Attitudes to Cardiac Xenotransplantation by Pediatric Heart Surgeons and Physicians

Abstract

<jats:sec><jats:title>Background:</jats:title><jats:p> Cardiac transplantation in early childhood is limited by scarcity of organ donors. Advances in cardiac xenotransplantation (XTx) research suggest that xenografts may one day represent an alternative to allografts. We sought to determine the attitudes among surgeons and cardiologists in the field of pediatric cardiac transplantation toward the potential use of XTx if this clinical option were to become a reality. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> A Likert-scale anonymous survey addressing the use of XTx in pediatric patients was sent to members of the Congenital Heart Surgeons (CHS) Society and the Pediatric Heart Transplant Society. Results were described and compared between the two surgeon/physician groups. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> Ninety-two CHS and 42 pediatric transplant cardiologists (PTC) responded (N = 134). The potential acceptance of XTx was high in both groups, assuming risks and results were similar to those of cardiac allotransplantation (88% CHS vs 81% PTC; P = .07). When asked if they would recommend a xenograft, if the results were anticipated to be inferior to those of cardiac allotransplantation, as a bridge to a human heart, potential acceptance fell dramatically but remained higher among CHS than PTC (41% vs 17%, p 0.02). Approximately only one-third of CHS and half of PTC preferred primary cardiac XTx for hypoplastic left heart syndrome if there was no waitlist time and had similar outcomes to allotransplantation. </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> Our findings suggest that potential acceptance of XTx by CHS and PTC would not be a major barrier if XTx demonstrated similar outcomes to allotransplantation. Acceptance by other congenital heart stakeholders remains to be investigated. </jats:p></jats:sec>

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

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

Addressing Concerns toward Xenotransplantation

“…Our interdisciplinary group has conducted multiple research surveys and focus groups to elicit the public's perception of pediatric cardiac and adult kidney xenotransplantation. [3][4][5] We have consulted numerous stakeholders, including religious leaders, organ procurement staff/administrators, healthcare providers who care for possible future candidates, patients themselves, parents of children who may need an organ or are transplant recipients, and local businesspersons. [3][4][5] In summary, these studies found little or no religious, ethical, or social concerns among these stakeholders, with considerable support for xenotransplantation given results are comparable to allotransplantation (which, of course, is not yet known).…”

“…[3][4][5] We have consulted numerous stakeholders, including religious leaders, organ procurement staff/administrators, healthcare providers who care for possible future candidates, patients themselves, parents of children who may need an organ or are transplant recipients, and local businesspersons. [3][4][5] In summary, these studies found little or no religious, ethical, or social concerns among these stakeholders, with considerable support for xenotransplantation given results are comparable to allotransplantation (which, of course, is not yet known). There was also support for its use to bridge patients until a deceased human donor organ could be obtained, which is our suggested therapy for infants.…”

Addressing concerns toward xenotransplantation

“…Our interdisciplinary group has conducted multiple research surveys and focus groups to elicit the public's perception of pediatric cardiac and adult kidney xenotransplantation. [4][5][6] We have consulted numerous stakeholders, including religious leaders, organ procurement staff/administrators, healthcare providers who care for possible future candidates, patients themselves, parents of children who may need an organ or are transplant recipients, and local businesspersons. [4][5][6] In summary, these studies found little or no religious, ethical, or social concerns among these stakeholders, with considerable support for xenotransplantation given results are comparable to allotransplantation (which, of course, is not yet known).…”