Introduction: Xenotransplantation (XTx) presents a promising clinical alternative to address the current shortage of human organs. Recently, XTx has been performed using decedent models and under expanded access approval as a prelude to human clinical trials. Before such trials can occur, public assessments are crucial to understand potential barriers to acceptance, as recommended by key regulatory bodies. This study aimed to elucidate attitudes toward XTx in the US and identify characteristics associated with barriers to acceptance.
Methods: A survey assessing demographic characteristics and attitudes toward XTx was distributed to a nationally representative sample of adults ≥ 18 years old in the US via the distribution platform, Cint™. Multivariable regression analysis was employed to identify characteristics associated with attitudes toward XTx.
Results: From May 25-June 14 2023, a total of 5008 respondents completed the survey. Respondents were evenly distributed across U.S. regions, aged 18-65, 47.6% male, 50.9% female, with 61.7% identifying as White, and half with a college degree or higher. Approximately 25% reported close transplant experiences as recipients or as waitlisted candidates, or were closely connected to a recipient or someone in need of an organ. Overall, <20% indicated they were familiar with XTx, yet >40% of respondents had heard of recent XTx experiments via the media. Approximately 40% expressed reservations about using pigs for human transplants and reported discomfort with the idea of receiving a pig organ for themselves, their child, or a loved one. Notably, 38% reported being more comfortable with a pig organ after learning during the survey that the source pig was genetically modified. If a pig organ were as effective as a human organ transplant, over 50% would opt for the pig organ if it meant a faster transplant. Even in the absence of xenotransplant outcome data, 36% expressed willingness to participate in experimental XTx if in need of an organ. However, 57% rated lack of current evidence of success or fear of rejection/complications as their top concerns. Just over half of survey respondents (54%) were concerned about potential xenozoonosis. Regression models consistently associated being younger, female, or a racial minority with lower acceptance of XTx.         
Conclusion: This study is the largest survey to date across the U.S. that explores public attitudes toward XTx. Despite overall acceptance, concerns persist. Identifying opportunities to increase public acceptance will be key as the field progresses toward human clinical trials and eventual translation to clinical practice.