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  • So I was privileged to train in transplantation

    譯者: Vikki Leung 審譯者: Joan Liu

  • under two great surgical pioneers:

    能在兩位偉大的外科先驅者

  • Thomas Starzl,

    手下學習移植手術,是我的榮幸。

  • who performed the world's first successful liver transplant

    一位是湯馬斯·史塔哲,

  • in 1967,

    於1967年成為世界上第一個

  • and Sir Roy Calne,

    成功完成肝臟移植手術的人﹐

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

    以及萊伊·卡恩爵士,

  • in the following year.

    於一年後﹐成為在英國第一個

  • I returned to Singapore

    進行肝臟移植手術的人。

  • and, in 1990,

    我回到新加坡﹐

  • performed Asia's first successful

    然後,於1990年

  • cadaveric liver transplant procedure,

    完成了亞洲首宗

  • but against all odds.

    屍肝移植手術,

  • Now when I look back,

    儘管手術困難重重。

  • the transplant was actually the easiest part.

    如今當我再檢討時﹐

  • Next, raising the money to fund the procedure.

    手術部分其實是最簡單的。

  • But perhaps the most challenging part

    其次就是湊錢去籌備手術的經費。

  • was to convince the regulators --

    但最具挑戰性的部分

  • a matter which was debated in the parliament --

    就是要說服監管者 -

  • that a young female surgeon

    這件事曾於議會受爭議 -

  • be allowed the opportunity

    去讓一位年輕女外科醫生

  • to pioneer for her country.

    獲得能為自己國家

  • But 20 years on,

    作出創舉的機會。

  • my patient, Surinder,

    但20年過去了﹐

  • is Asia's longest surviving

    而我的病人,薩倫德,

  • cadaveric liver transplant to date.

    是到目前為止﹐於亞洲生存最長久的

  • (Applause)

    屍肝移植手術的例子。

  • And perhaps more important,

    (掌聲)

  • I am the proud godmother

    但更重要的是,

  • to her 14 year-old son.

    我有幸成為她

  • (Applause)

    14歲兒子的教母。

  • But not all patients on the transplant wait list

    (掌聲)

  • are so fortunate.

    但並不是所有正在輪候移植手術的病人

  • The truth is,

    都是如此幸運。

  • there are just simply not enough donor organs

    事實上﹐

  • to go around.

    所捐獻的器官根本未能足夠

  • As the demand for donor organs

    去被妥善配置。

  • continues to rise,

    每當對捐獻器官的需求

  • in large part due to the aging population,

    主要由於人口老化而

  • the supply has remained relatively constant.

    持續上升﹐

  • In the United States alone,

    供應量仍是相對的維持不變。

  • 100,000 men, women and children

    僅在美國,

  • are on the waiting list for donor organs,

    已經有10萬人,包括男人﹑女人及小孩

  • and more than a dozen die each day

    正為得到捐助器官而輪候﹐

  • because of a lack of donor organs.

    而且每天有十幾人﹐

  • The transplant community

    正因缺乏捐獻的器官而死亡。

  • has actively campaigned in organ donation.

    器官移植界

  • And the gift of life

    曾積極推廣器官捐獻的活動。

  • has been extended

    而饋贈生命的意念﹐

  • from brain-dead donors

    已經

  • to living, related donors --

    從腦死亡的捐獻者

  • relatives who might donate an organ

    被延續至還在世的﹑有血緣關係的捐獻者 -

  • or a part of an organ,

    包括會將整個器官﹑或器官的一部份

  • like a split liver graft,

    捐贈的親屬﹐

  • to a relative or loved one.

    例如將肝臟分割移植

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

    到親屬或所愛的人身上。

  • the gift of life was then extended

    但由於所捐贈器官仍是嚴重短缺,

  • from living, related donors

    捐贈範圍再次被擴大﹐

  • to now living, unrelated donors.

    由還在世的﹑有血緣關係的捐獻者﹐

  • And this then has given rise

    伸延至還在世的﹑非血緣關係的捐獻者。

  • to unprecedented and unexpected

    因此就引發了一場

  • moral controversy.

    前所未有﹐以及意料之外的

  • How can one distinguish

    道德上的爭議。

  • a donation that is voluntary and altruistic

    我們如何才能辨別

  • from one that is forced or coerced

    一位出於自願和無私的捐獻者﹐

  • from, for example,

    以及一位被迫或受強制的捐獻者﹖

  • a submissive spouse, an in-law,

    例如﹐

  • a servant, a slave,

    一個唯命是從的配偶﹑一個媳婿﹑

  • an employee?

    一個僕人﹑一個奴隸,

  • Where and how can we draw the line?

    或者一位僱員?

  • In my part of the world,

    我們應該於那裡﹑以及怎樣劃清這條界線呢﹖

  • too many people live below the poverty line.

    於我的日常生活的四週﹐

  • And in some areas,

    太多人活在貧困線之下。

  • the commercial gifting of an organ

    而在一些地區,

  • in exchange for monetary reward

    由非血緣關係者

  • has led to a flourishing trade

    去透過活體器官捐贈

  • in living, unrelated donors.

    而換取金錢上的報酬﹐

  • Shortly after I performed the first liver transplant,

    已經是非常盛行的一種商業交易。

  • I received my next assignment,

    在完成首宗肝臟移植后不久,

  • and that was to go to the prisons

    我接到的下一個工作

  • to harvest organs

    便是到監獄裡面﹐

  • from executed prisoners.

    從被處決的死囚身上

  • I was also pregnant at the time.

    獲取器官。

  • Pregnancies are meant

    那時我還正懷了孕。

  • to be happy and fulfilling moments

    懷孕﹐

  • in any woman's life.

    對任何一位女人而言﹐是一段

  • But my joyful period

    讓人快樂及感到充實的時光。

  • was marred by solemn and morbid thoughts --

    但我這段本應是喜悅的時期﹐

  • thoughts of walking through

    卻被一陣陣幽暗的﹑帶著死亡氣息的思想沾污 -

  • the prison's high-security death row,

    回想著我曾步過

  • as this was the only route

    監獄裡最高嚴密的死囚區,

  • to take me to the makeshift operating room.

    因為那是到達臨時手術室的

  • And at each time,

    唯一的一條路。

  • I would feel the chilling stares

    而每當那時,

  • of condemned prisoners' eyes follow me.

    我就能感受到那些

  • And for two years,

    用令人毛骨悚然的目光﹐跟隨著我的死囚的眼睛。

  • I struggled with the dilemma

    接下來的兩年,

  • of waking up at 4:30 am

    我都於這困境中掙扎﹐

  • on a Friday morning,

    每個周五早上

  • driving to the prison,

    於凌晨四點半起床,

  • getting down, gloved and scrubbed,

    開車去到監獄﹐

  • ready to receive the body

    到地庫﹑戴上手套﹑消毒﹐

  • of an executed prisoner,

    準備接收一具

  • remove the organs

    被處決的死囚的屍體﹐

  • and then transport these organs

    從之切出器官﹐

  • to the recipient hospital

    再將這些器官帶回

  • and then graft the gift of life

    接受移植者的醫院﹐

  • to a recipient the same afternoon.

    然後再於同一天下午﹐

  • No doubt, I was informed,

    給接受者移植器官﹐從而贈予新生命。

  • the consent had been obtained.

    當然﹐他們都說

  • But, in my life,

    器官捐贈是獲得當事人同意。

  • the one fulfilling skill that I had

    但於我生命中﹐

  • was now invoking feelings of conflict --

    我所唯一擁有的﹑令我滿足的技能﹐

  • conflict ranging

    現今竟然產生了情感上的衝突 -

  • from extreme sorrow and doubt at dawn

    這種衝突包括

  • to celebratory joy

    從清晨時的極度悲傷和疑慮﹐至到

  • at engrafting the gift of life at dusk.

    黃昏時慶祝

  • In my team,

    因器官移植而給予病人重生的喜悅。

  • the lives of one or two of my colleagues

    於我的團隊中,

  • were tainted by this experience.

    有一兩位同事的一生

  • Some of us may have been sublimated,

    也就因這樣的經歷而矇上污點。

  • but really none of us remained the same.

    我們當中的一些人可能已經麻木了﹐

  • I was troubled

    但實際上沒有人不受到感染。

  • that the retrieval of organs from executed prisoners

    我很困擾﹐

  • was at least as morally controversial

    這種從死囚上取得器官的做法﹐

  • as the harvesting of stem cells

    至少在道德上是與

  • from human embryos.

    從人類胚胎中抓取幹細胞一樣

  • And in my mind,

    受到同等程度上的爭議。

  • I realized as a surgical pioneer

    而且我認為,

  • that the purpose of my position of influence

    身為一位外科手術的先鋒者﹐

  • was surely to speak up

    擁有具影響力的地位的存在意義﹐

  • for those who have no influence.

    就是在於可以替那些

  • It made me wonder

    沒有影響力的人發言。

  • if there could be a better way --

    這令我自問

  • a way to circumvent death

    究竟有沒有更好的方法 --

  • and yet deliver the gift of life

    一個可迴避牽涉死亡的﹑

  • that might exponentially impact

    而又同時可贈予新生命的方法。

  • millions of patients worldwide.

    這樣就能為全世界成千上萬的病人﹐

  • Now just about that time,

    帶來指數級的影響力。

  • the practice of surgery evolved

    也就是在同一時間,

  • from big to small,

    外科手術的技巧﹐進展到

  • from wide open incisions

    從大到小,

  • to keyhole procedures,

    從寬大的切口

  • tiny incisions.

    到鎖孔式的

  • And in transplantation, concepts shifted

    微創技術。

  • from whole organs to cells.

    而且移植手術的概念﹐已從整個器官

  • In 1988, at the University of Minnesota,

    移轉到細胞移植。

  • I participated in a small series

    1988年,在明尼蘇達大學,

  • of whole organ pancreas transplants.

    我參與了一系列小规模的

  • I witnessed the technical difficulty.

    整個胰臟移植手術。

  • And this inspired in my mind

    我親眼見證了此項技術的難度。

  • a shift from transplanting whole organs

    同時這啟發了我

  • to perhaps transplanting cells.

    去考慮將移植整個器官﹐

  • I thought to myself,

    轉移到細胞移植。

  • why not take the individual cells

    我在想,

  • out of the pancreas --

    何不考慮去將胰臟裡

  • the cells that secrete insulin to cure diabetes --

    個別的細胞提取 --

  • and transplant these cells? --

    即那些能分泌出胰島素而治愈糖尿病的細胞 --

  • technically a much simpler procedure

    再將這些細胞移植呢?--

  • than having to grapple with the complexities

    技術上而言﹐這類程序﹐

  • of transplanting a whole organ.

    相比起要因進行整個器官移植﹐而要應付繁複的事項﹐

  • And at that time,

    來得簡單得多。

  • stem cell research

    同時間﹐

  • had gained momentum,

    幹細胞研究方面﹐

  • following the isolation of the world's first

    亦繼於90年代時期﹐

  • human embryonic stem cells

    世上首次成功將

  • in the 1990s.

    人類胚胎幹細胞分離以後﹐

  • The observation that stem cells, as master cells,

    獲得了新的進展。

  • could give rise

    能將幹細胞用作母細胞

  • to a whole variety of different cell types --

    去發育成

  • heart cells, liver cells,

    一系列林林總總的細胞種類 --

  • pancreatic islet cells --

    心肌細胞﹑肝細胞﹑

  • captured the attention of the media

    胰島細胞 --

  • and the imagination of the public.

    這項發現﹐廣泛受到媒體關注﹐

  • I too was fascinated

    也激發了廣大市民的想象力。

  • by this new and disruptive cell technology,

    我也因這種全新的﹑

  • and this inspired a shift in my mindset,

    具影響力的細胞技術而著迷﹐

  • from transplanting whole organs

    思維亦被激發﹑而引起了轉變,

  • to transplanting cells.

    從將整個器官移植﹐

  • And I focused my research on stem cells

    轉移到細胞移植。

  • as a possible source

    我把研究焦點﹐放在

  • for cell transplants.

    利用幹細胞

  • Today we realize

    作為細胞移植來源之中。

  • that there are many different types of stem cells.

    今日﹐我們了解到

  • Embryonic stem cells

    有很多不同類型的幹細胞。

  • have occupied center stage,

    其中,胚胎幹細胞

  • chiefly because of their pluripotency --

    已占據了中心地位,

  • that is their ease in differentiating

    主要是因為它的多能性--

  • into a variety of different cell types.

    即是它們能輕鬆的分化成

  • But the moral controversy

    一系列林林總總的細胞種類。

  • surrounding embryonic stem cells --

    但是之所以胚胎幹細胞的範疇

  • the fact that these cells are derived

    在道德上備受爭議 --

  • from five-day old human embryos --

    是因為這些細胞來源於

  • has encouraged research

    5天大的人類胚胎。

  • into other types of stem cells.

    而正因為這種爭議﹐才更激勵人們去研究

  • Now to the ridicule of my colleagues,

    其他類型的幹細胞。

  • I inspired my lab

    我在同事的嘲諷聲中,

  • to focus on what I thought

    將實驗焦點

  • was the most non-controversial source of stem cells,

    放於我認為

  • adipose tissue, or fat, yes fat --

    最沒有爭議價值的幹細胞資源 --

  • nowadays available in abundant supply --

    脂肪組織﹐即是脂肪﹐對﹐是脂肪 --

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

    現今可垂手可得的 --

  • Fat-derived stem cells

    至少﹐我想像你和我一樣﹐都很樂意將它擺脫。

  • are adult stem cells.

    脂肪源幹細胞

  • And adult stem cells

    是一種成體幹細胞。

  • are found in you and me --

    而成體幹細胞是在

  • in our blood, in our bone marrow,

    你和我身體內都能找到 --

  • in our fat, our skin and other organs.

    於我們的血液中﹑骨髓中﹑

  • And as it turns out,

    脂肪中﹑皮膚中﹐以及其他器官中。

  • fat is one of the best sources

    而事實證明,

  • of adult stem cells.

    脂肪是成體幹細胞的

  • But adult stem cells

    最佳來源之一。

  • are not embryonic stem cells.

    但是成體幹細胞

  • And here is the limitation:

    並不是胚胎幹細胞。

  • adult stem cells are mature cells,

    它具有本身的限制﹕

  • and, like mature human beings,

    成體幹細胞是成熟的細胞,

  • these cells are more restricted in their thought

    而就像成年人一樣,

  • and more restricted in their behavior

    這些細胞﹐於思維上較為受到局限﹐

  • and are unable to give rise

    於行為上亦較為受到局限﹐

  • to the wide variety of specialized cell types,

    因此它們也無法像

  • as embryonic stem cells [can].

    胚胎幹細胞一般﹐可以分化成

  • But in 2007,

    多種具特定功能的細胞。

  • two remarkable individuals,

    但在2007年,

  • Shinya Yamanaka of Japan

    有兩位傑出人士 --

  • and Jamie Thomson of the United States,

    日本的山中伸彌﹐

  • made an astounding discovery.

    以及美國的占美·湯臣 --

  • They discovered

    作出了驚人的發現。

  • that adult cells, taken from you and me,

    他們發現

  • could be reprogrammed

    那些取自你我身上的成體細胞﹐

  • back into embryonic-like cells,

    可以重組還原成

  • which they termed IPS cells,

    類似胚胎的細胞。

  • or induced pluripotent stem cells.

    他們將之命名為IPS細胞,

  • And so guess what,

    或稱誘導培養多潛能幹細胞。

  • scientists around the world and in the labs

    於是如你我所料﹐

  • are racing

    世界各地的﹑以及在實驗室中的科學家﹐

  • to convert aging adult cells --

    都爭先恐後的

  • aging adult cells from you and me --

    去將正在老化的成體細胞轉化 --

  • they are racing to reprogram these cells

    那些取自你我身上的﹑正在老化的成體細胞 --

  • back into more useful IPS cells.

    他們都想搶先將這些細胞重組

  • And in our lab,

    成為更有用的IPS細胞。

  • we are focused on taking fat

    而在實驗室裡,

  • and reprogramming

    我們專注于提取脂肪

  • mounds of fat

    以及將一堆堆的脂肪﹐

  • into fountains of youthful cells --

    重編成

  • cells that we may use

    如泉噴湧的幼年細胞 --

  • to then form other,

    那些可用作

  • more specialized, cells,

    轉化為其他

  • which one day may be used as cell transplants.

    更為特定的細胞,

  • If this research is successful,

    以便日後可用作細胞移植的用途。

  • it may then reduce the need

    如果這項研究成功的話,

  • to research and sacrifice

    它就能減少

  • human embryos.

    要研究和犧牲

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

    人類胚胎的需求。

  • that the promise of stem cells

    事實上,當中有很多炒作,但亦同時存在

  • will one day provide cures

    有朝一日可以利用幹細胞

  • for a whole range of conditions.

    去治療

  • Heart disease, stroke, diabetes,

    一系列的病症的希望。

  • spinal cord injury, muscular dystrophy,

    心臟病﹑中風﹑糖尿病﹑

  • retinal eye diseases --

    脊髓損傷﹑肌肉萎縮﹑

  • are any of these conditions

    視網膜疾病 --

  • relevant, personally, to you?

    以上病症之中﹐