who were admitted to the hepatology clinic of a university hospital in Turkey. Of the 360 patients (n = 360) interviewed, 351 were deemed eligible for inclusion. A questionnaire was used to collect data. The Kolmogorov-Smirnov test, median, standard deviation, minimum-maximum, number, percentage, and Pearson's chi-square test were used for statistical analysis.

RESULTS

Of the patients, 78.3% were religious and adhered to religious requirements, and 87.2% considered their religious beliefs when making important decisions. In all, 41.3% of the participants believed that organ or tissue transplantation from animals to humans is ethical, while 70.1% of the participants believed that organ and tissue transplantation from non-halal animals to humans was impossible. Specifically, 56.7% would not allow organ or tissue transplantation from a non-halal animal to themselves or a relative. Knowledge and attitude towards XTx were not affected by transplantation type (p > .05), but were affected by sex and educational level (p < .05).

CONCLUSION

This study found that LT patients generally oppose XTx. To enhance knowledge and awareness, religious leaders and healthcare professionals should organize comprehensive and effective seminars on this topic.

The muslim patient and medical treatments based on porcine ingredients

Porcine-derived products serve as an effective solution for a wide range of human ailments; however, there may be objections to their use due to Islamic religious prohibitions on consuming products derived from pigs. In order to enhance the cultural competence of medical practitioners who treat Muslim individuals, which constitute about one fifth of the world population, this study aimed at evaluating the knowledge and positions of Muslim patients on this subject. A questionnaire presenting 15 uses of porcine-derived materials was filled out by 809 Muslims. The level of knowledge about the permissibility of these uses and participants' position on whether it should be approved was assessed. Findings show that Muslims are not familiar with Islamic religious jurisprudence that permits the use of porcine products to save lives after it has undergone an essential transformation known as Istihala. The respondents expressed a negative attitude towards the medical use of porcine-derived substances based on imprecise knowledge about the permissibility of use of porcine-derived materials, devices and treatments. We offer recommendations for improving the informed consent obtained from Muslim patients prior to conducting porcine-based treatments.

Fogging to combat dengue: factors influencing stakeholders' attitudes in Malaysia

BACKGROUND

Fogging is a conventional technique used to combat Aedes mosquitoes and prevent dengue disease. It is often implemented in outbreak areas or areas harbouring a high density of Aedes mosquitoes. Currently, studies on stakeholders' attitudes towards fogging are still limited in number. Therefore, this study aims to assess Malaysian attitudes, and identify the predicting factors influencing such attitudes.

METHODS

A validated instrument was used to interview 399 randomly selected respondents from the public (n = 202, 50.6%) and scientists (n = 197, 49.4%) in the Klang Valley region of Malaysia. The data were analysed using PLS-SEM involving Smart-PLS software.

RESULTS

The results confirmed that stakeholder attitudes toward fogging should be viewed in terms of a multi-dimensional association. The stakeholders surveyed were highly positive with regard to the application of fogging to control dengue but professed moderate concerns as to associated risks. The PLS-SEM analyses demonstrated that the perceived benefit was the most important factor influencing attitudes, followed by trust in key players.

CONCLUSIONS

This result provides a good insight from the perspective of education and unravels the underlying fundamentals of stakeholders' attitudes toward the fogging technique. The findings also provide a positive indicator to the responsible parties involved to continue the usage of this technique in conjunction with improvements with regard to its safety aspects, and possibly in combination with other environmental-friendly alternatives in order to achieve a healthy environment without dengue in Malaysia.

Determinants of stakeholders' attitudes and intentions toward supporting the use of Wolbachia-infected Aedes mosquitoes for dengue control

BACKGROUND

A recent approach in controlling dengue is by using the Wolbachia-infected Aedes mosquito (WiAM). The approach has been reported to be more effective than traditional methods, such as fogging. Therefore, it is imperative to assess the factors predicting its acceptance among stakeholders before implementing this technology more widely in Malaysia.

METHODS

The survey data were collected from two primary stakeholder groups using a stratified random sampling technique. The two primary stakeholder groups were scientists (n = 202) and the public (n = 197) in the Klang Valley region of Malaysia, a hot spot area known for the high rate of dengue cases. The respondents answered questions on a seven-point Likert scale survey regarding trust in key players, attitudes toward nature versus materialism, religiosity, perceived benefits, perceived risks, attitudes, and intentions. The data were analyzed using Smart Partial Least Square (SmartPLS) software (version 3.2.6) to determine the predictors influencing attitudes and intentions to support the use of WiAM technology.

RESULTS

The results indicated a strong positive relationship between attitudes and intentions to support the use of WiAM (β = 0.676, p < 0.001). The most important significant predictor for attitudes was perceived benefits (β = 0.493, p < 0.001), followed by perceived risks (β = - 0.080, p = 0.048). Trust in key players, attitudes toward nature versus material, and religiosity had indirect relationships with attitudes through the perceived benefits and risks.

CONCLUSIONS

The identified predictors can serve as indicators for the decision-making process regarding WiAM implementation in Malaysia and other developing countries with similar demographics and cultures.

Organ transplants of the future: planning for innovations including xenotransplantation

The future clinical application of animal-to-human transplantation (xenotransplantation) is of importance to society as a whole. Favourable preclinical data relevant to cell, tissue and solid organ xenotransplants have been obtained from many animal models utilizing genetic engineering and protocols of pathogen-free husbandry. Findings have reached a tipping point, and xenotransplantation of solid organs is approaching clinical evaluation, the process of which now requires close deliberation. Such discussions include considering when there is sufficient evidence from preclinical animal studies to start first-in-human xenotransplantation trials. The present article is based on evidence and opinions formulated by members of the European Society for Organ Transplantation who are involved in the Transplantation Learning Journey project. The article includes a brief overview of preclinical concepts and biology of solid organ xenotransplantation, discusses the selection of candidates for first-in-human studies and considers requirements for study design and conduct. In addition, the paper emphasizes the need for a regulatory framework for xenotransplantation of solid organs and the essential requirement for input from public and patient stakeholders.

Stakeholders' attitudes to outdoor residual spraying technique for dengue control in Malaysia: A PLS-SEM approach

Outdoor Residual Spraying (ORS) technique is a complementary preventive measure for dengue. The alarming number of dengue cases in Malaysia requires an alternative method to control dengue besides the traditional method such as fogging. However, the introduction of new technologies depends on social acceptance. Therefore, this study was important to determine the factors that influence stakeholders' attitudes towards the ORS and the moderating factor. A validated instrument was used to randomly interview 399 respondents representing two stakeholder groups which consist of scientists, and the public in Klang Valley, Malaysia. The findings revealed that the stakeholders claimed to have a high degree of religiosity, a high level of trust in the key players, perceived ORS as having high benefits, and displayed highly positive attitudes towards the ORS. The attitudes model towards the ORS model was developed using the SmartPLS software version. The perceived benefit was endorsed as the most important direct predictor of attitudes towards the ORS (ß = 0.618, P<0.001), followed by trust in the key players (ß = 0.151, P<0.001). It is also interesting to note that religiosity served as a moderator for the association between perceived benefit (ß = 0.075, P = 0.024) and perceived risk (ß = 0.114, P = 0.006) with attitudes towards the ORS. The identified predictor factors of stakeholders' attitudes toward the ORS and the moderating factor can serve as indicators for social acceptance of ORS in developing countries. These indicators can help the policymakers in decision making to implement this technique.

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.

The Integration and Harmonisation of Secular and Islamic Ethical Principles in Formulating Acceptable Ethical Guidelines for Modern Biotechnology in Malaysia

The Malaysian government recognises the potential contribution of biotechnology to the national economy. However, ongoing controversy persists regarding its ethical status and no specific ethical guidelines have been published relating to its use. In developing such guidelines, it is important to identify the underlying principles that are acceptable to Malaysian society. This paper discusses the process of determining relevant secular and Islamic ethical principles and establishing their similarities before harmonising them. To achieve this, a series of focus group discussions were conducted with 23 knowledge experts representing various stakeholders in the biotechnology community. Notably, several principles between the secular and Islamic perspectives are indirectly or directly similar. All the experts agreed with the predominant six ethical principles of secular and Islamic philosophy and their importance and relevance in modern biotechnology. These are beneficence and non-maleficence as the main or overarching principles, the preservation of religious and moral values, the preservation of the intellect and the mind, the protection of human safety, the protection of future generations, and protection of the environment and biological diversity. Several adjustments were made to the terminologies and definitions of these six principles to formulate acceptable guiding principles for the ethics of modern biotechnology in Malaysia. These can then be adopted as core values to underpin future national guidelines on modern biotechnology ethics. These principles will be particularly important in guiding the policy makers, enforcers, industries and researchers to streamline their activities. In so doing, modern biotechnology and its products can be properly managed without jeopardising the interests of the Muslim community as well as the general public. Importantly, they are expansive and inclusive enough to embrace the religious sensitivity of diverse quarters of Malaysia.

Determinants of stakeholders' intention to adopt pharmacogenomic

Pharmacogenomics (PGx) testing, which aims to identify the genes that affect our responses to drugs, has been favoured by healthcare professionals as a means of maximising drug efficacy and improving the safety and cost-effectiveness of healthcare. Support from the public is needed to determine the successful development of this technology and its implementation in society. Therefore, the objective of this paper was to analyse factors that influence stakeholders' intentions to adopt pharmacogenomic testing in Malaysia. A validated instrument was administered through face-to-face interviews with a total of 421 adult respondents who were stratified according to 2 stakeholder groups: healthcare providers (n = 221) and patients/family members (n = 200). The data were then analysed using SPSS® version 24 software and the advanced multivariate statistical approach of Partial Least Square (PLS) path modelling in order to analyse the complex relationships among variables. Results of the studies indicated that the Malaysian stakeholders had a high amount of trust in the key players (mean score of 5.31), perceived high benefits (mean score of 5.53) and claimed to have high intentions of adopting PGx (mean score of 5.39). The majority of the predictors have significant direct relationships with the intention to adopt PGx, with the exception of moral concerns. Perceived benefits appeared to be the most important direct predictor of the intention to adopt PGx testing (ß = 0.371, P < 0.001) followed by trust in the key players (ß = 0.312, P < 0.001), engagement (ß = 0.272, P < 0.001) and religiosity (ß = 0.133, P < 0.01). In addition, perceived risks also had a direct negative association with the intention to adopt PGx (ß = -0.096, P < 0.05). At the same time, the perceived benefits also served as a mediator for all the other factors except risk. The results provide insights into the multidimensional nature of the determinants of the intention to adopt PGx testing in Malaysia. Although the results showed that the stakeholders in Malaysia were very positive towards PGx testing, they were also cautious about it. The predictors identified in this study can serve as indicators for social acceptance of PGx testing to facilitate the clinical research and implementation of PGx.