Part 1 Storyville


Part 1

Similar Content

Browse content similar to Part 1. Check below for episodes and series from the same categories and more!

Transcript


LineFromTo

This programme contains scenes which some viewers may find upsetting

0:00:020:00:06

You are really lucky, you know.

0:00:130:00:14

Because this morning I fight with

0:00:140:00:17

a journalist from Swedish television.

0:00:170:00:20

She wanted an interview

0:00:200:00:23

about the allegations.

0:00:230:00:26

We decided no, not to do it.

0:00:260:00:28

This is Paolo Macchiarini,

0:00:330:00:35

one of the world's best-known surgeons

0:00:350:00:39

in one of his most difficult moments.

0:00:390:00:41

He had declined almost every interview from the world's media,

0:00:430:00:47

but he agreed to talk just to me.

0:00:470:00:49

Perhaps he was hoping it would be an opportunity to tell his version,

0:00:500:00:54

or that I at least would tell the story with all its complexities.

0:00:540:00:57

Though neither of us knew it then,

0:01:000:01:02

this would eventually lead to his spectacular downfall.

0:01:020:01:05

At the time, he still enjoyed his reputation

0:01:070:01:10

as one of the world's most pioneering surgeons.

0:01:100:01:13

Surgeons in Sweden have carried out the world's first transplant

0:01:200:01:24

of a synthetic organ...

0:01:240:01:25

An 11-year-old boy has had pioneering treatment to

0:01:250:01:28

rebuild his windpipe using stem cell...

0:01:280:01:31

Macchiarini is trying to solve one of medicine's biggest challenges -

0:01:310:01:35

the lack of spare parts when something

0:01:350:01:38

goes wrong inside our bodies.

0:01:380:01:40

He has already made headlines round the world,

0:01:410:01:44

by attempting to create the world's first windpipe out of plastic.

0:01:440:01:47

In what seems like the plot from a science fiction novel,

0:01:490:01:51

researchers built a new windpipe...

0:01:510:01:53

We are just a few years away from all this happening,

0:01:530:01:56

all the organs being built in a lab.

0:01:560:01:58

So far, there are 17 people around the world who have had one of

0:01:580:02:02

Macchiarini's windpipes implanted.

0:02:020:02:04

But for most of them, everything still ended the same way -

0:02:070:02:11

with death.

0:02:110:02:13

You think this is one of the biggest medical scandals?

0:02:180:02:20

If you do experimental surgery in humans and you know beforehand

0:02:210:02:26

that it's a disaster.

0:02:260:02:27

Macchiarini has been accused of falsifying research

0:02:290:02:31

and of experimenting on humans.

0:02:310:02:35

While I was filming,

0:02:350:02:36

police began investigating some of his operations

0:02:360:02:39

on suspicion of causing

0:02:390:02:41

bodily harm and involuntary manslaughter.

0:02:410:02:45

Yet, he still enjoyed the support of the scientific establishment.

0:02:450:02:48

So who is Paolo Macchiarini?

0:03:000:03:02

Is he a genius?

0:03:030:03:04

Or is he a fraud?

0:03:050:03:06

How far can you risk a human life in the name of cutting-edge science?

0:03:090:03:13

And are some of the world's top medical institutions complicit in

0:03:140:03:18

supporting his experimental work?

0:03:180:03:20

The process of getting answers was far tougher than I'd anticipated.

0:03:210:03:25

Does a human life have a price?

0:04:320:04:35

I didn't do anything wrong.

0:04:380:04:40

I just did my job.

0:04:540:04:56

For me, it all started at the end of 2014,

0:05:190:05:22

when Macchiarini was accused of falsifying research results

0:05:220:05:26

and of gross misconduct.

0:05:260:05:28

Could this really have happened at the Karolinska Institute,

0:05:290:05:32

Sweden's prestigious medical university,

0:05:320:05:35

the home of the Nobel Prize?

0:05:350:05:37

These allegations were very serious, of course.

0:05:380:05:40

What if they were true?

0:05:410:05:43

I decided to find out what had happened.

0:05:440:05:47

And soon I got to meet Paolo Macchiarini

0:05:500:05:52

at his lab in the Karolinska Institute in Sweden.

0:05:520:05:55

-OK.

-OK.

-So this...

0:06:000:06:04

KEYPAD BEEPS

0:06:060:06:08

My first surprise came right away.

0:06:230:06:26

Macchiarini's space at the Institute looked so small and modest.

0:06:260:06:30

Thank you.

0:06:300:06:32

But according to Macchiarini,

0:06:320:06:34

big things were happening in this ordinary setting.

0:06:340:06:37

This is, however, I think, the most advanced lab

0:06:370:06:41

that we do have here.

0:06:410:06:44

One of the most advanced in, I can frankly say, in the world.

0:06:460:06:51

We have a series of

0:06:510:06:55

devices and tools to evaluate

0:06:550:06:58

the organs,

0:06:580:07:00

whether biological or artificial,

0:07:000:07:02

and here we do everything from the brain to the heart,

0:07:020:07:06

to the lungs, to the kidney, to the intestines,

0:07:060:07:09

to the urethra and other investigations.

0:07:090:07:14

Countless people die each year because their organs stop working.

0:07:180:07:23

The shortage of new organs is one of medicine's biggest problems

0:07:230:07:28

and it is this issue that Macchiarini is trying to solve.

0:07:280:07:31

Organs from rats float in these flasks.

0:07:340:07:37

Hearts and kidneys, oesophagi and tracheas.

0:07:380:07:42

Organs that will bathe in stem cells

0:07:430:07:46

and perhaps, one day in the future, become artificial organs.

0:07:460:07:50

Macchiarini would revolutionise the medical world, if he succeeds.

0:07:540:07:58

Even though the lab is small, this was Macchiarini's main base.

0:08:000:08:05

He travels constantly and collaborates with researchers around the world.

0:08:050:08:10

'Especially in Russia.'

0:08:100:08:12

Findings here, you may apply perhaps in Russia?

0:08:120:08:15

Of course, the findings here will be available to everyone because they

0:08:150:08:21

will be published in the public domain.

0:08:210:08:23

But clearly, by sharing the information, we can move

0:08:230:08:29

at a level, at a higher speed and knowledge.

0:08:290:08:32

'But it's due to his work in Stockholm

0:08:340:08:36

'that he is under pressure now.'

0:08:360:08:37

One needs to explain to me what is my interest in...

0:08:580:09:01

..doing illegal surgeries or...

0:09:030:09:05

..fabricating or manipulating data.

0:09:070:09:10

Why I should be so foolish.

0:09:100:09:13

Being what the media call me, a superstar, I am always,

0:09:180:09:23

in German is "Black Peter", the bad boy.

0:09:230:09:26

Being famous, it's very easy to attack...

0:09:270:09:29

..before even the judgment has come, the final judgment.

0:09:310:09:35

I think it's quite unfair

0:09:350:09:38

and has destroyed my reputation and my honourability.

0:09:380:09:43

And you know exactly the media don't come back...

0:09:450:09:49

..they highlight the bad things, but not the good things.

0:09:500:09:54

Hi.

0:09:590:10:00

In 2010, Macchiarini was headhunted by the Karolinska Institute to

0:10:030:10:08

start up a centre for research and transplantation of new organs.

0:10:080:10:12

The whole world of academia competes over famous scientists like

0:10:150:10:19

Macchiarini. Almost how sports clubs buy players.

0:10:190:10:23

Top scientists can mean both revolutionary discoveries

0:10:250:10:28

and bigger grants for the university.

0:10:280:10:31

The very best are hunted from all over the world.

0:10:330:10:35

And Macchiarini has also been signed up by Russia.

0:10:380:10:41

I travelled with Paolo to Krasnodar,

0:10:550:10:58

the south of the country, his second base.

0:10:580:11:00

This was the start of several long journeys.

0:11:050:11:07

Macchiarini's story was much bigger and stranger

0:11:090:11:12

than I ever could have imagined.

0:11:120:11:15

-Hello.

-Hello, how are you?

-Fine, how are you?

0:11:160:11:18

Good.

0:11:180:11:20

Not usually.

0:11:250:11:26

I'm working for the university.

0:11:370:11:39

We are trying to create new organs.

0:11:410:11:43

Frankenstein.

0:11:460:11:47

It hit me how untouched Paolo seemed

0:11:530:11:55

by the allegations that had been made against him.

0:11:550:11:58

It was as if it was just a minor glitch.

0:11:590:12:02

Macchiarini had set himself far more ambitious goals.

0:12:030:12:06

'My dream would be, as I always say,'

0:12:080:12:11

to avoid the surgery.

0:12:110:12:14

It's crazy, right? A surgeon who would say that.

0:12:140:12:17

But, for instance, use the cells to restore the function of an organ.

0:12:170:12:22

That would be perfect.

0:12:220:12:23

So cell therapy, is, to my eyes, the future.

0:12:260:12:30

Paolo was hoping to change the very foundations of modern medical care.

0:12:320:12:37

It's been a long fight for you to do this?

0:12:390:12:42

Oh, yes.

0:12:430:12:44

Do you feel that you are closer to

0:12:450:12:48

actually succeeding now than you have been before?

0:12:480:12:50

If I would have more time to dedicate to science,

0:12:510:12:54

without dealing with all this...

0:12:540:12:58

other issues and complaints,

0:12:580:13:00

allegations and attacks and so forth, then, yes.

0:13:000:13:03

So the allegations and the complaints,

0:13:070:13:10

they do hinder your work,

0:13:100:13:11

they take up a lot of time?

0:13:110:13:14

Right now, I'm doing almost only that,

0:13:140:13:15

so clearly I cannot have a relaxed and creative mind

0:13:150:13:21

right now.

0:13:210:13:23

It's been going on six months.

0:13:230:13:25

Interesting, something you can talk about?

0:13:270:13:31

No, because the deal was, we would not talk about this, remember that?

0:13:310:13:35

'Of course I remembered.

0:13:370:13:38

'Macchiarini had let me into his world on one condition,

0:13:390:13:43

'he wanted to bide his time before responding to the allegations.

0:13:430:13:47

'His Swedish employer, the Karolinska Institute,

0:13:480:13:51

'was still investigating his case.

0:13:510:13:53

'The process must be allowed to run its course.'

0:13:530:13:57

Perfect.

0:13:570:13:58

Like it.

0:14:100:14:11

Changes.

0:14:110:14:12

OK, see you later or tomorrow morning.

0:14:150:14:17

Later, or tomorrow morning? About six.

0:14:170:14:19

OK. See you, cheers, Paolo, it was really nice.

0:14:210:14:24

Good.

0:14:240:14:25

Here, in southern Russia, near Crimea and the Black Sea,

0:14:490:14:53

Paolo is creating a centre for transplantation and research.

0:14:530:14:58

It aims to be world leading.

0:14:580:14:59

The base of the project is Paolo's lab at the University of Krasnodar.

0:15:040:15:08

Wait...

0:15:250:15:27

-Sorry.

-You should come now...

0:15:280:15:30

Who? Now.

0:15:300:15:32

OK...

0:15:320:15:33

Elena Gubareva is Paolo's research director here.

0:15:330:15:38

She has created an artificial diaphragm,

0:15:380:15:40

one of the muscles we use to breathe.

0:15:400:15:43

She has done,

0:15:430:15:44

I mean, the leader on this,

0:15:440:15:46

transplanting the entire diaphragm on the left side...

0:15:460:15:50

-Incredible.

-..which is incredible.

0:15:500:15:52

Just incredible. Nobody has done that with that success rate.

0:15:520:15:56

But...nobody believes it.

0:15:560:16:00

Whether it is because it is coming from Russia,

0:16:000:16:05

whether it is because I am under investigation

0:16:050:16:09

from all these allegations,

0:16:090:16:11

whether it is because it is too incredible.

0:16:110:16:14

So we are having difficulties in...

0:16:140:16:18

publishing it, but you will see it, how it works.

0:16:180:16:23

So that's...

0:16:230:16:25

..part of the challenge of this new field, this high technology,

0:16:270:16:34

this new advanced field.

0:16:340:16:37

Everything that is new scares and people do not trust,

0:16:370:16:41

it's like Mahatma Gandhi,

0:16:410:16:43

first they don't believe,

0:16:430:16:45

then they criticise you and then they start to...

0:16:450:16:48

When you were dying, when you die, maybe you were right.

0:16:480:16:52

Maybe.

0:16:520:16:53

But I'm not Mahatma Gandhi.

0:16:540:16:55

OK, I think you should wear your coat

0:16:580:17:01

because we should go...

0:17:010:17:04

OK.

0:17:040:17:05

'Elena shows me the rest of the lab.

0:17:050:17:08

'This is a controversial part of medical research.

0:17:080:17:11

'Most people are never allowed in.'

0:17:110:17:13

You should go to animal.

0:17:130:17:15

This is cages for animals, this is for big animals,

0:17:220:17:25

for pigs, which will bring us in future.

0:17:250:17:29

These cages are for rabbits and rats.

0:17:290:17:33

They live here. This is for different types of investigation.

0:17:330:17:37

Right, are you ready?

0:17:440:17:46

-Just a minute, please.

-Just a minute, OK.

0:17:480:17:51

We will go in the surgical room to do all the steps of the operation.

0:17:510:17:56

You can see. And now we will bring it to a surgical room.

0:18:080:18:13

Experiments on cells alone are often not enough to prove if a treatment

0:18:320:18:37

will work on the human body.

0:18:370:18:39

But if the experiments aren't performed on a human guinea pig,

0:18:400:18:44

you may need something else.

0:18:440:18:46

It might seem cruel,

0:18:490:18:51

and at times it is.

0:18:510:18:53

First, you remove the diaphragm from the donor rat.

0:18:580:19:03

The muscle is then washed in strong chemicals

0:19:060:19:08

so that all the donor cells are gone.

0:19:080:19:11

You are then left with a dead scaffold of a diaphragm.

0:19:130:19:16

This scaffold is then submerged in a solution of stem cells from the rat

0:19:200:19:25

that will receive the new muscle.

0:19:250:19:27

Then the rat that will get the new muscle, the receiver rat,

0:19:300:19:33

is opened up and the old diaphragm is removed.

0:19:330:19:36

The new muscle scaffold is taken out of its bath and implanted into the

0:19:380:19:43

receiver rat.

0:19:430:19:44

The idea is that the stem cells will morph into different

0:19:470:19:50

cell types to create a new organ.

0:19:500:19:53

This is animals after treatment and these two rats are rats after

0:19:570:20:02

transplantation of diaphragm after six months.

0:20:020:20:06

They are absolutely healthy

0:20:060:20:08

and there are no problems with health.

0:20:080:20:11

They have a good health status.

0:20:110:20:14

These two guys are basically world unique, right?

0:20:140:20:16

Yep, yep.

0:20:160:20:18

-The first?

-The first.

0:20:180:20:20

'According to Gubareva and Macchiarini,

0:20:200:20:22

'these two rats are the first animals in the world

0:20:220:20:25

'to breathe with the help of an artificial muscle.'

0:20:250:20:28

100 years ago, everybody said that heart transplantation is impossible,

0:20:280:20:34

but now we can see that heart transplantation is not routine,

0:20:340:20:38

but everybody knows it is possible to do.

0:20:380:20:42

It's very important, never stop.

0:20:420:20:44

Try to do everything what you can.

0:20:440:20:47

-Bye.

-Bye-bye.

0:20:480:20:49

'I got to see more and more of the lab and I couldn't help but be

0:20:500:20:54

'impressed. What they were trying to achieve was simply great.

0:20:540:20:59

'To Gubareva and Macchiarini it didn't seem to be questioned IF

0:20:590:21:03

'the new method with transplanted organs would ever become reality,

0:21:030:21:07

'but rather WHEN the big breakthrough would happen.'

0:21:070:21:10

We started with the trachea and now we are at

0:21:100:21:13

a higher level of complexity

0:21:130:21:15

because the oesophagus needs to contract,

0:21:150:21:19

the muscle diaphragm needs to contract, so all this capacities,

0:21:190:21:24

function capacities, needs to be preserved.

0:21:240:21:26

We do hope that

0:21:280:21:31

possibly in the middle of next year we could think to,

0:21:310:21:36

after having all the ethical commissions clearance,

0:21:360:21:39

to have the green light to do it in humans.

0:21:390:21:42

Paolo told me he intends to go from rat to human in just one year,

0:21:490:21:54

which is fast.

0:21:540:21:56

And during this time,

0:21:590:22:00

he will also need to test his new artificial muscles on more animals.

0:22:000:22:04

Here in Sochi, near the Black Sea,

0:22:110:22:13

there is one of the world's largest facilities

0:22:130:22:16

for experiments on monkeys.

0:22:160:22:17

Under communism, well guarded secret departments of the Soviet military

0:22:190:22:23

were located here.

0:22:230:22:24

Civilian scientists are now able to experiment

0:22:260:22:28

on the thousands of monkeys that live here.

0:22:280:22:31

But the preparations for Paolo's trials here in Sochi

0:22:340:22:37

have been delayed.

0:22:370:22:38

-Hello.

-Hello, nice to meet you.

0:22:450:22:47

How are you?

0:22:470:22:48

'We are about four months...'

0:22:550:22:57

We have a four-month delay

0:22:590:23:01

on the timescale because we haven't done that much progress since we

0:23:010:23:07

started, and this...

0:23:070:23:09

Research grants are so strict that if we don't provide results,

0:23:110:23:15

then we will not be able to continue the grant.

0:23:150:23:18

She wanted to know which,

0:23:260:23:28

-what timing for grant, this research.

-Yesterday.

0:23:280:23:31

-Yesterday.

-My problem is that nothing happens, and I hate that.

0:23:310:23:35

I mean, it makes no sense, and then we talk and we talk and we talk,

0:23:350:23:40

and nothing happens.

0:23:400:23:41

The last time we met in December and now we are

0:23:410:23:45

almost in April and nothing has been done, and clearly we cannot

0:23:450:23:51

continue in this way because otherwise when we need to do

0:23:510:23:54

the technical report of the project...

0:23:540:23:56

Nyet, nyet, nyet.

0:23:560:24:00

Then it's very bad.

0:24:000:24:02

Unfortunately, things need to be done, so...

0:24:070:24:10

Ladies!

0:24:130:24:14

Normally, scientists would start with test tubes,

0:24:230:24:27

then experiment on rats,

0:24:270:24:29

move on to bigger animals and after that, humans.

0:24:290:24:33

That is usually how medical research works to avoid the risks escalating.

0:24:350:24:40

If Paolo had always worked in this way,

0:24:420:24:44

this film may never have happened.

0:24:440:24:46

But he hasn't.

0:24:480:24:49

Though Paolo aimed to test on animals here in Krasnodar,

0:24:550:24:59

he'd already tested a similar method on humans.

0:24:590:25:02

It was in 2008 that he took that controversial step.

0:25:040:25:07

This is Claudia Castillo.

0:25:110:25:12

She sought Macchiarini's help

0:25:140:25:16

after one of her bronchi had closed up.

0:25:160:25:18

A defect which medicine back then couldn't cure.

0:25:200:25:22

This was something completely new - tracheas and stem cells.

0:25:370:25:41

This is how it was explained to the world...

0:25:410:25:43

Paolo cut out a piece of the windpipe from a dead donor.

0:25:460:25:49

The piece was then washed clean of donor cells.

0:25:530:25:55

Then Claudia's stem cells were taken from her bone marrow.

0:25:590:26:02

The cleansed windpipe was bathed in Claudia's stem cell solution and

0:26:060:26:11

a little piece of it was inserted into Claudia.

0:26:110:26:14

Even if Macchiarini had taken big risks,

0:26:340:26:36

it all seemed to have worked out.

0:26:360:26:39

'The scientists believe their technique can immediately help up to

0:26:400:26:44

'3,000 people like Claudia across Europe

0:26:440:26:46

'and eventually tens of thousands

0:26:460:26:48

'more with diseases like cancer of the larynx.'

0:26:480:26:51

Macchiarini's method became world news.

0:26:510:26:54

The prestigious medical journal the Lancet ranked his research article

0:26:550:27:00

amongst the year's ten most important.

0:27:000:27:02

So, in this case, it's not just a promise,

0:27:040:27:07

we've achieved what we set out to do.

0:27:070:27:08

It's a major achievement in the history of medicine.

0:27:080:27:11

In a short space of time,

0:27:150:27:17

Macchiarini went on to transplant several new tracheas.

0:27:170:27:20

In London, he participated in an operation

0:27:250:27:28

on a ten-year-old Irish boy,

0:27:280:27:30

who was born with a trachea too small.

0:27:300:27:32

'It saved his life and has been described as a kind of miracle.'

0:27:320:27:37

In Moscow, on a woman from Kazakhstan,

0:27:370:27:41

and in Florence, on a young British woman with cancer.

0:27:410:27:45

Macchiarini's status as a star was now at its peak.

0:27:500:27:54

He was desirable prey for universities and hospitals

0:28:110:28:14

around the globe,

0:28:140:28:17

but in the end, it was Russia and Sweden who hired him.

0:28:170:28:21

Macchiarini took the Karolinska Institute by storm,

0:28:230:28:26

not least among the surgeons, who thought he was fantastic.

0:28:260:28:29

Here was a colleague who was not only extremely competent in his

0:28:310:28:34

handiwork, but he also seemed to be revolutionising an entire science.

0:28:340:28:39

Karl-Henrik Grinnemo is a surgeon and researcher.

0:29:090:29:13

Together with his colleague, Matthias Corbascio,

0:29:130:29:16

he was asked to help Macchiarini set up the unit.

0:29:160:29:19

Macchiarini was now commissioned to start up an international centre for

0:29:400:29:44

transplantation and surgery at the Karolinska Institute.

0:29:440:29:47

He was meant to do research at the Institute

0:29:480:29:51

and also perform experimental surgery at its hospital.

0:29:510:29:54

Paolo had also been asked to do research on other vital organs.

0:30:170:30:22

But the pressure was intense.

0:31:120:31:14

Paolo was expected to have started

0:31:160:31:18

ground-breaking operations within three months.

0:31:180:31:21

But months went by without Paolo performing a single transplant.

0:31:240:31:28

And he was also facing other problems.

0:31:310:31:34

Paolo had carried out transplants

0:31:360:31:38

on nearly ten patients using his new method,

0:31:380:31:40

but several tracheas had started to collapse.

0:31:400:31:44

How was he going to solve this?

0:31:450:31:47

Paolo had a new idea.

0:31:480:31:50

This time, something really untested.

0:31:500:31:53

He would stop the transplants using donated wind pipes,

0:31:540:31:58

and instead manufacture artificial ones out of plastic.

0:31:580:32:02

But who would be the guinea pig?

0:32:040:32:06

By chance, he came across a patient in Iceland.

0:32:120:32:15

A student from Eritrea by the name of Andemariam Beyene.

0:32:160:32:20

Andemariam was studying geothermal energy.

0:32:210:32:24

He was finding it hard to breathe.

0:32:270:32:29

For a while he thought it was asthma, but the drugs didn't help.

0:32:310:32:35

Then his Icelandic doctor discovered he had cancer of the trachea.

0:32:350:32:40

In 2011, Andemariam's ability to breathe worsened again.

0:32:560:33:01

His Icelandic doctor began to look abroad for specialist help.

0:33:010:33:05

The Karolinska Hospital suggested Macchiarini.

0:33:050:33:09

One patient was referred from Iceland that was given,

0:33:090:33:14

in Harvard in Boston,

0:33:140:33:16

a life expectancy of six months because he was already operated on.

0:33:160:33:20

He had a shortness of breath

0:33:200:33:22

and the case was discussed here, multidisciplinary and...

0:33:220:33:27

..we decided that he was at risk of suffocation.

0:33:290:33:31

We were in need of something now and not tomorrow.

0:33:330:33:37

Paolo now decided to try his new idea with plastic tracheas on Andemariam.

0:33:370:33:41

Compared to the old procedure that we did so far since 2008,

0:33:430:33:48

a completely new approach where

0:33:480:33:51

we don't use natural wind pipes,

0:33:510:33:56

but synthetic polymers to build a custom-made individual windpipe.

0:33:560:34:04

The operation was performed

0:34:070:34:09

at Karolinska University Hospital in June 2011.

0:34:090:34:12

Karl-Henrik Grinnemo was one of several surgeons

0:34:180:34:21

who assisted during the operation.

0:34:210:34:23

The surgery was very difficult.

0:35:090:35:11

You had three experienced surgeons at the operating table,

0:35:110:35:15

but believe me, it was one of the most difficult surgeries we did

0:35:150:35:19

and it was the first time we used this material.

0:35:190:35:22

Not optimum material, because it was done in a hurry and to afford.

0:35:220:35:27

A ground-breaking surgery gave a man back his trachea and his life.

0:36:480:36:52

He is the first person...

0:36:520:36:54

There were great headlines, and just as they had hoped,

0:36:540:36:57

Macchiarini and the Karolinska Institute

0:36:570:36:59

caught the world's attention.

0:36:590:37:00

It's his tissue, it's his cells,

0:37:000:37:02

but those cells have differentiated

0:37:020:37:04

from bone marrow cells to become all the different cell types.

0:37:040:37:07

So it really is a living, breathing organ at this point.

0:37:070:37:10

Over a month later, Beyene is not only breathing,

0:37:100:37:12

but on the road to recovery.

0:37:120:37:15

He is soon to be discharged from the hospital and heading home to his family.

0:37:150:37:19

But things didn't look quite as good

0:37:190:37:21

for one of Macchiarini's earlier patients, Keziah Shorten...

0:37:210:37:25

..the young British woman who Macchiarini had

0:37:270:37:30

transplanted a donated trachea into in Florence.

0:37:300:37:33

After some time at home in England,

0:37:350:37:38

her doctors observed that

0:37:380:37:40

the transplant had failed and that her windpipe was hanging loose.

0:37:400:37:44

For a long time, her British doctors

0:37:460:37:48

had been collaborating with Macchiarini,

0:37:480:37:51

but now they had to manage a disastrous situation on their own.

0:37:510:37:55

We were faced with a very difficult clinical problem here at UCL,

0:37:560:38:02

of a girl, aged 20, who had had a terrible carcinoma,

0:38:020:38:06

cancer of her windpipe,

0:38:060:38:08

and had had this operated on elsewhere.

0:38:080:38:11

She'd had the windpipe essentially removed,

0:38:120:38:14

reconstructed in a different way, and that had all broken down.

0:38:140:38:18

However, having seen what had happened in Sweden,

0:38:200:38:23

we felt this offered her some chance.

0:38:230:38:26

The plastic trachea Macchiarini had used on Andemariam had been

0:38:280:38:31

manufactured in London by one of Birchall's colleagues.

0:38:310:38:35

Birchall now ordered one more for Keziah.

0:38:370:38:40

We did put a synthetic.

0:38:430:38:45

I was the one who stitched in the top end, and my thoracic colleagues

0:38:450:38:48

stitched from the bottom end of this synthetic implant.

0:38:480:38:51

Even when working with it, you could tell it was too rigid, it wasn't...

0:38:510:38:55

You couldn't see any evidence of any cells there.

0:38:550:38:58

Microscopically, there may have been some cells.

0:38:580:39:01

There was certainly no respiratory lining.

0:39:010:39:03

Um, I...

0:39:030:39:05

You know, it was a bit of plastic.

0:39:050:39:07

An expensive bit of plastic.

0:39:070:39:09

I couldn't see it working, and sure enough, it didn't work.

0:39:100:39:13

Keziah's trachea was made from the same plastic as Andemariam's.

0:39:150:39:19

It was a special plastic called POSS-PCU.

0:39:210:39:24

The POSS-PCU had not performed as well as we'd hoped.

0:39:260:39:29

It hadn't integrated into its surroundings very well

0:39:290:39:32

and had become infected,

0:39:320:39:34

principally with fungus, but also with some bacteria as well.

0:39:340:39:36

The two ends of the trachea, really, were very loose,

0:39:390:39:42

they had not integrated at all.

0:39:420:39:44

There were sutures that were holding it in place, but very loosely.

0:39:440:39:47

She remained on the intensive care unit at UCL

0:39:480:39:51

for another six weeks or so,

0:39:510:39:52

but then was able to be discharged back to Brighton,

0:39:520:39:55

on the south coast of England, to be with her family for a few months.

0:39:550:39:58

Keziah's condition worsened.

0:40:020:40:04

Shortly afterwards, she passed away.

0:40:050:40:08

The material doesn't really work, basically.

0:40:110:40:13

In its present form, that particular material

0:40:130:40:17

is not the solution to tracheal transplantation right now.

0:40:170:40:22

But the British surgeons weren't the only ones

0:40:390:40:41

doubting Paolo's plastic tracheas.

0:40:410:40:43

A colleague of theirs, Pierre Delaere, was working in Belgium.

0:40:450:40:49

He was astounded to hear about Paolo's operation on Andemariam.

0:40:500:40:54

Delaere warned the Vice Chancellor at Karolinska.

0:41:420:41:45

He claimed that Macchiarini's research studies

0:41:460:41:49

were misleading the general public and the medical world,

0:41:490:41:51

making people believe that plastic tracheas actually worked,

0:41:510:41:55

despite it being physically impossible.

0:41:550:41:58

Karolinska ignored the warning.

0:42:370:42:40

And the hospital went ahead with the next plastic operation

0:42:410:42:45

on an American suffering from cancer,

0:42:450:42:48

who had found Macchiarini on the internet.

0:42:480:42:50

My name is Christopher Lyles.

0:42:500:42:52

Born and raised in Maryland, graduated Morgan State University.

0:42:540:42:58

I have a four-year-old.

0:42:580:43:01

I want to see her grow.

0:43:010:43:02

I'm not going anywhere.

0:43:050:43:06

Lyles was operated on in November 2011.

0:43:100:43:13

Just four months later he was dead.

0:43:140:43:17

Two out of the world's three patients

0:43:190:43:21

with plastic tracheas were now dead.

0:43:210:43:24

But Delaere's warnings never took hold in the media.

0:43:260:43:29

From the outside it all looked good.

0:43:290:43:32

During the spring of 2012,

0:43:350:43:37

a German TV crew began to follow Macchiarini very closely.

0:43:370:43:41

The scan would be, eventually, of some help as well.

0:43:410:43:45

So...

0:43:450:43:47

Here are some shots from the German team's unedited footage.

0:43:470:43:50

When I see this, it feels like stepping into a time machine,

0:43:510:43:55

as everything was caught on tape,

0:43:550:43:58

not least the difficulties with Macchiarini's project.

0:43:580:44:01

But, please, try to answer this question,

0:44:020:44:05

because he's making me crazy. I hate that.

0:44:050:44:07

In this material, I would make several serious discoveries.

0:44:070:44:12

May Lin.

0:44:120:44:14

You do not forget me.

0:44:150:44:16

OK, bye.

0:44:180:44:19

Bye.

0:44:200:44:21

Wow.

0:44:220:44:24

Behind the scenes, Paolo was obviously well aware of the death.

0:45:040:45:09

But it didn't seem to stop him.

0:45:090:45:11

Even though Paolo couldn't be sure why his patient had died,

0:45:330:45:37

he still made plans for new operations.

0:45:370:45:39

In the US, he collaborated with the biotech company Harvard Bioscience.

0:45:410:45:46

Here's how the president of the company, David Green, presented the method.

0:45:460:45:51

The bioreact we build is actually no bigger than this.

0:45:510:45:53

It's about the size of a shoebox,

0:45:530:45:55

and inside there's a rotating part...

0:45:550:45:57

Green manufactured Macchiarini's bioreactor,

0:45:570:46:01

the plastic box with the tracheas bathed in stem cells.

0:46:010:46:04

For the viewers, David Green described

0:46:040:46:07

the method as if it was magic.

0:46:070:46:10

The plastic would come to life in no time.

0:46:100:46:12

What's it made out of?

0:46:120:46:14

It's actually made out of a plastic polymer material

0:46:140:46:16

that's a bit porous and so the cells can settle into those pours

0:46:160:46:20

inside the matrix and start to grow. It feels like home to them.

0:46:200:46:23

After a few days, the patient's own blood vessels actually grow into the

0:46:230:46:28

scaffold and make it really part of him.

0:46:280:46:30

And what's going on? Are they actually growing and multiplying?

0:46:300:46:33

Yes, that's exactly right.

0:46:330:46:34

But on the beach in 2012, everything sounded a little different.

0:46:340:46:38

What I was about to hear would come as a shock to me.

0:46:430:46:47

Paolo was explaining there was something wrong

0:47:120:47:15

with Andemariam's plastic trachea.

0:47:150:47:17

And not only with that one, but also with the new plastic tracheas.

0:47:170:47:21

And despite the problems being unsolved,

0:47:220:47:25

he intended to go ahead with new operations in just a few weeks.

0:47:250:47:30

I am quite unhappy about this,

0:47:300:47:33

because either we know exactly what's going on,

0:47:330:47:36

because otherwise... I mean...

0:47:360:47:37

Seven people in my lab have worked 24 hours a day for

0:47:370:47:41

the last three weeks doing biocompatibility,

0:47:410:47:44

and then this is shit now.

0:47:440:47:45

So I think that we need to redo everything again.

0:47:450:47:48

We lost two weeks

0:47:480:47:50

by doing this.

0:47:500:47:52

Macchiarini's team in Stockholm was desperately trying

0:48:150:48:18

to solve the problems.

0:48:180:48:20

And his haste to develop these techniques

0:48:200:48:23

seem to have become ingrained in his working practices.

0:48:230:48:26

If you have a patient that dies because of the new technology

0:48:290:48:33

then you always ask you...

0:48:330:48:35

Did I do something wrong? Do I have the right to continue?

0:48:370:48:41

Should I continue?

0:48:410:48:42

Um...

0:48:430:48:44

What should we do better?

0:48:460:48:47

So even with 25, these yellow...

0:48:470:48:51

..things are appearing.

0:48:520:48:54

It's very draining.

0:48:560:48:57

It's not a pleasant sensation at all.

0:48:580:49:03

Good. Thank you again for outstanding work.

0:49:050:49:08

But still, you learn only by doing.

0:49:110:49:14

It's going to be quite difficult to distinguish

0:49:150:49:18

the two measurements that we get.

0:49:180:49:21

Difficult but not impossible, right?

0:49:210:49:23

So he should do it, he must do it.

0:49:250:49:28

There is no changes or no choices.

0:49:280:49:31

I am seeing that we are still improving and we need to improve all the time.

0:49:310:49:37

And only by doing, we improve.

0:49:370:49:39

All these studies are ongoing.

0:49:520:49:54

This could be the future.

0:49:540:49:56

Thank you so much.

0:49:560:49:58

APPLAUSE

0:49:580:50:00

That's the kind of surgeon I want on my team.

0:50:160:50:18

If I'm on the wrong side of the knife,

0:50:180:50:20

I want a guy like Paolo Macchiarini trying to get me through this.

0:50:200:50:22

He's very experienced in transplantation,

0:50:250:50:27

experienced tracheal surgery,

0:50:270:50:29

so you don't say anything.

0:50:290:50:31

We need people like Paolo to force the issue,

0:50:360:50:38

to get a decision, to say,

0:50:380:50:40

"Let's just do this, even though we don't have all the answers."

0:50:400:50:44

The idea of this

0:50:440:50:45

trachea transplantation is something magic, really.

0:50:450:50:49

-He's the only one.

-Yes.

0:50:580:51:00

But the result so far makes you hopeful?

0:51:060:51:10

Oh, yes. Of course, otherwise I would already have stopped.

0:51:100:51:14

Paolo had the support of some of the leading lights in his field.

0:51:220:51:27

And you can view the setbacks in more than one way.

0:51:270:51:31

Sure, two out of the three patients with plastic tracheas were dead,

0:51:310:51:36

but you might also point out that one of the three was alive,

0:51:360:51:40

and you could count that as a success to build on.

0:51:400:51:43

So how do you feel, physically?

0:51:450:51:48

I'm OK.

0:51:480:51:49

Always, we speak of relatively,

0:51:490:51:53

so from time to time it was going to be positive, going OK.

0:51:530:51:59

So I'm very optimistic in the future.

0:51:590:52:03

So, how is this day for you?

0:52:030:52:06

One year exactly after the operation of Andemariam.

0:52:060:52:10

I'm very pleased to see him doing so well and it is

0:52:120:52:15

a gratification for all the efforts that we have done

0:52:150:52:19

in the past and we continue to do.

0:52:190:52:21

So it is a major achievement

0:52:210:52:23

for every other patient that would need this type of transplantation.

0:52:230:52:29

What if the plastic method was fundamentally correct,

0:52:310:52:35

but that the patients had been too ill?

0:52:350:52:38

So far, Paolo had been allowed to use the plastic tracheas

0:52:550:52:59

in order to save lives.

0:52:590:53:01

Now he wanted to test this method on healthier and stronger patients

0:53:030:53:07

who were not in any immediate danger of dying.

0:53:070:53:10

Paolo had succeeded with something almost impossible.

0:53:250:53:29

Without extensive animal testing,

0:53:290:53:31

he got the go-ahead for using humans as guinea pigs.

0:53:310:53:34

He was to test the plastic tracheas in Russia,

0:53:410:53:45

on subjects who suffered from old injuries

0:53:450:53:48

but were not acutely ill or dying.

0:53:480:53:51

In order to choose the right subjects,

0:53:530:53:55

they trawled many candidates.

0:53:550:53:57

The German TV crew was there to record the operation.

0:53:590:54:02

This is Julia Tuulik, a teacher and former dancer from St Petersburg.

0:54:050:54:10

She won the chance to be the first experimental subject.

0:54:130:54:17

She was asked to record a video explaining why they should pick her.

0:54:190:54:23

Thank you for everybody that you came.

0:56:150:56:17

This is the final brainstorming before the transplantation and,

0:56:170:56:21

as a matter of fact, the patient, Julia,

0:56:210:56:23

tomorrow will be the first patient

0:56:230:56:26

entering a clinical trial.

0:56:260:56:29

So tomorrow we plan to do the

0:56:290:56:31

first in human ever done tracheal transplant

0:56:310:56:34

using bio-artificial scaffolds.

0:56:340:56:36

Julia was about to receive the world's fourth plastic trachea.

0:57:060:57:10

Her only living predecessor was in Iceland, Andemariam.

0:57:150:57:18

And at the Karolinska Hospital in Stockholm

0:57:210:57:24

there waited yet another patient.

0:57:240:57:26

By testing it on a patient as healthy as Julia,

0:57:270:57:31

would Macchiarini now be able to prove that his method was ingenious?

0:57:310:57:35

Would it be a success?

0:57:370:57:39

Nice to meet you.

0:57:410:57:42

Do they know the problem?

0:57:430:57:45

No, what is your problem?

0:57:460:57:47

Being at the cutting edge...

0:58:050:58:06

..you are always wrong,

0:58:080:58:10

until sooner, more likely later, you demonstrate the opposite.

0:58:100:58:16

Why should I give up?

0:58:180:58:21

I'm not the type to give up.

0:58:210:58:22

Download Subtitles

SRT

ASS