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Population of Senegal Residents in Spain: Acceptance of Organ Xenotransplantation
Population of Senegal Residents in Spain: Acceptance of Organ Xenotransplantation Antonio Ríosa,b,c,*, Joaquín Carrilloa, Ana I. López-Navasd, Laura Martínez-Alarcóna,b, Marco Antonio Ayala-Garcíaa,e, Álvaro Sáncheza, Guillermo Ramisa,f, Pascual Parrillaa,b,c, and Pablo Ramíreza,b,c a International Collaborative Donor Project (”Proyecto Colaborativo Internacional Donante”), Murcia, Spain; bTransplant Unit, Surgery Service, IMIB - Virgen de la Arrixaca University Clinical Hospital, Murcia, Spain; cDepartment of Surgery, University of Murcia, Murcia, Spain; dDepartment of Psychology, Catholic University of Murcia (UCAM), Murcia, Spain; eSchool of Medicine of the University of Quetzalcoatl in Irapuato, Guanajuato, Mexico; and fFaculty of Veterinary Medicine, University of Murcia, Murcia, Spain
ABSTRACT Introduction. Spain is a great receptor of immigration from sub-Saharan people like the Senegalese. This population is not very familiar with the process of organ donation and transplantation, and even less toward new therapies related to transplantation, such as xenotransplantation (XenoTx). Objective. Analyze the attitude toward XenoTx among the Senegalese population living in Spain. Material and Methods. Population under study. Population born in Senegal and resident in Spain. Inclusion criteria. Sample of population over 15 years stratified by age and sex, according to census data and immigrant assistance associations. Instrument. Validated questionnaire of attitude toward donation and organ transplantation “PCID-XenoTxRíos.” Field work. Random selection of respondents based on stratification. The support of immigration support associations was required to obtain sample locations. The completion was anonymous and self-administered. Results. A sample of 468 Senegalese was obtained. Twenty percent (n ¼ 92) would accept a solid organ xenotransplant if the results were similar to human organs, 40% (n ¼ 188) have doubts, and 40% (n ¼ 188) would not accept it. If the results were worse than with human organs, only 8% would accept it (n ¼ 38). Respondents with a favorable attitude toward XenoTx presented a more favorable attitude toward cadaveric donation (70.5% vs 31.3%; P < .001). The attitude toward acceptance of XenoTx is related to socio-personal factors (P < .05), knowledge about the process of organ donation and transplantation (P < .05), social interaction factors (P < .001), and religious factors (P < .05). Conclusions. Senegalese residing in Spain do not have a favorable attitude toward XenoTx. A direct relationship between the attitude toward XenoTx and organ donation is observed.
T
HE lack of organs to meet the demand, and the progressive increase in the number of indications for transplantation, make current donation rates insufficient to meet the minimum needs [1e3]. The xenotransplantation (XenoTx) organ investigation is progressing in its goal of finding solutions to the lack of organs for transplantation, as ª 2020 Elsevier Inc. All rights reserved. 230 Park Avenue, New York, NY 10169
Transplantation Proceedings, XX, 1e3 (2020)
this therapy could provide an unlimited source of organs. This clinical reality is still distant, especially in nonvital organs (eg, the kidney) with replacement therapies until *Address correspondence to Dr Antonio Ríos Zambudio, Avenida de la Libertad n 208, Casillas 30007, Murcia, Spain. Tel: 34.968.27.07.57. E-mail: [email protected] 0041-1345/20 https://doi.org/10.1016/j.transproceed.2019.11.045
1
2
RÍOS, CARRILLO, LÓPEZ-NAVAS ET AL
transplantation. But in other organs without these alternative therapies, XenoTx could be used as a bridge treatment until the arrival of a human organ in a zero-code situation [1,4e6]. In preclinical trials, it has been shown that, even with limitations, they are capable of functioning [1]. The acceptance of such therapy by the public is important for its future application. In Spain, studies have already been done analyzing the attitude toward XenoTx in the native population and health professionals, which is quite favorable [2e6]. However, an important social change is taking place, with multiple emigrant population groups that need to be studied in this regard [4e9]. African countries such as Senegal are exporters of immigrants who settle in Spain, people who are not very familiar with the process of organ donation and transplantation, and even less, with new transplant-related therapies, such as XenoTx. Studying this type of population group is especially important in countries such as Spain, where there are research and development units for XenoTx [7,10]. The objective of this study is to analyze the attitude toward XenoTx of organs and tissues in the Senegalese population living in Spain and the variables that influence their attitude. METHOD Population Study The study sample was taken from the “International Donor Collaborative Project” and formed by a population born in Africa, in the country of Senegal, and which now resides in Spain. Those older than 15 years stratified by age and sex were eligible for inclusion in the study. A random representative sample was obtained and stratified according to gender and age, based on the last population census and data obtained from associations of aid to the African immigrant population residing in Spain without official documentation. The appraisal tool used was a validated questionnaire of attitude toward the acceptance of an organ from an animal, with identical results to that of a human. “PCID-XenoTx-Ríos” [10] explains 61.180% of the total variance, with a Cronbach’s Alpha Reliability coefficient of 0.720. A random selection of people was surveyed according to the stratification. The completion was anonymized and self-administered. Verbal consent was asked to
collaborate in the study. Student t test, c2, Fisher and a logistic regression analysis were applied. The P values less than .05 were considered statistically significant.
RESULTS Attitude Toward Organ XenoTx
A sample of 468 Senegalese was obtained. If the results of the solid organ XenoTx were similar to those obtained with human organs, 20% (n ¼ 92) would accept a XenoTx, 40% (n ¼ 188) have doubts, and 40% (n ¼ 188) would not accept it. If the results were worse than with human organs, only 8% would accept it (n ¼ 38), and 44% (n ¼ 208) would not accept XenoTx. The remaining 47% (n ¼ 222) have doubts. The respondents with a positive attitude toward XenoTx present a more favorable attitude toward the donation of cadaveric organs, being 70.5% in favor, in contrast to 31.3% of those who have a negative XenoTx attitude (P < .001) (Table 1). Determination of the Profile Toward XenoTx of Organs If the Results Were Similar to Those Obtained With Human Organs
The following variables are associated with the attitude toward the acceptance of XenoTx as a means of obtaining organs for transplantation: 1. Sociopersonal variables, which include having offspring (P ¼ .034) and university studies (P < .001); 2. Knowledge about and attitude toward organ donation and transplantation, which includes considering the need for a transplant for oneself in the future against those who do not consider this situation (P < .001); 3. Social interaction and prosocial behavior, which includes being in favor of the donation of cadaver organs (P < .001), having previously had some relationship with the field of donation and organ transplantation (P ¼ .012), not knowing the partner’s opinion on this issue (P < .001), and performing prosocial altruistic activities (P < .001); and 4) Religious variables, which includes being Catholic (P ¼ .001) and considering that the professed religion is in favor of donation and organ transplantation (P < .001) (Table 1).
Table 1. Variables Affecting Attitude Toward Xenotransplantation Among Senegalese Population Residing in Spain Variables
In Favor (n ¼ 115; 72%)
Socio-personal Offspring Yes Level of studies University students Knowledge about and attitude toward organ donation and transplantation Possibility of needing a transplant for oneself Yes Social interaction and prosocial behavior Attitude toward deceased organ donation In favor Previous relationship ODT Yes Opinion of partner toward donation and transplantation I don’t know Perform prosocial activities Yes Religious Religion Catholics Know the attitude of your religion toward transplantation In favor Abbreviation: ODT, organ donation and transplantation.
Not For (n ¼ 67; 28%)
P
No No studies
.034 <.001
I don’t know
<.001
No No Against No but I would like to
<.001 .012 <.001 <.001
Muslims Against
.001 <.001
ACCEPTANCE OF ORGAN XENOTRANSPLANTATION
Multivariate
The multivariate analysis persists as independent variables as follows: 1. carrying out prosocial activities (odds ratio ¼ 9.615; P < .001), and 2. considering the possibility of needing a transplant in the future (odds ratio ¼ 66.666; P < .001).
DISCUSSION
Advances in genetics and immunology with the development of transgenic technology have strongly boosted studies on XenoTx. Despite this, in recent years numerous barriers have not been overcome. Even so, research continues to turn these transgenic organs into "bridge organs" until the possibility of being able to perform a human organ transplant. Despite everything, it is important to consider that the XenoTx of organs is conditioned to the social acceptance of this therapy [1e6]. In studies conducted at the population level, the acceptance rates of XenoTx are variable, being objectified and conditioned mainly by the level of studies and the opinion of the partner, there is also a close relationship between the attitude toward the XenoTx and the attitude toward human donation [11,12]. According to Omnell et al [13], if a person is in favor of receiving a human organ, they are also prepared to receive an animal organ, as long as the results are the same. In this study, the Senegalese population residing in Spain has a favorable attitude towards XenoTx of organs of only 20%. These data are below those obtained in the Spanish population, which the percentage is greater than 70% [2e6]. The latest studies conducted in different immigrant population groups in Spain do not show a very favorable attitude toward XenoTx of organs [14]. In conclusion, we can say that the population of Senegalese residing in Spain does not present a favorable attitude toward XenoTx, objectifying a direct relationship between the attitude toward XenoTx and toward organ donation.
REFERENCES [1] Ríos A, López-Gómez S, Belmonte J, López-Navas A, Sánchez A, Carrillo J, et al. Acceptance of the xenotransplantation of organs among the population of the Spanish Gypsy ethnic group. Transplant Proc 2019;51:293e5. [2] Conesa C, Ríos A, Ramírez P, Sánchez J, Sánchez E, Rodríguez MM, et al. Attitudes of primary care professionals in
3 Spain toward xenotransplantation. Transplant Proc 2006;38: 853e7. [3] Ríos A, López-Navas AI, López-López A, Gómez FJ, Iriarte J, Herruzo R, et al. The level of acceptance of Spanish medical students of the transplantation of solid organs from animals: a stratified and multicenter study. Xenotransplantation 2015;22:476e86. [4] Ríos A, López-Navas AI, Martínez-Alarcón L, Sánchez J, Ramis G, Ramírez P, et al. A study of the attitude of LatinAmerican residents in Spain toward organ xenotransplantation. Xenotransplantation 2014;21:149e61. [5] Ríos A, Martínez-Alarcón L, Sánchez J, Jarvis N, Ramis G, López A, et al. The attitude of Scottish citizens to xenotransplantation in the southeast of Spain: an emerging population subgroup. Transplant Proc 2010;42:2126e9. [6] Ríos A, Ramírez P, Martínez L, Jarvis N, Sánchez J, Rodríguez MM, et al. British citizens in a regional community of southeastern Spain with a pre-clinical organ xenotransplantation program. A study of attitude toward xenotransplantation. Xenotransplantation 2007;14:255e64. [7] Ríos Zambudio A. Proyecto Colaborativo Internacional Donante [International Colaborative Donor Projet]. Cir Esp 2018;96:69e75. in Spanish. [8] Ríos A, López-Navas A, Navalón JC, Martínez-Alarcón L, Ayala-García MA, Sebastián MJ, et al. The Latin-American population in Spain and organ donation. Attitude toward deceased organ donation and organ donation rates. Transplant Int 2015;28: 437e47. [9] Ríos A, Carrillo J, López-Navas AI, Ayala-García MA, Á Sánchez, Hernández AM, et al. Multivariate analysis of factors that condition the attitude toward organ donation among the population of Mali residents in Spain. Transplant Proc 2019;51: 269e72. [10] Ríos A, López-Navas AI, De-Francisco C, Sánchez A, Hernández AM, Ramírez P, et al. Attitude toward organ and tissue xenotransplantation questionnaire (PCID-XENOTx-Ríos): characteristics and psychometric properties of the validation in Spanishspeaking populations. Transplant Proc 2018;50:2303e7. [11] Ríos A, Cascales P, Martínez L, Sánchez J, Jarvis N, Parrilla P, et al. Emigration from the British Isles to south-eastern Spain: a study of attitudes toward organ donation. Am J Transplant 2007;7:2020e30. [12] Conesa C, Ríos Zambudio A, Ramírez P, Rodríguez MM, Canteras M, Parrilla P. Importancia de los profesionales de Atención Primaria en la educación sanitaria de la donación de órganos [Importance of primary health-care professionals in the sanitary education about organ donation]. Aten Primaria 2004;34:528e33 [in Spanish]. [13] Omnell M, Persson NH, Ranstam J, Hermeren G. Xenotransplantation public perceptions: rather cells than organs. Xenotransplantation 2003;10:72e9. [14] Ríos A, López-Navas AI, Flores-Medina J, Ayala MA, Garrido G, José Sebastián M, et al. Level of acceptance of solid organ and tissue xenotransplantation among the Bolivian population residing in Spain. Transplant Proc 2018;50:2300e2.
ABSTRACT Introduction. Spain is a great receptor of immigration from sub-Saharan people like the Senegalese. This population is not very familiar with the process of organ donation and transplantation, and even less toward new therapies related to transplantation, such as xenotransplantation (XenoTx). Objective. Analyze the attitude toward XenoTx among the Senegalese population living in Spain. Material and Methods. Population under study. Population born in Senegal and resident in Spain. Inclusion criteria. Sample of population over 15 years stratified by age and sex, according to census data and immigrant assistance associations. Instrument. Validated questionnaire of attitude toward donation and organ transplantation “PCID-XenoTxRíos.” Field work. Random selection of respondents based on stratification. The support of immigration support associations was required to obtain sample locations. The completion was anonymous and self-administered. Results. A sample of 468 Senegalese was obtained. Twenty percent (n ¼ 92) would accept a solid organ xenotransplant if the results were similar to human organs, 40% (n ¼ 188) have doubts, and 40% (n ¼ 188) would not accept it. If the results were worse than with human organs, only 8% would accept it (n ¼ 38). Respondents with a favorable attitude toward XenoTx presented a more favorable attitude toward cadaveric donation (70.5% vs 31.3%; P < .001). The attitude toward acceptance of XenoTx is related to socio-personal factors (P < .05), knowledge about the process of organ donation and transplantation (P < .05), social interaction factors (P < .001), and religious factors (P < .05). Conclusions. Senegalese residing in Spain do not have a favorable attitude toward XenoTx. A direct relationship between the attitude toward XenoTx and organ donation is observed.
T
HE lack of organs to meet the demand, and the progressive increase in the number of indications for transplantation, make current donation rates insufficient to meet the minimum needs [1e3]. The xenotransplantation (XenoTx) organ investigation is progressing in its goal of finding solutions to the lack of organs for transplantation, as ª 2020 Elsevier Inc. All rights reserved. 230 Park Avenue, New York, NY 10169
Transplantation Proceedings, XX, 1e3 (2020)
this therapy could provide an unlimited source of organs. This clinical reality is still distant, especially in nonvital organs (eg, the kidney) with replacement therapies until *Address correspondence to Dr Antonio Ríos Zambudio, Avenida de la Libertad n 208, Casillas 30007, Murcia, Spain. Tel: 34.968.27.07.57. E-mail: [email protected] 0041-1345/20 https://doi.org/10.1016/j.transproceed.2019.11.045
1
2
RÍOS, CARRILLO, LÓPEZ-NAVAS ET AL
transplantation. But in other organs without these alternative therapies, XenoTx could be used as a bridge treatment until the arrival of a human organ in a zero-code situation [1,4e6]. In preclinical trials, it has been shown that, even with limitations, they are capable of functioning [1]. The acceptance of such therapy by the public is important for its future application. In Spain, studies have already been done analyzing the attitude toward XenoTx in the native population and health professionals, which is quite favorable [2e6]. However, an important social change is taking place, with multiple emigrant population groups that need to be studied in this regard [4e9]. African countries such as Senegal are exporters of immigrants who settle in Spain, people who are not very familiar with the process of organ donation and transplantation, and even less, with new transplant-related therapies, such as XenoTx. Studying this type of population group is especially important in countries such as Spain, where there are research and development units for XenoTx [7,10]. The objective of this study is to analyze the attitude toward XenoTx of organs and tissues in the Senegalese population living in Spain and the variables that influence their attitude. METHOD Population Study The study sample was taken from the “International Donor Collaborative Project” and formed by a population born in Africa, in the country of Senegal, and which now resides in Spain. Those older than 15 years stratified by age and sex were eligible for inclusion in the study. A random representative sample was obtained and stratified according to gender and age, based on the last population census and data obtained from associations of aid to the African immigrant population residing in Spain without official documentation. The appraisal tool used was a validated questionnaire of attitude toward the acceptance of an organ from an animal, with identical results to that of a human. “PCID-XenoTx-Ríos” [10] explains 61.180% of the total variance, with a Cronbach’s Alpha Reliability coefficient of 0.720. A random selection of people was surveyed according to the stratification. The completion was anonymized and self-administered. Verbal consent was asked to
collaborate in the study. Student t test, c2, Fisher and a logistic regression analysis were applied. The P values less than .05 were considered statistically significant.
RESULTS Attitude Toward Organ XenoTx
A sample of 468 Senegalese was obtained. If the results of the solid organ XenoTx were similar to those obtained with human organs, 20% (n ¼ 92) would accept a XenoTx, 40% (n ¼ 188) have doubts, and 40% (n ¼ 188) would not accept it. If the results were worse than with human organs, only 8% would accept it (n ¼ 38), and 44% (n ¼ 208) would not accept XenoTx. The remaining 47% (n ¼ 222) have doubts. The respondents with a positive attitude toward XenoTx present a more favorable attitude toward the donation of cadaveric organs, being 70.5% in favor, in contrast to 31.3% of those who have a negative XenoTx attitude (P < .001) (Table 1). Determination of the Profile Toward XenoTx of Organs If the Results Were Similar to Those Obtained With Human Organs
The following variables are associated with the attitude toward the acceptance of XenoTx as a means of obtaining organs for transplantation: 1. Sociopersonal variables, which include having offspring (P ¼ .034) and university studies (P < .001); 2. Knowledge about and attitude toward organ donation and transplantation, which includes considering the need for a transplant for oneself in the future against those who do not consider this situation (P < .001); 3. Social interaction and prosocial behavior, which includes being in favor of the donation of cadaver organs (P < .001), having previously had some relationship with the field of donation and organ transplantation (P ¼ .012), not knowing the partner’s opinion on this issue (P < .001), and performing prosocial altruistic activities (P < .001); and 4) Religious variables, which includes being Catholic (P ¼ .001) and considering that the professed religion is in favor of donation and organ transplantation (P < .001) (Table 1).
Table 1. Variables Affecting Attitude Toward Xenotransplantation Among Senegalese Population Residing in Spain Variables
In Favor (n ¼ 115; 72%)
Socio-personal Offspring Yes Level of studies University students Knowledge about and attitude toward organ donation and transplantation Possibility of needing a transplant for oneself Yes Social interaction and prosocial behavior Attitude toward deceased organ donation In favor Previous relationship ODT Yes Opinion of partner toward donation and transplantation I don’t know Perform prosocial activities Yes Religious Religion Catholics Know the attitude of your religion toward transplantation In favor Abbreviation: ODT, organ donation and transplantation.
Not For (n ¼ 67; 28%)
P
No No studies
.034 <.001
I don’t know
<.001
No No Against No but I would like to
<.001 .012 <.001 <.001
Muslims Against
.001 <.001
ACCEPTANCE OF ORGAN XENOTRANSPLANTATION
Multivariate
The multivariate analysis persists as independent variables as follows: 1. carrying out prosocial activities (odds ratio ¼ 9.615; P < .001), and 2. considering the possibility of needing a transplant in the future (odds ratio ¼ 66.666; P < .001).
DISCUSSION
Advances in genetics and immunology with the development of transgenic technology have strongly boosted studies on XenoTx. Despite this, in recent years numerous barriers have not been overcome. Even so, research continues to turn these transgenic organs into "bridge organs" until the possibility of being able to perform a human organ transplant. Despite everything, it is important to consider that the XenoTx of organs is conditioned to the social acceptance of this therapy [1e6]. In studies conducted at the population level, the acceptance rates of XenoTx are variable, being objectified and conditioned mainly by the level of studies and the opinion of the partner, there is also a close relationship between the attitude toward the XenoTx and the attitude toward human donation [11,12]. According to Omnell et al [13], if a person is in favor of receiving a human organ, they are also prepared to receive an animal organ, as long as the results are the same. In this study, the Senegalese population residing in Spain has a favorable attitude towards XenoTx of organs of only 20%. These data are below those obtained in the Spanish population, which the percentage is greater than 70% [2e6]. The latest studies conducted in different immigrant population groups in Spain do not show a very favorable attitude toward XenoTx of organs [14]. In conclusion, we can say that the population of Senegalese residing in Spain does not present a favorable attitude toward XenoTx, objectifying a direct relationship between the attitude toward XenoTx and toward organ donation.
REFERENCES [1] Ríos A, López-Gómez S, Belmonte J, López-Navas A, Sánchez A, Carrillo J, et al. Acceptance of the xenotransplantation of organs among the population of the Spanish Gypsy ethnic group. Transplant Proc 2019;51:293e5. [2] Conesa C, Ríos A, Ramírez P, Sánchez J, Sánchez E, Rodríguez MM, et al. Attitudes of primary care professionals in
3 Spain toward xenotransplantation. Transplant Proc 2006;38: 853e7. [3] Ríos A, López-Navas AI, López-López A, Gómez FJ, Iriarte J, Herruzo R, et al. The level of acceptance of Spanish medical students of the transplantation of solid organs from animals: a stratified and multicenter study. Xenotransplantation 2015;22:476e86. [4] Ríos A, López-Navas AI, Martínez-Alarcón L, Sánchez J, Ramis G, Ramírez P, et al. A study of the attitude of LatinAmerican residents in Spain toward organ xenotransplantation. Xenotransplantation 2014;21:149e61. [5] Ríos A, Martínez-Alarcón L, Sánchez J, Jarvis N, Ramis G, López A, et al. The attitude of Scottish citizens to xenotransplantation in the southeast of Spain: an emerging population subgroup. Transplant Proc 2010;42:2126e9. [6] Ríos A, Ramírez P, Martínez L, Jarvis N, Sánchez J, Rodríguez MM, et al. British citizens in a regional community of southeastern Spain with a pre-clinical organ xenotransplantation program. A study of attitude toward xenotransplantation. Xenotransplantation 2007;14:255e64. [7] Ríos Zambudio A. Proyecto Colaborativo Internacional Donante [International Colaborative Donor Projet]. Cir Esp 2018;96:69e75. in Spanish. [8] Ríos A, López-Navas A, Navalón JC, Martínez-Alarcón L, Ayala-García MA, Sebastián MJ, et al. The Latin-American population in Spain and organ donation. Attitude toward deceased organ donation and organ donation rates. Transplant Int 2015;28: 437e47. [9] Ríos A, Carrillo J, López-Navas AI, Ayala-García MA, Á Sánchez, Hernández AM, et al. Multivariate analysis of factors that condition the attitude toward organ donation among the population of Mali residents in Spain. Transplant Proc 2019;51: 269e72. [10] Ríos A, López-Navas AI, De-Francisco C, Sánchez A, Hernández AM, Ramírez P, et al. Attitude toward organ and tissue xenotransplantation questionnaire (PCID-XENOTx-Ríos): characteristics and psychometric properties of the validation in Spanishspeaking populations. Transplant Proc 2018;50:2303e7. [11] Ríos A, Cascales P, Martínez L, Sánchez J, Jarvis N, Parrilla P, et al. Emigration from the British Isles to south-eastern Spain: a study of attitudes toward organ donation. Am J Transplant 2007;7:2020e30. [12] Conesa C, Ríos Zambudio A, Ramírez P, Rodríguez MM, Canteras M, Parrilla P. Importancia de los profesionales de Atención Primaria en la educación sanitaria de la donación de órganos [Importance of primary health-care professionals in the sanitary education about organ donation]. Aten Primaria 2004;34:528e33 [in Spanish]. [13] Omnell M, Persson NH, Ranstam J, Hermeren G. Xenotransplantation public perceptions: rather cells than organs. Xenotransplantation 2003;10:72e9. [14] Ríos A, López-Navas AI, Flores-Medina J, Ayala MA, Garrido G, José Sebastián M, et al. Level of acceptance of solid organ and tissue xenotransplantation among the Bolivian population residing in Spain. Transplant Proc 2018;50:2300e2.