Perspectives of Patients on the Kidney Transplant Waitlist Regarding Willingness to Undergo Xenotransplantation

BACKGROUND: Xenotransplantation, the use of genetically modified pigs as organ donors, is entering clinical trials in kidney transplantation. Although the medical community has long considered xenotransplant a potential solution to the organ shortage, the perspective of potential recipient's is not well described. METHODS: We distributed a survey to patients > 18 years of age on our kidney transplant waitlist assessing the following: demographics, insurance status, current waitlist status, transplant history, knowledge of xenotransplantation and recent xenotransplant news, willingness to accept a xenokidney, and reservations regarding xenotransplantation. Surveys were administered through three different modalities: email, electronic medical record patient portal, and physical mailings. A total of 717 patients were surveyed between April and June 2024. Quantitative statistical analysis was performed as well as sentiment and thematic analysis of free-text responses. RESULTS: Of 717 eligible individuals, 79 responses were received (response rate 11%), 59% were electronic and 41% were sent through physical mail. Respondents were 42% female, 25% African American, 85% with at least some college education, 46% with public insurance, and 58% reported religion as very important. Most respondents noted some awareness of xenotransplantation (77%) and many expressed a favorable impression (62%). Survey modality demonstrated a racial difference in response, with African American patients more likely to respond via physical mail (p = 0.014). Overall, the majority of respondents expressed a willingness to accept a xenokidney if outcomes were comparable to allografts (81%) or as a bridge to allotransplantation (65%), with similar findings on the sentiment and thematic analysis. The most common concerns expressed included organ rejection and incompatibility (30%), anxiety over the lack of long-term outcome data (25%) and organ durability (20%). CONCLUSIONS: Most patients on our kidney transplant wait list reported positive attitudes toward xenotransplantation and were willing to consider it under various circumstances, independent of anticipated time to transplant or reported time on the wait list. Knowledge of recent transplant events appeared to influence patient perceptions of xenotransplant. Using multiple survey methods was important to capture a sample more representative of our waitlist.