“At the publication of this public census, we’ve opened Pandora’s box and we’re going to have to make a change,” Pavan Najran (The Christie Hospital NHS Foundation Trust, Manchester, UK) said at a recent meeting, referencing a UK-wide survey looking at the use of medical devices that contain animal derivatives. Touted as the first and largest study of its kind, Najran underlined the poignancy of the results set against increasing patient autonomy, religious diversity in the UK and consent.
During his Global Embolization Symposium and Technologies (GEST; 15–18 May, New York, USA) presentation Najran shared that, during a drain removal as an interventional radiology fellow, he recalled being handed a pot of bovine collagen, realising that the patient on the table did not know that this was going to be used and had not consented.
“From that point, I kept reading small case reports and even legal documentation throughout the years about patients retrospectively taking action against hospitals because a mesh repair contained animal derivative, and I thought to myself that it’s time we had a true reflection from the population as to the use of these devices,” Najran explained.
Via an electronic survey, Najran and his team collected responses from 407 patients who were given examples of emergency and non-emergency scenarios in which devices with animal derivatives may be used. The majority of responders were white British/Welsh/Scottish/Northern Irish, followed by Asian/Asian British-Indian and Asian/Asian British-Pakistani. Most respondents had received higher education to undergraduate or postgraduate degree level. Those with no religion and meat-eaters made up a large proportion of respondents.
Religion as an influencing factor was a central focus for Najran and his team. Among respondents, 12 identified as Buddhist, 96 Christian (including all Christian denominations), 19 Hindu, six Jewish, 76 Muslim, two Sikh, nine preferred not to say and 16 marked ‘other’.
Ranging from completely unacceptable to completely acceptable, Najran shared that across groups “there is huge resistance to the use of both bovine and porcine products in either emergency or non-emergency settings”.
“Looking at the Christian population, there is a move toward slightly more acceptable in all groups, but there is a significant proportion of those rejecting the use of such products,” said Najran. “In the Muslim population, as expected, there is a greater rejection in the porcine group, but actually in the bovine group as well.”
Among responders who identified as having no religion (171) unacceptability was high, with 73.7% and 80.7% of responders stating no acceptability in an emergency and elective setting, respectively.
In the meat-eating group—which accounted for 149 respondents—33.5% specified no acceptability for the use of devices with animal derivatives in an emergency setting, and 40.9% responded no acceptability for their use in an elective setting. Vegetarians and vegans indicated greater rejection of these devices in any setting, a resistance Najran and his team had anticipated.
Given the UK’s increasing diversity, Najran raised that “there is an increasing possibility of a mismatch between what is medically possible and what is personally acceptable”. Demonstrating the gravity of this mismatch for some religious groups, the speaker drew attention to Jehovah’s Witness, who refuse to accept blood products, yet the use of animal derivatives in devices is a “neglected topic”.
“Right now, we can use such products in our patients without having to consent them or even discuss it with them before the procedure, which really needs to change,” Najran stated. “We need to approach our patients far more holistically and we need to consider the patient’s personal requirements and what is acceptable to them prior to performing a procedure.”
Najran’s approach to address this issue is twofold—he believes consent gained from patients after informing them of animal derivatives in devices that may be used in their procedure must be made a legal requirement, and industry must collaborate to provide the best option in these circumstances.
Recently, Najran and his team were called to discuss this research at the House of Commons and are seeking to secure funding for a national survey to gain “healthier data” from the UK population at large, he stated.
