Public Consultation on Xenotransplantation - Viewpoints - Attitudes towards Xenotransplantation in seven countries

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Attitudes surveyed in seven countries

[ Source : Council of Europe 2000: Working Party on Xenotransplantation, Strasbourg, July 2000. Reprinted with permission. ]

The Council of Europe* recently published summaries of surveys on attitudes towards xenotransplantation in:

Canada

The survey was administered for Health Canada’s Therapeutics Products Programme. It surveyed some 2526 Canadians 15 years and older and considered seven questions: two on transplantation and five on xenotransplantation.

	% Yes
Question	Total		Male		Female
1. Have you indicated that you are willing to donate an organ or tissue for transplant upon death (for example, on your drivers’ license, health insurance card, or notifying your next of kin)?	52%		52%		52%
2. (If answer was NO in #1) Would you be willing to donate an organ or tissue for transplant upon death?	49%		50%		48%
3. Have you read or heard about medical researchers proposing to use animal organs for transplant into humans, or are you not sure if you’ve heard about this?	75%		76%		74%
4. Have you heard that one of the risks of animal-to-human transplants is the possibility that an unknown and new disease might be transmitted from the animal organ to the person receiving the transplant, or are you not sure if you’ve heard about this risk?	45%		47%		42%
5. (If answer was YES in #4) Have you heard about the possibility that, if the person receiving the transplant is infected by a new disease, there is a risk that people who come into contact with that person might also become infected and sick, or are you not sure if you’ve heard about this risk?	41%		44%		38%
6. If a human organ were not available, would you consider an animal-to-human transplant for yourself or a member of your family?	54%		63%		45%
7. In view of the fact that animal-to-human transplants may pose a risk to the general population, what role would you personally want to play in decisions about the acceptability of carrying out this procedure in Canada?	Kept informed	Involved in meetings		Invited to comment		No role
	62%	24%		22%		12%

Table 1 Results Canada

Those most likely to be aware of xenotransplantation were seniors (87%) and university graduates (85%). By comparison, awareness was lower than average among unskilled workers (61%) and high school and university students (62%).

Based on their current knowledge of potential risks, about half the respondents said they would consider an animal to human transplant for themselves or a member of their family if a human organ were not available. Slightly more than a third (38%) said "Yes" unequivocally and another 16% indicated conditional acceptance. Over a third (39%) said they would refuse a xenograft and 8% were undecided. Women (55%) were more likely to say they would refuse a xenograft than men (37%).

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Australia

The survey was undertaken in Sydney Australia on 133 patients who had received human transplants.

	Disagree %	Neutral %	Agree %
If a close relative died, I would agree to the donation of organs	12.4	3.5	81.4
I would accept an organ from a living relative	29.2	8.8	61.1
I would accept an organ from genetically unrelated, but living person e.g. spouse	26.5	11.5	41.6
I would accept an organ from an animal closely related to man e.g. baboon, chimp	45.1	11.5	41.6
I would accept an organ from a species distant to man e.g. pig or sheep	44.2	13.2	41.6
It is appropriate to breed animals to provide organs for transplant	33.6	17.7	47.8

Table 2 Results Australia

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United States

The following contains the results of two surveys of attitudes towards xenotransplantation. The first survey was conducted by the National Kidney Foundation and polled 1200 randomly selected individuals. The second by a team from the St. Vincent Medical Centre, Los Angeles California who surveyed 100 patients regarding their attitudes.

National Kidney Foundation
Nearly all those surveyed (94%) were aware of the shortage of organs for transplantation and most (62%) accept the concept of xenotransplantation as a viable option. Support for xenotransplantation was with some reservations. Respondents reported concerns over organ compatibility, success rate, and cross-species contamination.

St. Vincent Medical Centre
Respondents included 65 men, and 35 women. Their ages ranged from 17 to 74 years old, and their racial composition was 72 whites, 18 Hispanics, 5 African Americans, and 4 Asian Americans.

80% of patients agreed with xenografting in an emergency situation, and ten patients stated they would not have xenografts "under no circumstances." In descending order patients preferred the following organ sources: human (96%), monkey (44%), mechanical (43%), pig (42%), or dog (34%). Twenty-four patients thought that a xenograft would change their appearance, personality, and eating or sexual habits.

The survey also elicited religious and ethical viewpoints. However, these did not appear to differ on the basis of religion, although within religious groups the cultural or ethnic background did at times seem to play a role in the reasons some animals were viewed as acceptable or unacceptable to donors. For example, Catholics of Mexican-American origin felt that dogs and pigs had poor hygiene and were therefore not acceptable donors.

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France

This survey looked at the attitudes to xenotransplantation by a number of different groups: physicians, nurses, technicians and students. The survey team had a 97.1% response rate, respondents were given full background material on xenotransplantation, and unsure were scored as no. The conclusion of the survey was that the more information that was given about xenotransplantation, the more acceptable the procedure was.

	Physicians n=91	Nurses n=128	Technicians n=85	Students n=321
Mean age	42.1 (9.4)	36.7 (7.9)	38.0 (11.5)	23.3 (4.4)
Male	65.9	15.9	29.5	34.6
Believing in God	56.5	59.2	53.7	53.9
Involved in transplantation	41.8	39.1	47.7	0
Definition of xenotransplantation given to participants
Wish to continue research	94.3	87.2	92.6	90.5
Approve of xenotransplantation	73.1	73.8	68.0	80.3
Accept xenografts in any circumstance	54.9	33.9	41.3	48.3
Only in life or death	69.2	60.8	68.4	72.1
Despite infection risk	42.0	28.9	40.7	23.1
Information given on theoretical infectious risk
Accept xenograft	85.4	72.2	76.6	74.6
Of all organs and tissues	74.1	71.4	73.9	87.7
Only if vital risk	57.5	50.8	56.4	52.1
Not matter of life of death but handicap	56.8	71.4	71.3	67.5
Information given on choice of pig as source
Support xenotransplantation	88.1	74.8	85.1	82.3

Table 3 Results France

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Germany

The survey was undertaken to assess attitudes towards xenogeneic compared to allogenic organ transplantation. Detailed questionnaires were given to 1049 patients who either had received transplants or were on waiting lists for various organs. The survey indicates that 77% of patients would accept xenografts while 7% would refuse them if results were similar to allotransplantation. If xenotransplantation were associated with increased risks due to more intensive medication 58% would still accept them. Acceptance of xenografts was significantly higher in patients who had received transplants and among males. Age, religion, waiting time, and type of organ were not found to influence acceptance rates. Xenografts were thought to be associated with considerable or severe emotional stress by 23% of patients, versus 3% for allografts. The pig was the preferred source animal, and gene therapeutic manipulation for improved results was accepted by 84%.

I would accept a xenograft if transplanted with a similar success as a human graft:	Waiting List Patients (n=327)	Transplanted Patients (n=722)
Yes	55%	53%
Yes, in an urgent situation	16%	30%
Don’t know	17%	12%
No	12%	5%
I would accept a xenograft even in case of more immunosupression and related side effects:	Waiting List Patients (n=327)	Transplanted Patients (n=722)
Yes	12%	10%
Yes, in an urgent situation	26%	57%
Don’t know	19%	16%
No	43%	17%
Knowledge about the following characteristics of a transplanted organ would cause severe or considerable emotional stress:	All Patients (n=1049)
Human graft, donor of opposite sex	1%
Human graft, donor with criminal history	13%
Human graft, donor age >65 years	23%
Xenograft	23%
I have major concerns about xenotransplantation because of:	All Patients (n=1049)
Inferior function	60%
Disease transmission	52%
Emotional stress	24%
Animal rights	15%
Personality change	15%
Religious reasons	5%

Table 4 Results Germany

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Sweden

The Department of Public Health and Caring Science/Social Medicine conducted a study on Swede’s attitudes about the transplantation of organs and tissues from different sources.

A random sample of 1500 inhabitants were sent a questionnaire asking about their opinion on transplantation and transplantation issues. The response rate was 71%. Organs from living donors were preferred (77%), then organs from deceased donors (69%), then artificial organs (63%), and last animal organs (40%).

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England

The survey was undertaken by the British Kidney Association. They asked 850 patients known to them how they would respond and why to the offer of a xenograft. Respondents were given a full explanation of the procedure of xenotransplantation – the source animal being a transgenic pig. The results were as follows.

663 (78%) willing to receive pig kidney
144 (17%) were not
43 (5%) unsure

Reasons against included religion and the special breeding of pigs for donation.

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