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

譯者: C Leung 審譯者: 麗玲 辛

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

2020 年 11月，在新冠疫情 (COVID) 最高峰時，

that we got a call from a local hospital

我們接到當地醫院的電話，

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

說他們有一位 22 歲的男士 患有新冠肺炎，

and he has difficulty breathing.

並且呼吸困難。

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

他們不得不給他注射鎮定劑 並插上呼吸管，

and wanted to see if they could transfer him to UCLA

想詢問是否可以將他轉移到 加州大學洛杉磯分校醫院，

for higher level of care.

接受更高級別的醫療。

When he arrived,

當他抵達時，

his blood-oxygen level was quite low,

他的血氧水平很低，

and we had no choice

我們別無選擇

but to connect him to an artificial lung machine.

只能將他連接到人工肺機。

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

之後幾天到一週裡，他慢慢醒來，

started walking around, regained his strength.

開始四處走動，恢復了體力。

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

而很明顯，他的肺部 受到新冠病毒不可逆轉的損害。

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

我們別無選擇， 只能把他列入肺移植名單。

He was placed on the national list,

他被列入全國名單。

and he waited and waited.

他等啊等，

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

他在加護病房等待了近 10 個月， 才找到一副合適的肺。

You know, his blood type was O.

要知道，他的血型是 O 型。

As some of you may know,

你們有些人可能知道，

O blood type individuals are universal donors,

O 型血的人是全適捐血者，

but it's very difficult to find matches for.

但很難找到配對的人。

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

在加護病房住的十個月裡，

he was getting up and walking around every day,

他每天都起床走動，

socializing with the staff.

跟醫護人員聊天。

He even got married in the ICU to his girlfriend.

他甚至與女友在加護病房結婚。

The nurses had a beautiful ceremony,

護士們舉行了一場盛大儀式，

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

並為他準備了結婚蛋糕 送給加護病房的每個人，

including some of the heart surgery patients

包括一些心臟手術的病人，

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

那些人兩三天前 才接受過心臟外科手術。

Well, I did his double lung transplant.

我幫他做了雙肺移植手術。

Everything went well, and he went home.

一切都很順利，他回家了。

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

只是六個月後， 他因新肺的排斥反應而回來。

Imagine a day when patients who need organ transplant,

想像有一天，需要器官移植的患者

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

不必在 ICU 中等待數月或數年；

or years, as outpatient,

只要看門診， 病人就可以獲得捐贈器官。

would have access to donor organs.

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

更重要的是， 排斥反應不再是考慮因素，

or part of the equation.

也不再是個問題。

The case of this 22-year-old gentleman

這位 22 歲男士的案例

highlights the lifesaving nature of organ transplantation,

凸顯出器官移植的救生性質，

but it also illustrates some of the challenges

但也說明了我們在這個領域 面臨的一些挑戰。

that we face in this field.

When we list a patient for organ transplant,

當我們將患者列入器官移植的名單時，

their name goes on the list, a national list.

他們的名字會出現在全國名單上。

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

並會根據他們的血型、

body size and a few other factors.

體型和其他一些因素與捐贈者配對。

We then send a team out to the donor hospital

然後我們派出一個團隊 前往捐贈者的醫院，

where they stop the donor organ,

在那裡他們使捐贈者的器官停止運作，

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

將其放在冰上，然後放入 Igloo 冷卻器中，

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

這種冷卻器你現在 在任一家五金店都買得到。

And then they rush back to the recipient hospital,

然後他們趕回受贈者的醫院，

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

在那裡我們盡一切努力，

減少人體器官在冰上的時間。

that a human organ is sitting on ice.

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

畢竟人體器官不應該保存在冰上。

We have a limited period of time

在器官變得無法使用之前，

before the organ becomes unusable.

我們的時間有限。

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

對於人類的心臟來說， 大約是四到六個小時。

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

對於人類肺部來說， 大約有六到八個小時。

For the liver, maybe a little bit longer.

對於肝臟，也許時間長一點。

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

所以我們努力做到 不論日夜都可以進行移植手術，

and rush through that.

並盡快完成。

And then after the transplant,

接著移植後，

we have to treat these patients with powerful medications

我們必須讓這些患者服用強效藥物，

to suppress the immune system.

來抑制免疫系統。

You know, everyone has a set of proteins

每個人都有一組蛋白質，

that is unique to each and every one of us.

都是獨一無二的，

It's like our signature.

就像我們的簽名。

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

當我們從一個人身上取出器官， 並將其移植到另一個人身上時，

the recipient's immune system recognizes those proteins as foreign

受贈者的免疫系統 會將這些蛋白質識別為外來物，

and starts attacking them,

並開始攻擊它們，

leading to the graft injury, to the organ injury,

導致移植損傷、器官損傷

and possible rejection.

及可能的排斥反應。

Organ transplantation

器官移植

is considered one of the miracles of modern medicine.

被認為是現代醫學的奇蹟。

The concept of taking a vital human organ from a donor

從捐贈者身上取出重要的人體器官，

and transplanting it into somebody else

並將其移植到其他人體內，

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

使其發揮作用並帶來正常的壽命，

was a science fiction only 40-50 years ago.

這種事在 40 至 50 年前 只是科幻小說。

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

然而，我們在世界各地 幾乎每天都在這樣做。

Despite the successes, there are several challenges

儘管移植成功，

器官移植領域還會面臨一些挑戰。

facing the field of organ transplantation.

Broadly speaking, there are two that stand out.

大致來說，有兩個挑戰特別明顯。

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

第一個是我們沒有足夠的捐贈器官，

shortage of donors.

即缺乏捐贈者。

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

更重要的是，我們無法 讓人體器官存活超過數小時。

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

容我暫停，為器官捐贈大肆宣傳一下。

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

今晚在座或任何正收聽此演講的人，

I hope that you consider signing your driver's license

我希望你能考慮在駕駛執照上簽署，

and becoming an organ donor.

並成為器官捐贈者。

A single organ donor can save up to eight human lives

單一器官捐贈者 可以拯救多達八個人的生命，

and improve the quality of life for many more.

並改善更多人的生活品質。

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

器官捐贈是悲劇發生時的遺澤，

premature tragedy,

悲劇太早到來，

and saves lives.

但能拯救生命。

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

器官移植領域面臨的 第二個挑戰是排斥反應。

the fact that everybody’s protein is unique

每個人的蛋白質都是獨一無二，

and the recipient's body reacts to those proteins

受贈者的身體 會對這些蛋白質產生反應，

and causes injury and rejection.

並導致損傷和排斥。

Well, there is good news.

有個好消息。

There has been one advance in the field of organ transplantation

在過去十年內，器官移植領域

in the past ten years

有一項進步，

that may address both of these challenges,

可能會解決這兩個挑戰，

and that is “machine perfusion.”

那就是「機器灌注」。

Machine perfusion is a portable platform

機器灌注是一個便攜式平台，

the size of a small refrigerator

小型冰箱般大小，

that circulates blood through the donor organ

可在捐贈者體外

outside of the donor body.

將血液循環到捐贈的器官。

As far as the donor organ is concerned,

就捐贈者器官而言，

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

在機器灌注時， 它像是仍在捐贈者的體內。

The human heart continues to beat.

心臟繼續跳動，

The human lung continues to breathe.

肺部繼續呼吸，

The liver continues to produce bile.

肝臟繼續產生膽汁。

And of course, your kidney continues to produce urine.

當然，腎臟會繼續產生尿液。

With machine perfusion, we continue to maintain a human organ

通過機器灌注， 在人類歷史上我們首次

for the first time in human history

讓人體器官處於人體外

outside of a human body, alive.

仍可維持運作。

With that time is no longer an issue.

有了這技術，時間就不再是問題。

We can share organs across broad areas of geography.

我們可以跨越地理區域，共享器官。

We can share organs across continents.

我們可以跨越各大洲共享器官。

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

通過機器灌注， 我們就能修復捐贈器官。

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

假設我們有一副患有肺炎的肺部，

We can actually treat with very high doses of antibiotics

我們其實可以在機器上 使用非常高劑量的抗生素

on the machine

進行治療，

and try to improve the donor lungs

並嘗試改善捐贈者肺部的情況，

at levels that would not have been possible

原本因毒性和副作用，

to give it to the donor

無法捐給受贈者。

because of the toxicities and the side effects.

But we can do that with machine perfusion.

但我們可以通過機器灌注來做到這點。

But the real benefit of machine perfusion

但機器灌注的真正好處

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

在於它使我們有機會 在移植前對捐贈器官

before transplantation.

進行改變。

Our group, as well as others,

我們的小組以及其他團隊

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

已經證明我們可以 將不同的血型轉換為 O 血型，

the universal donor.

即全適捐血者。

You remember the gentleman in the ICU

你還記得 ICU 裡的那位先生

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

因為沒有足夠的 O 型捐贈者 而必須等 10 個月。

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

但我們可以將不同的血型 轉換為 O 血型。

This may be a reality within the next five years.

這可能在未來五年內成為現實。

Another potential opportunity for the machine perfusion

機器灌注的另一個潛在機會

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

是我們實際上可以改變 捐贈器官的遺傳結構。

We can add genes. We can silence genes.

我們可以添加某些基因， 也可以壓制某些基因。

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

我剛提到那些導致 排斥反應的外來蛋白質。

We can actually silence those genes.

我們實際上可以壓制這些基因。

There have been studies that have shown

有研究顯示，

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

在動物中，你實際上可以 將細胞轉移到捐贈器官，

so that it masks the expression of those foreign proteins.

從而掩蓋這些外來蛋白的表現。

We can engineer organs

我們可以改變器官，

specifically suited for a potential recipient.

特別為潛在受贈者而設。

I have been in the field of organ transplantation

我在器官移植領域

for more than 25 years,

工作超過 25 年，

and I've never been more excited

我對這個領域的未來

about what the future holds for this field.

感到前所未有的興奮。

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

想像有一天， 在未來的 10 到 20 年內，

when a patient who needs an organ transplant,

一個需要器官移植的病人，

through no fault of their own --

儘管不是他的錯，

they may have been born with a condition,

他可能生來就患有某種疾病，

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

或可能患有需要器官移植的疾病，

schedules their transplant on a certain day,

他預約在某天進行移植，

goes to the hospital on that day,

當天去醫院，

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

可能實際在機器上 看到要移植到他體內的器官，

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

跳動的心臟、呼吸中的肺部，

gets the transplant.

然後進行移植。

And rejection is no longer part of the equation,

排斥反應將不再是個問題，

it is not part of their future.

也不是他未來的一部分。

They're given a second chance at life

他獲得了重生的機會，

and live happily ever after.

從此過著幸福的生活。

Thank you.

謝謝。

(Applause)

（掌聲）