The Miracle of Organ Donation — and a Breakthrough for the Future | Abbas Ardehali | TED

翻译人员: Jinshang Wang 校对人员: suya f.

It was in November of 2020, at the height of the COVID pandemic,

在 2020 年 11 月， 在新冠大流行最严重的时候，

that we got a call from a local hospital

我们接到一家当地医院的电话，

that they have a 22-year old gentleman who has COVID pneumonia

说他们有一位 22 岁的 绅士得了新冠肺炎，

and he has difficulty breathing.

所以导致呼吸困难。

They had to sedate him and put a breathing tube in him,

医院不得不给他注射 镇静剂并插上呼吸管，

and wanted to see if they could transfer him to UCLA

他们想看看能否将他转院 到加州大学洛杉矶分校（医院）

for higher level of care.

接受更好的治疗。

When he arrived,

当他到达时，

his blood-oxygen level was quite low,

他的血氧水平非常低，

and we had no choice

我们别无选择，

but to connect him to an artificial lung machine.

只能给他上人造肺仪器。

Over the course of the next few days to a week, he slowly woke up,

在接下来的几天到一周的时间里， 他慢慢苏醒过来，

started walking around, regained his strength.

开始四处走动，恢复体力。

And it became quite clear that his lungs are irreversibly damaged by COVID virus.

很明显，新冠病毒对他的肺部 造成了不可逆的损伤。

We had no choice but to put him on the lung transplant list.

我们别无选择，不得不将他 列入肺移植名单。

He was placed on the national list,

他被放入了国家（等候）名单，

and he waited and waited.

他等了又等。

He waited for nearly 10 months in the ICU for a suitable pair of lungs.

他在重症监护病房等了将近 10 个月 才配对了合适的肺部。

You know, his blood type was O.

你知道，他的血型是 O。

As some of you may know,

正如有些人所知的那样，

O blood type individuals are universal donors,

O 型血的人是全适供血者，

but it's very difficult to find matches for.

但却很难找到匹配（的供体）。

During those ten months that he was living in the ICU,

在他住在重症监护病房的 那 10 个月里，

he was getting up and walking around every day,

他每天起床四处走动，

socializing with the staff.

与医护交流。

He even got married in the ICU to his girlfriend.

他甚至在重症监护病房 与女友完婚了。

The nurses had a beautiful ceremony,

护士们（为他）办了美好的仪式，

and they had his wedding cake that they served to everyone in the ICU,

他们给重症监护病房的所有人 分享了他的结婚蛋糕，

including some of the heart surgery patients

包括一些在两三天前接受过

who had had open heart surgery two or three days before.

开胸心脏手术的心脏手术患者。

Well, I did his double lung transplant.

好吧，我主刀了他的双肺移植手术。

Everything went well, and he went home.

手术一切顺利，他（出院）回家了。

Only six months later, he came back with the rejection of the new lungs.

才六个月，他因新肺部的 排斥反应重返医院。

Imagine a day when patients who need organ transplant,

想象一下，如果有一天， 需要器官移植的患者

they don't have to wait for months in the ICU,

不必在重症监护病房等几个月，

or years, as outpatient,

或等上几年， 而是作为门诊患者，

would have access to donor organs.

就可以接受捐赠器官（移植）。

And more importantly, rejection is no longer part of the factor,

更重要的是， 排斥反应不再是因子的一部分，

or part of the equation.

或是问题的一部分。

The case of this 22-year-old gentleman

这位 22 岁的男士的病例

highlights the lifesaving nature of organ transplantation,

凸显了器官移植能挽救生命的本质，

but it also illustrates some of the challenges

但它也显示了我们在

that we face in this field.

该领域面临的一些挑战。

When we list a patient for organ transplant,

当我们安排患者进行器官移植时，

their name goes on the list, a national list.

他们的名字就会出现在名单上， 一个全国范围的名单。

And a donor is matched to them based on their blood type,

捐赠者要与病患匹配， 基于他们的血型、

body size and a few other factors.

体型和一些其他的因素。

We then send a team out to the donor hospital

然后，我们派出一个医疗队 去捐赠者所在医院，

where they stop the donor organ,

在那里他们摘取捐赠器官，

put it on ice and put it in an Igloo cooler,

把它放在冰上 然后放入易酷乐保温箱里，

a cooler that you can get at any hardware store these days.

现在这种保温箱 你在任何五金店都可以买到。

And then they rush back to the recipient hospital,

然后他们赶回受者所在的医院，

where we do everything we can to minimize the duration of the time

在那里我们会尽一切努力缩短

that a human organ is sitting on ice.

人体器官在冰上放置的时间。

You know, after all, human organs are not supposed to be kept on ice.

你知道，毕竟，人体器官 本不应该放置在冰上。

We have a limited period of time

我们在器官丧失活性前的

before the organ becomes unusable.

（可利用）时间是有限。

For human hearts, it's about four to six hours.

对于人的心脏来说， 大约有四到六个小时。

For human lungs, it's about six to eight hours.

对于人体肺部来说， 大约六到八个小时。

For the liver, maybe a little bit longer.

对于肝脏来说， 可能会更长一些。

So we try to do the transplant surgery any time of the day and night,

因此，我们做移植手术，不分日夜，

and rush through that.

尽快完成手术。

And then after the transplant,

然后，在完成移植之后，

we have to treat these patients with powerful medications

我们必须给这些患者用强力的药物

to suppress the immune system.

抑制（他们的）免疫系统。

You know, everyone has a set of proteins

你知道，每个人都有一组

that is unique to each and every one of us.

独一无二的蛋白质。

It's like our signature.

就像我们的签名一样。

When we take an organ from one person and transplant it into somebody else,

当我们从一个人身上取出器官 并将其移植到他人体内时，

the recipient's immune system recognizes those proteins as foreign

受体的免疫系统会 将这些蛋白质识别为外来物

and starts attacking them,

并开始攻击它们，

leading to the graft injury, to the organ injury,

从而导致移植物损伤、器官损伤

and possible rejection.

和可能的排斥反应。

Organ transplantation

器官移植被认为 是现代医学的奇迹之一。

is considered one of the miracles of modern medicine.

The concept of taking a vital human organ from a donor

从捐赠者身体中取出 重要的人体器官，

and transplanting it into somebody else

将其移植到他人体内，

and having it function and work and lead to a normal lifespan

并让器官（在受体内）工作， 让受体能活到正常寿命

was a science fiction only 40-50 years ago.

这在 40 到 50 年前 像是科幻小说。

Yet we're doing this virtually every day all across the world.

然而（现在）我们几乎每天 都在世界各地实现这样的事儿。

Despite the successes, there are several challenges

虽有成功案例， 但器官移植领域

facing the field of organ transplantation.

仍面临多种挑战。

Broadly speaking, there are two that stand out.

从广义上讲， 有两大（挑战）尤为突出。

The first one is we just don't have enough donor organs,

第一个问题是我们没有 足够的捐赠器官，

shortage of donors.

缺少捐赠者。

And importantly, we cannot keep the human organs alive beyond a few hours.

尤为重要的是，我们无法使 人体器官保持活力超过几个小时。

Let me pause for a moment and put in a plug for organ donation.

让我暂停一下， 为器官捐赠插播一下。

For anyone who's here tonight, or anyone listening to this segment,

对于任何今晚在座的观众， 或者任何正在收听这段内容的听众，

I hope that you consider signing your driver's license

我希望你考虑签署你的驾照 （捐献登记）

and becoming an organ donor.

成为器官捐赠者。

A single organ donor can save up to eight human lives

一个器官捐献者 可以挽救多达八人的生命，

and improve the quality of life for many more.

并改善更多人的生活质量。

Organ donation is one's legacy at a time of tragedy,

器官捐赠是在（发生）悲剧、

premature tragedy,

突发不测时一个人的遗赠，

and saves lives.

可以挽救（其他）生命。

The second challenge facing the field of organ transplantation is the rejection:

器官移植领域面临的 第二大挑战是排斥反应：

the fact that everybody’s protein is unique

每个人的蛋白质 都是独一无二的，

and the recipient's body reacts to those proteins

受体的身体会 对这些蛋白质产生反应

and causes injury and rejection.

并导致损伤和排斥反应。

Well, there is good news.

好吧，有个好消息。

There has been one advance in the field of organ transplantation

在过去的十年中，器官移植 领域取得了一项进展，

in the past ten years

that may address both of these challenges,

可能可以应对这两大挑战，

and that is “machine perfusion.”

那就是 “机械灌注”。

Machine perfusion is a portable platform

机械灌注是一个像小冰箱一样

the size of a small refrigerator

大小的便携式平台，

that circulates blood through the donor organ

它在供体的外部

outside of the donor body.

进行供体器官的循环血液。

As far as the donor organ is concerned,

就捐赠器官而言，

on machine perfusion, it's still in the donor body.

在机器灌注时， 它仍在捐赠者体内。

The human heart continues to beat.

人的心脏继续在跳。

The human lung continues to breathe.

人肺继续在呼吸。

The liver continues to produce bile.

肝脏继续产生胆汁。

And of course, your kidney continues to produce urine.

当然，你的肾脏会 继续产生尿液。

With machine perfusion, we continue to maintain a human organ

通过机器灌注，我们在人类历史上

for the first time in human history

首次在人体之外 继续维持人体器官的活性。

outside of a human body, alive.

With that time is no longer an issue.

有了这个，时间就不再是问题了。

We can share organs across broad areas of geography.

我们可以在广阔的 地理范围共享器官。

We can share organs across continents.

我们可以（实现）跨洲共享器官。

With machine perfusion, we can actually repair a donor organ.

通过机器灌注， 我们实际上可以修复捐赠器官。

Let's say that we have a pair of lungs that has pneumonia.

假设我们有一对肺脏患有肺炎。

We can actually treat with very high doses of antibiotics

实际上，我们可以在机器上 使用超高剂量的抗生素进行治疗，

on the machine

and try to improve the donor lungs

并尝试将捐赠者的被病毒 和副作用侵害

at levels that would not have been possible

to give it to the donor

而原本无法用于捐献的肺部

because of the toxicities and the side effects.

进行治疗改善。

But we can do that with machine perfusion.

但是我们可以通过机器灌注 来做到这一点。

But the real benefit of machine perfusion

但是机器灌注的真正好处是，

is that it gives us an opportunity to make changes to the donor organ

它使我们有机会在移植之前

对供体器官进行（治疗）改变。

before transplantation.

Our group, as well as others,

我们的医疗组以及其他组

have shown that we can convert different blood types to O blood type,

已经证实我们可以将 不同的血型转化为 O 型，

the universal donor.

即全适供血者。

You remember the gentleman in the ICU

你还记得重症监护病房里的 那位男士

who had to wait for 10 months because there’s not enough O donors.

因为没有足够的 O 型捐赠者 而不得不等了 10 个月。

But we can convert different blood types to an O blood type.

但我们可以将不同的血型 转化为 O 型血型。

This may be a reality within the next five years.

这可能在未来五年内 成为现实。

Another potential opportunity for the machine perfusion

机器灌注的 另一个潜在机会是，

is that we can actually make changes in the genetic makeup of the donor organ.

我们实际上可以改变供体器官 的基因构成。

We can add genes. We can silence genes.

我们可以添加基因。 我们可以实现基因沉默。

I mentioned to you those foreign proteins that were the cause of rejection.

我向你提过那些外来蛋白 造成了排斥反应的。

We can actually silence those genes.

我们实际上可以沉默这些基因。

There have been studies that have shown

有研究表明，

that in animals you can actually transfer cells into the donor organ

在动物体内，你实际上可以 将细胞转移到供体器官中，

so that it masks the expression of those foreign proteins.

这样它就可以掩盖这些 外来蛋白的表现。

We can engineer organs

我们可以将器官

specifically suited for a potential recipient.

为潜在受体的度身定制。

I have been in the field of organ transplantation

我在器官移植领域

for more than 25 years,

工作了超过 25 年，

and I've never been more excited

我对这个领域的未来前景

about what the future holds for this field.

感到无比兴奋。

Imagine a day, in the next maybe 10 to 20 years,

想象一下， 在接下来的 10 到 20 年中，

when a patient who needs an organ transplant,

需要进行器官移植的患者——

through no fault of their own --

他们可能出生时

they may have been born with a condition,

天生患有某种疾病，

or they may have acquired a condition that needs organ transplant --

或者他们可能得了 需要器官移植的疾病——

schedules their transplant on a certain day,

当他们在某一天安排了器官移植移植，

goes to the hospital on that day,

当天他们入院，

may actually see the organ that is to be transplanted into them

亲眼目睹将要移植的器官，

on a machine, with a heart beating and a lung breathing,

连着机器，依旧有心跳，有呼吸，

gets the transplant.

完成移植手术。

And rejection is no longer part of the equation,

而且，排斥反应不再是问题的一部分，

it is not part of their future.

不再影响他们的未来。

They're given a second chance at life

他们得到了第二次生命，

and live happily ever after.

从此过上幸福的生活。

Thank you.

谢谢。

(Applause)

（掌声）