Susan Lim: Transplant cells, not organs

翻译人员: Bear Jin 校对人员: Pei Zhang

So I was privileged to train in transplantation

能在两位伟大的外科先驱者

under two great surgical pioneers:

手下学习移植手术，是我的荣幸。

Thomas Starzl,

一位是托马斯·斯达泽，

who performed the world's first successful liver transplant

世界上第一个成功完成肝脏移植手术的人

in 1967,

在1967年，

and Sir Roy Calne,

另一位是罗伊·卡恩爵士，

who performed the first liver transplant in the U.K.

在英国第一个完成肝脏移植手术的人

in the following year.

在世界首例肝脏手术完成之后的一年（1978）。

I returned to Singapore

我回到新加坡

and, in 1990,

然后，在1990年

performed Asia's first successful

完成了亚洲首例

cadaveric liver transplant procedure,

尸肝移植手术，

but against all odds.

尽管手术困难重重。

Now when I look back,

现在，当我回过头来看的时候，

the transplant was actually the easiest part.

手术部分其实是最简单的。

Next, raising the money to fund the procedure.

其次是，凑钱来准备手术的费用。

But perhaps the most challenging part

但最有难度的是

was to convince the regulators --

是让那些立法者明白一件事实--

a matter which was debated in the parliament --

这件事曾在议会辩论过--

that a young female surgeon

就是一个年轻女外科医生

be allowed the opportunity

有没有资格

to pioneer for her country.

获得国家外科先驱的称号。

But 20 years on,

20年过去了，

my patient, Surinder,

我的病人，萨伦德，

is Asia's longest surviving

是到目前为止的亚洲尸肝移植的

cadaveric liver transplant to date.

最长存活者。

(Applause)

（掌声）

And perhaps more important,

但更重要的是，

I am the proud godmother

我有幸成为她

to her 14 year-old son.

14岁儿子的教母。

(Applause)

（掌声）

But not all patients on the transplant wait list

但并不是所有在移植手术表单上排队等侯的病人

are so fortunate.

都是那么幸运。

The truth is,

现实是，

there are just simply not enough donor organs

捐献的器官根本不够

to go around.

用。

As the demand for donor organs

对捐献器官需求

continues to rise,

持续的增加，

in large part due to the aging population,

很大程度上是因为人口的老龄化，

the supply has remained relatively constant.

然而器官的供应还是相对的保持不变。

In the United States alone,

仅美国而言，

100,000 men, women and children

就有10万人，有男人，女人还有小孩

are on the waiting list for donor organs,

都在等待捐助的器官的名单之中，

and more than a dozen die each day

而且每天有十几人死亡

because of a lack of donor organs.

就因为缺少捐献的器官。

The transplant community

移植团体

has actively campaigned in organ donation.

活跃于器官捐献的活动中。

And the gift of life

而且器官（捐赠范围）

has been extended

已经被扩大化

from brain-dead donors

从脑死亡的捐献者

to living, related donors --

到还在世的有血缘关系的亲属捐献者

relatives who might donate an organ

这样的亲属捐献者可能会捐献整个器官

or a part of an organ,

或者部分器官，

like a split liver graft,

例如将肝脏部分移植

to a relative or loved one.

给亲属或者是所爱的人。

But as there was still a dire shortage of donor organs,

但是捐献器官还是非常紧缺，

the gift of life was then extended

接着器官（捐赠范围）再一次扩大

from living, related donors

从活着的有血缘关系的亲属捐献者

to now living, unrelated donors.

到现在活着的没有血缘关系的非亲属捐献者。

And this then has given rise

这样就引发了

to unprecedented and unexpected

前所未有的

moral controversy.

一场道德纷争。

How can one distinguish

怎么才能辨别出

a donation that is voluntary and altruistic

捐献者是出于自愿和无私

from one that is forced or coerced

而不是被迫或强制捐献器官

from, for example,

举个例子，在

a submissive spouse, an in-law,

顺从的伴侣，媳婿，

a servant, a slave,

仆人，奴隶，

an employee?

雇员这样的身份下我们如何分辨捐赠的自愿性？

Where and how can we draw the line?

这条界限我们如何以及怎样加以区分？

In my part of the world,

在我生活周围，

too many people live below the poverty line.

很多人都生活在贫困线之下。

And in some areas,

在有些地方，

the commercial gifting of an organ

用活体器官

in exchange for monetary reward

来换取金钱上的回报

has led to a flourishing trade

已经是非常盛行的

in living, unrelated donors.

的一种商业交易。

Shortly after I performed the first liver transplant,

在完成首例肝移植后不久，

I received my next assignment,

我接到的下一个任务

and that was to go to the prisons

就是去监狱里

to harvest organs

从执行死刑的犯人身上

from executed prisoners.

获取器官。

I was also pregnant at the time.

在那时我已经怀孕了。

Pregnancies are meant

孕期

to be happy and fulfilling moments

是个让人高兴和充满喜悦的时期

in any woman's life.

对每个女人来说都是这样。

But my joyful period

但是本该属于我的这段喜悦的时期

was marred by solemn and morbid thoughts --

却被一种幽暗的病态的境况所损坏。

thoughts of walking through

这种境况就是步行穿过

the prison's high-security death row,

监狱的最高安保的死囚区，

as this was the only route

因为这是到临时的手术室（从死刑犯身上移取器官）

to take me to the makeshift operating room.

的唯一的一条路。

And at each time,

每当这时，

I would feel the chilling stares

我就能感到那

of condemned prisoners' eyes follow me.

跟随我的死刑犯人眼中的令人毛骨悚然的目光。

And for two years,

之后的2年，

I struggled with the dilemma

我都挣扎在这样的困境中

of waking up at 4:30 am

每周五早上

on a Friday morning,

凌晨四点半醒来，

driving to the prison,

开车去到监狱，

getting down, gloved and scrubbed,

着手准备，戴上手套，消毒，

ready to receive the body

准备从

of an executed prisoner,

死刑犯人的尸体中

remove the organs

移出器官

and then transport these organs

然后将这些器官带回

to the recipient hospital

到接受者的医院

and then graft the gift of life

之后当天下午

to a recipient the same afternoon.

给接受者移植这些器官。

No doubt, I was informed,

毫无疑问，手术是

the consent had been obtained.

是获得了准许（捐赠器官）。

But, in my life,

但是我一生，

the one fulfilling skill that I had

我拥有的唯一在行的技术

was now invoking feelings of conflict --

使我产生了情感上的冲突

conflict ranging

这种感情上的冲突

from extreme sorrow and doubt at dawn

从清晨时的极度悲伤和疑虑一直延续

to celebratory joy

到黄昏时

at engrafting the gift of life at dusk.

庆祝移植器官成功的喜悦。

In my team,

在我的团队中，

the lives of one or two of my colleagues

有一两个同事的生活

were tainted by this experience.

也被这样的经历所困扰。

Some of us may have been sublimated,

我们中的一些人已经可以接受这样的状况，

but really none of us remained the same.

但是实际上没有人还是原来的自己。

I was troubled

我很担忧

that the retrieval of organs from executed prisoners

这种从死刑囚犯上得来器官的做法。

was at least as morally controversial

这种做法起码在道德上看来是有争议的

as the harvesting of stem cells

就像从人类胚胎中

from human embryos.

获取干细胞一样有争议。

And in my mind,

而且我认为，

I realized as a surgical pioneer

作为一名外科先锋人物

that the purpose of my position of influence

我拥有影响力的地位的目的

was surely to speak up

就是为了

for those who have no influence.

替那些没有影响力的人说话。

It made me wonder

这让我思考

if there could be a better way --

是否有更好的方法--

a way to circumvent death

即能绕过死亡

and yet deliver the gift of life

而又同时获得器官的方法。

that might exponentially impact

这样可能会以指数级的影响力影响到

millions of patients worldwide.

全世界成千上万的病人。

Now just about that time,

也就是在那个时候，

the practice of surgery evolved

外科手术

from big to small,

逐渐从宏观到微观

from wide open incisions

从大的开放性的切口

to keyhole procedures,

到孔洞式的

tiny incisions.

微创技术。

And in transplantation, concepts shifted

而且移植手术的概念已经转变成了

from whole organs to cells.

从完整的器官移植到细胞移植。

In 1988, at the University of Minnesota,

1988年，在明尼苏达大学，

I participated in a small series

我参与了一个小规模的

of whole organ pancreas transplants.

完整胰脏移植手术。

I witnessed the technical difficulty.

我亲眼目睹了此项技术的难度。

And this inspired in my mind

同时这激发了我

a shift from transplanting whole organs

关于从移植整个器官

to perhaps transplanting cells.

到移植细胞的思考。

I thought to myself,

我在想，

why not take the individual cells

为什么不能把那些能分泌出胰岛素治愈糖尿病的个体细胞

out of the pancreas --

移出

the cells that secrete insulin to cure diabetes --

胰腺

and transplant these cells? --

然后移植这些细胞呢？

technically a much simpler procedure

从技术的角度讲这更为简单

than having to grapple with the complexities

相比起进行整个器官移植

of transplanting a whole organ.

手术的复杂性。

And at that time,

当时，

stem cell research

干细胞研究

had gained momentum,

已经有了一定的进展，

following the isolation of the world's first

世界上首次分离出

human embryonic stem cells

人类胚胎干细胞

in the 1990s.

是在90年代。

The observation that stem cells, as master cells,

干细胞，也叫主细胞，

could give rise

能发育成

to a whole variety of different cell types --

完整的不同种类的细胞-

heart cells, liver cells,

像心肌细胞，肝细胞，

pancreatic islet cells --

胰岛细胞--

captured the attention of the media

这项发现引起了媒体的广泛关注

and the imagination of the public.

也激发了公众的想象力。

I too was fascinated

我也被这种全新的

by this new and disruptive cell technology,

分离细胞的技术所吸引，

and this inspired a shift in my mindset,

同时这激发了我思维上的转变，

from transplanting whole organs

从移植整个器官

to transplanting cells.

到移植细胞。

And I focused my research on stem cells

我把研究集中放在

as a possible source

可能会成为

for cell transplants.

细胞移植来源的干细胞中。

Today we realize

今天我们认识到

that there are many different types of stem cells.

有很多种不同种类的干细胞。

Embryonic stem cells

其中，胚胎干细胞

have occupied center stage,

占据了中心地位，

chiefly because of their pluripotency --

主要是因为它的多能性--

that is their ease in differentiating

就是胚胎干细胞能轻松的分化成

into a variety of different cell types.

不同种类的细胞。

But the moral controversy

但是之所以胚胎干细胞

surrounding embryonic stem cells --

在道德上备受非议是

the fact that these cells are derived

因为这些细胞来源于

from five-day old human embryos --

5天大的人类胚胎--

has encouraged research

正是因为这种争议才激励人们研究

into other types of stem cells.

其他类型的干细胞。

Now to the ridicule of my colleagues,

在同事的嘲讽声中，

I inspired my lab

我将实验放在

to focus on what I thought

集中研究

was the most non-controversial source of stem cells,

最没有争议的干细胞源

adipose tissue, or fat, yes fat --

那就是脂肪组织，或叫脂肪，对是肥肉

nowadays available in abundant supply --

现如今随处可以找到脂肪

you and I, I think, would be very happy to get rid of anyway.

我想你和我一样肯定很乐意摆脱它。

Fat-derived stem cells

脂肪源干细胞

are adult stem cells.

是一种成体干细胞。

And adult stem cells

成体干细胞在

are found in you and me --

你和我身上都能找到--

in our blood, in our bone marrow,

它存在于血液，骨髓，

in our fat, our skin and other organs.

脂肪，皮肤和其他器官中。

And as it turns out,

同时这也证明，

fat is one of the best sources

脂肪是成体干细胞的

of adult stem cells.

最优来源之一。

But adult stem cells

但是成体干细胞

are not embryonic stem cells.

并不是胚胎干细胞。

And here is the limitation:

它有其自身的局限性：

adult stem cells are mature cells,

成体干细胞是成熟的细胞，

and, like mature human beings,

就像成年人一样，

these cells are more restricted in their thought

较难改变它们的思维定势

and more restricted in their behavior

较难改变它们的行为方式

and are unable to give rise

同时它们也不能像胚胎干细胞一样

to the wide variety of specialized cell types,

分化成很多种

as embryonic stem cells [can].

特定的功能细胞。

But in 2007,

但是在2007年，

two remarkable individuals,

两位杰出人士，

Shinya Yamanaka of Japan

日本京都大学教授山中伸弥教授

and Jamie Thomson of the United States,

和美国的杰米·汤普逊，

made an astounding discovery.

有了一项令人震惊的发现。

They discovered

他们发现

that adult cells, taken from you and me,

那些从你我身上获取的成体细胞

could be reprogrammed

可以重组

back into embryonic-like cells,

变回到类似胚胎的干细胞，

which they termed IPS cells,

他们将这些细胞命名为IPS细胞，

or induced pluripotent stem cells.

或称为诱导性多潜能干细胞。

And so guess what,

你猜怎么着，

scientists around the world and in the labs

全世界科学家在实验室中

are racing

争先恐后的

to convert aging adult cells --

转变

aging adult cells from you and me --

从你我身上的得来的成体细胞，

they are racing to reprogram these cells

他们竞相重组这些细胞

back into more useful IPS cells.

使之成为更有用的IPS细胞。

And in our lab,

在实验室，

we are focused on taking fat

我们专注于提取脂肪

and reprogramming

并重新编辑,

mounds of fat

将成堆的脂肪

into fountains of youthful cells --

变成幼年细胞

cells that we may use

我们可以将这些幼年的细胞

to then form other,

转化为其他细胞，

more specialized, cells,

更为特定的细胞，

which one day may be used as cell transplants.

而转化后的这些细胞或许也可以用作细胞移植。

If this research is successful,

如果这项实验成功的话，

it may then reduce the need

它就能减少用于

to research and sacrifice

研究和

human embryos.

牺牲人类胚胎的需求数量。

Indeed, there is a lot of hype, but also hope

真的，这样说也许有些夸张，但是我们也希望

that the promise of stem cells

干细胞

will one day provide cures

能够在将来治愈

for a whole range of conditions.

下列一系列的病症，

Heart disease, stroke, diabetes,

心脏病，中风，糖尿病，

spinal cord injury, muscular dystrophy,

脊髓损伤，肌肉萎缩，

retinal eye diseases --

视网膜病症--

are any of these conditions

在以上病症中有与你

relevant, personally, to you?

有关的吗？

In May 2006,

2006年5月，

something horrible happened to me.

有件恐怖的事情发生在我身上。

I was about to start a robotic operation,

我在进行常规手术的准备，

but stepping out of the elevator

但是当我走出电梯

into the bright and glaring lights of the operating room,

来到手术室的明亮炫目的手术灯下的时候，

I realized

我感觉到

that my left visual field

左眼

was fast collapsing into darkness.

很快就看不到任何东西了。

Earlier that week,

那一周的早些时候，

I had taken a rather hard knock

我在春末滑雪时

during late spring skiing -- yes, I fell.

跌了蛮重的一跤--是的，我摔倒了。

And I started to see floaters and stars,

紧接着眼冒金星，

which I casually dismissed

当时我并没有重视这个现象

as too much high-altitude sun exposure.

只认为那是高海拔阳光照射过多的缘故。

What happened to me

这件事

might have been catastrophic,

发生以后，

if not for the fact

如果我没有

that I was in reach of good surgical access.

接受良好的手术治疗的话，我想现在对我来说，肯定是场大灾难。

And I had my vision restored,

经过了三个月（并不算长的时间）

but not before a prolonged period of convalescence --

一直保持头向下的状态的康复期

three months --

之后

in a head down position.

我的视力恢复了。

This experience

这次的经历

taught me to empathize more with my patients,

让我更加能体谅患者

and especially those with retinal diseases.

特别是有视觉疾病的患者。

37 million people worldwide

世界上3700万人

are blind,

是盲人，

and 127 million more

同时1亿2700万的人

suffer from impaired vision.

饱受视觉受损的困扰。

Stem cell-derived retinal transplants,

视网膜干细胞移植，

now in a research phase,

目前正处于研究的阶段，

may one day restore vision,

也许将来的某天它就能帮世界上成千上万

or part vision,

视觉障碍患者

to millions of patients with retinal diseases worldwide.

重现光明，或者恢复部分视力。

Indeed, we live

确实，我们生活在

in both challenging

一个即富有挑战

as well as exciting times.

又令人刺激的年代。

As the world population ages,

当全球人口出现老龄化，

scientists are racing

科学家们竞相

to discover new ways

去寻找新的方法：

to enhance the power of the body

通过干细胞治愈自身

to heal itself through stem cells.

来达到提高人体机能的目的。

It is a fact

事实上，

that when our organs or tissues are injured,

当器官或者组织受损时，

our bone marrow

我们的骨髓

releases stem cells

会通过血液循环向血液中

into our circulation.

释放干细胞。

And these stem cells

这些干细胞

then float in the bloodstream

漂浮在血液中

and hone in to damaged organs

找到受损的器官然后

to release growth factors

释放出生长因子

to repair the damaged tissue.

来修复受损组织。

Stem cells may be used as building blocks

干细胞就好比是砌墙用的砖块

to repair damaged scaffolds within our body,

修复身体中受损的支架，

or to provide new liver cells

或是变成新的肝细胞

to repair damaged liver.

来修复受损的肝脏。

As we speak, there are 117 or so clinical trials

在我们说话的时候，大约有117例用

researching the use of stem cells

干细胞来治疗肝脏疾病

for liver diseases.

的临床实验在进行。

What lies ahead?

那种病症是世界上的头号杀手？

Heart disease

心脏病

is the leading cause of death worldwide.

是世界上首要死亡原因。

1.1 million Americans

每年有110万美国人

suffer heart attacks yearly.

心脏病发作。

4.8 million

480万人

suffer cardiac failure.

患有心力衰竭。

Stem cells may be used

干细胞可以通过

to deliver growth factors

传递生长因子

to repair damaged heart muscle

来修复受损的心肌

or be differentiated

也可以分化成

into heart muscle cells

不同的心肌细胞

to restore heart function.

来恢复心脏机能。

There are 170 clinical trials

有170例临床实验

investigating the role of stem cells in heart disease.

正在研究干细胞在心脏疾病中所起的作用。

While still in a research phase,

这虽然尚在研发阶段，

stem cells may one day herald

但是干细胞就给我们预示了

a quantum leap in the field of cardiology.

以后会在心脏学领域会有巨大的突破。

Stem cells provide hope for new beginnings --

干细胞为新的起点带来了希望，

small, incremental steps,

这个希望是循序渐进的，

cells rather than organs,

是用细胞移植来代替是器官移植，

repair rather than replacement.

是用修复器官来代替是取代器官。

Stem cell therapies

干细胞疗法

may one day reduce the need for donor organs.

将来会减少对于捐献器官的需求。

Powerful new technologies

强有力的新科技

always present enigmas.

总是向人们展现它的神秘。

As we speak,

就在我们说话的时候，

the world's first human embryonic stem cell trial for spinal cord injury

世界上首例用人类胚胎干细胞治疗脊髓受损的实验

is currently underway

在美国食品药物管理局批准下

following the USFDA approval.

正在进行当中。

And in the U.K.,

同时在英国，

neural stem cells to treat stroke

用神经干细胞来治疗中风

are being investigated in a phase one trial.

也正处于临床阶段。

The research success that we celebrate today

我们今天所称赞的这些研究成果

has been made possible

之所以成为现实

by the curiosity and contribution and commitment

是要归功于那些具有探索和献身精神的

of individual scientists

科学家

and medical pioneers.

和医学界先锋们。

Each one has his story.

每个人都有属于自己的故事。

My story has been about my journey

而我的故事是我从器官移植

from organs to cells --

走到细胞移植的一段旅程，

a journey through controversy,

这其中即充满了争议，

inspired by hope --

同时又有希望的鼓舞。

hope that, as we age,

这个希望就是当我们老去的时候

you and I may one day celebrate longevity

你和我有一天能在良好的生活水平下

with an improved quality of life.

来庆祝人类的长寿。

Thank you.

谢谢。