"Will I Still be Myself?" Opposition to Xenotransplantation Among Chinese Kidney Transplant Candidates: A Qualitative Study.

Abstract

Background: Kidney transplantation remains the preferred treatment for end-stage renal disease (ESRD), yet its application is constrained by a persistent shortage of donor organs. Xenotransplantation has emerged as a promising alternative, but its clinical adoption faces complex ethical, cultural, and psychological barriers.

Methods: Using a phenomenological approach, we conducted semi-structured face-to-face interviews with 18 kidney transplant candidates who opposed xenotransplantation at West China Hospital of Sichuan University between June and August 2025. Data were analyzed inductively using NVivo software in conjunction with Colaizzi's seven-step method.

Results: Four interrelated themes captured the key barriers to acceptance: (1) Anxiety about physical self-identity and social pressure-fears of losing bodily integrity or facing stigma; (2) Concerns about medical safety-perceived risks of rejection, infection, and technological uncertainty; (3) Information barriers and decision-making dilemmas-fragmented information and lack of professional guidance; and (4) Lack of trust and security mechanisms-mistrust in both the technology and institutional safeguards.

Conclusions: The acceptance of xenotransplantation among Chinese kidney transplant candidates who oppose xenotransplantation is hindered by multidimensional, interlinked factors involving identity, safety, knowledge, and trust. Addressing these specific barriers through targeted transparent education, ethical governance, and institutional trust-building strategies is essential for the responsible clinical integration of xenotransplantation and also provides a reference for communicating with skeptical candidates in clinical practice.