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

Abstract

Background Clinical trials of xenotransplantation (XTx, ie, cross‐species transplantation, specifically the transplantation of genetically engineered pig organs into human recipients) are due to start within a few years. Methods Five focus groups were conducted in April‐May 2019, among local religious leaders (N = 10), organ procurement staff/administrators (N = 5), patients and parents of patients who may need an organ transplant or are transplant recipients (N = 9), and local businesspersons in the community (N = 3). Groups were audio‐recorded, transcribed, and analyzed with NVivo software to identify themes of participants’ thoughts to XTx. Results An overall Cohen's kappa statistic of 0.71 was established. In general, there was wide agreement among participants that XTx is an exciting and acceptable option to explore as an organ alternative. Concerns were expressed primarily regarding issues of animal ethics, stigma regarding how pigs are viewed in society, organ allocation logistics, quality of life after receiving a xenograft, and how XTx would be accepted by certain theological traditions. Conclusion Overall, various stakeholders accepted XTx as a clinical option. However, there were ethical, social, and physical concerns raised. Future studies exploring the development of education strategies that may help alleviate concerns related to XTx before it becomes a clinical alternative are needed among the general public, potential XTx candidates, and their family members.

“You cannot stay in the laboratory forever”*: Taking pig kidney xenotransplantation from the laboratory to the clinic

“…The opinions of patients, health care professionals, and members of the public need to be sought. A number of surveys and focus groups have been organized by Paris and his colleagues during the past three years, which indicate that the public is largely supportive of xenotransplantation [80] , [81] , [82] , [83] , [84] , [85] , [86] . The influence of religious beliefs has also been explored [ 87 , 88 ].…”

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.…”

Don't pig(!) the wrong heart!

“…Basic problems of immune response have not been fully answered 22–24 . Patient selection is completely unclear and it appears, that there is no distinct patient population that could even remotely and temporarily benefit from cardiac xenotransplantation 25,26 . Fundamental ethical questions have been addressed, but only within the xenotransplant community 23 .…”