Susan Lim is perhaps not the likeliest of candidates when one brings to mind the image of a stem cell researcher. A surgical pioneer, Dr. Lim performed the first liver transplant in Asia, for which she received numerous honours. She brings a refreshing outlook on stem cell research with her recent TED talk, entitled “Transplant cells, not organs”.
While those of us in the stem cell community may be well aware of the moral, legal and ethical concerns surrounding the use of stem cells, particularly embryonic stem cells, Dr. Lim’s talk brings to light many ethical issues surrounding organ transplant.
Often portrayed as the “gift of life”, organ transplants are now regular performed to replace ailing kidneys, hearts, livers and lungs. As the skill of doctors has increased, so too has the need for organ transplants, such that demand has easily outpaced availability. The Western world has tried to keep pace by relaxing the rules for organ donations – for example, by allowing unrelated donations from living donors. But as these rules have expanded, so has the opportunity for exploitation. While the need for informed medical consent for organ donors is stressed, it is easy to see how people can be pushed into “donating” an organ, through outside authority, familial pressures, or social-economic pressures. Living donors undertake risk by going under the knife and may suffer medical complications, as a teenager in China found out after selling his kidney for an iPad.
Dr. Lim talks about her own harrowing experiences as a young doctor where she traveled each morning to collect the organs of recently executed Chinese prisoners. China has attempted to crack down on coercive organ donation practices in recent years by disallowing live donations between unrelated people. But as the Lancet reports, progress towards a more transparent organ donation system has been slow and many prisoners continue to become organ donors upon death.
Dr. Lim portrays her personal experiences facing these condemned prisoners as the motivation that pushed her to look for alternatives, which eventually led her to stem cells. Dr. Lim speak with genuine amazement and awe about the wonders of stem cell technology and its potential in regenerative medicine. She says that stem cells “inspired a shift in my mindset, from transplanting whole organs to transplanting cells. And I focused my research on stem cells as a possible source of cell transplants.”
I found it interesting that Dr. Lim suggests that we one day replace organ transplants with cell transplants. Are the ethical questions surrounding ES cells less important than the ethical questions surrounding live organ donations? Or will they be avoided entirely? Dr. Lim suggests by focusing research on adult stem cells, the concerns regarding ES cells become irrelevant. But it’s not quite that simple: induced pluripotent stem cells, derived from adult skin and often hailed as the solution to the embryonic dilemma, are not without their own set of ethical and political issues. From a research and medical standpoint, many of these induced pluripotent stem cells face questions regarding their efficacy and difficulties in standardization of production. Issues pertaining to informed consent and commercialization also characterize adult stem cells.
While only touching lightly on research and somewhat utopian, this is an interesting TED talk which neatly combines stem cells with ethical issues from a different perspective – one well worth viewing!