Questionnaire for data collection Please enable JavaScript in your browser to complete this form.1. Contact address (person who provides information. This information will be treated confidentially)?TitleMr.Mrs.Professor.Associate professorMDMD/PHDPHDName *FirstLastAddressAddress Line 1CityState / Province / RegionPostal CodeAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia (Republic of)MadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States of AmericaUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)Viet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweCountryInstitutionTelephone 1 *Telephone 2Email *2. What is the source of your information about human xenotransplantation practices?PublicationCongressAdvertisementOthersCould you please send a copy of your source of information to our office located at Sichuan Provincial people's hospital? (see Contact addresses)If other, please specify3. What is the therapeutic purpose of this xenotransplantation treatment?a. Acute liver failure b. Other end-stage liver diseasesc. Chronic cardiac failured. Chronic renal failuree. Diabetesf. Burnsg. Impotencyh. Neurological degenerative disorders i. Others degenerative disorder j. Other treatments If other,please specify4. Where and when is this human xenotransplantation practice taking place?CountryTimingComment5. Is this treatment part of a clinical trial? * YesNo Item #1 YesItem #1 No 6. What is the animal source of the xenotransplantation product?i. Pigii. Non-human primateiii. Rativ. Mousev. OthersIf other,please specify 7. Source animals * YesNo Do you have information about source animals?Do you have information about source animals? YesDo you have information about source animals? No 8. Testing of safety * YesNo Do you have information about testing of safety?Do you have information about testing of safety? YesDo you have information about testing of safety? No 9. What type of cells was transplanted? * HepatocytesIslets of langerhansFetal islet like cell clustersPurkinje cellsNeural precursors cellsEmbryonic stem cellsMesenchymal stem cellsFetal sheep cells Cells: HepatocytesCells: Islets of langerhansCells: Fetal islet like cell clustersCells: Purkinje cellsCells: Neural precursors cellsCells: Embryonic stem cellsCells: Mesenchymal stem cellsCells: Fetal sheep cells What type of tissues was transplanted? * SkinCardiac valves Cells: SkinCells: Cardiac valves What type of organs was transplanted? * LiverHeartKidneyPancreasLungSmall intestineCornea Cells: LiverCells: HeartCells: KidneyCells: PancreasCells: LungCells: Small intestineCells: Cornea If other,please specify 10. What type of exposure to xenogeneic cells was involved? YesNo Solid-organ xenotransplantation:Solid-organ xenotransplantation: YesSolid-organ xenotransplantation: NoCellular xenotransplantation:Cellular xenotransplantation: YesCellular xenotransplantation: NoTissue xenotransplantation:Tissue xenotransplantation: YesTissue xenotransplantation: NoHuman cells exposed to xenogeneic Feeder cell:Human cells exposed to xenogeneic Feeder cell: YesHuman cells exposed to xenogeneic Feeder cell: NoExtracorporeal perfusion:Extracorporeal perfusion: YesExtracorporeal perfusion: NoEncapsulation:Encapsulation: YesEncapsulation: NoOther bioartificial isolation device:Other bioartificial isolation device: YesOther bioartificial isolation device: No If other,please specify11. Transplant recipientYesNoDo you have information about transplant recipients?How are the transplant recipients being monitored for infections?Which microbial agents have been tested in transplant recipients?Has this microbiological testing been done by a registered laboratory?YesNoif yes, which?if not, by whom?What testing methods were used?Serological or culture assay testingImmunohistopathologyImmunofluorescenceRadioimmunoassayELISAPCROthersIf other,please specify What samples are taken and how often? For how long will they continue to be taken?For how long will they be stored?How often is the patient seen for follow-up?How long are the patients followed?Location of the clinical follow-up examination:YesNoIn the same clinic?if yes, which? if no, where? 12. Have results been presented at a scientific congress?YesNoif yes, where?13. Have results been published in a scientific journal?YesNoIf yes, where? Could you please give the reference?14. Is this human clinical trial performed with governmental and/or institutional oversight and supervision?YesNoif yes, which?15. Was the trial approved by a public health authorities(ministry of health, governmental agency...)?YesNoif yes, which? 16.Was the trial overseen by a public health authorities(ministry of health, governmental agency...)?YesNoif yes, which? 17. CommentCommentSubmit