Susan Lim: Transplant cells, not organs

譯者: Vikki Leung 審譯者: Joan Liu

So I was privileged to train in transplantation

能在兩位偉大的外科先驅者

under two great surgical pioneers:

手下學習移植手術，是我的榮幸。

Thomas Starzl,

一位是湯馬斯·史塔哲，

who performed the world's first successful liver transplant

於1967年成為世界上第一個

in 1967,

成功完成肝臟移植手術的人﹐

and Sir Roy Calne,

以及萊伊·卡恩爵士，

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

於一年後﹐成為在英國第一個

in the following year.

進行肝臟移植手術的人。

I returned to Singapore

我回到新加坡﹐

and, in 1990,

然後，於1990年

performed Asia's first successful

完成了亞洲首宗

cadaveric liver transplant procedure,

屍肝移植手術，

but against all odds.

儘管手術困難重重。

Now when I look back,

如今當我再檢討時﹐

the transplant was actually the easiest part.

手術部分其實是最簡單的。

Next, raising the money to fund the procedure.

其次就是湊錢去籌備手術的經費。

But perhaps the most challenging part

但最具挑戰性的部分

was to convince the regulators --

就是要說服監管者 －

a matter which was debated in the parliament --

這件事曾於議會受爭議　－

that a young female surgeon

去讓一位年輕女外科醫生

be allowed the opportunity

獲得能為自己國家

to pioneer for her country.

作出創舉的機會。

But 20 years on,

但20年過去了﹐

my patient, Surinder,

而我的病人，薩倫德，

is Asia's longest surviving

是到目前為止﹐於亞洲生存最長久的

cadaveric liver transplant to date.

屍肝移植手術的例子。

(Applause)

（掌聲）

And perhaps more important,

但更重要的是，

I am the proud godmother

我有幸成為她

to her 14 year-old son.

14歲兒子的教母。

(Applause)

（掌聲）

But not all patients on the transplant wait list

但並不是所有正在輪候移植手術的病人

are so fortunate.

都是如此幸運。

The truth is,

事實上﹐

there are just simply not enough donor organs

所捐獻的器官根本未能足夠

to go around.

去被妥善配置。

As the demand for donor organs

每當對捐獻器官的需求

continues to rise,

主要由於人口老化而

in large part due to the aging population,

持續上升﹐

the supply has remained relatively constant.

供應量仍是相對的維持不變。

In the United States alone,

僅在美國，

100,000 men, women and children

已經有10萬人，包括男人﹑女人及小孩

are on the waiting list for donor organs,

正為得到捐助器官而輪候﹐

and more than a dozen die each day

而且每天有十幾人﹐

because of a lack of donor organs.

正因缺乏捐獻的器官而死亡。

The transplant community

器官移植界

has actively campaigned in organ donation.

曾積極推廣器官捐獻的活動。

And the gift of life

而饋贈生命的意念﹐

has been extended

已經

from brain-dead donors

從腦死亡的捐獻者

to living, related donors --

被延續至還在世的﹑有血緣關係的捐獻者　－

relatives who might donate an organ

包括會將整個器官﹑或器官的一部份

or a part of an organ,

捐贈的親屬﹐

like a split liver graft,

例如將肝臟分割移植

to a relative or loved one.

到親屬或所愛的人身上。

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

但由於所捐贈器官仍是嚴重短缺，

the gift of life was then extended

捐贈範圍再次被擴大﹐

from living, related donors

由還在世的﹑有血緣關係的捐獻者﹐

to now living, unrelated donors.

伸延至還在世的﹑非血緣關係的捐獻者。

And this then has given rise

因此就引發了一場

to unprecedented and unexpected

前所未有﹐以及意料之外的

moral controversy.

道德上的爭議。

How can one distinguish

我們如何才能辨別

a donation that is voluntary and altruistic

一位出於自願和無私的捐獻者﹐

from one that is forced or coerced

以及一位被迫或受強制的捐獻者﹖

from, for example,

例如﹐

a submissive spouse, an in-law,

一個唯命是從的配偶﹑一個媳婿﹑

a servant, a slave,

一個僕人﹑一個奴隸，

an employee?

或者一位僱員？

Where and how can we draw the line?

我們應該於那裡﹑以及怎樣劃清這條界線呢﹖

In my part of the world,

於我的日常生活的四週﹐

too many people live below the poverty line.

太多人活在貧困線之下。

And in some areas,

而在一些地區，

the commercial gifting of an organ

由非血緣關係者

in exchange for monetary reward

去透過活體器官捐贈

has led to a flourishing trade

而換取金錢上的報酬﹐

in living, unrelated donors.

已經是非常盛行的一種商業交易。

Shortly after I performed the first liver transplant,

在完成首宗肝臟移植后不久，

I received my next assignment,

我接到的下一個工作

and that was to go to the prisons

便是到監獄裡面﹐

to harvest organs

從被處決的死囚身上

from executed prisoners.

獲取器官。

I was also pregnant at the time.

那時我還正懷了孕。

Pregnancies are meant

懷孕﹐

to be happy and fulfilling moments

對任何一位女人而言﹐是一段

in any woman's life.

讓人快樂及感到充實的時光。

But my joyful period

但我這段本應是喜悅的時期﹐

was marred by solemn and morbid thoughts --

卻被一陣陣幽暗的﹑帶著死亡氣息的思想沾污　－

thoughts of walking through

回想著我曾步過

the prison's high-security death row,

監獄裡最高嚴密的死囚區，

as this was the only route

因為那是到達臨時手術室的

to take me to the makeshift operating room.

唯一的一條路。

And at each time,

而每當那時，

I would feel the chilling stares

我就能感受到那些

of condemned prisoners' eyes follow me.

用令人毛骨悚然的目光﹐跟隨著我的死囚的眼睛。

And for two years,

接下來的兩年，

I struggled with the dilemma

我都於這困境中掙扎﹐

of waking up at 4:30 am

每個周五早上

on a Friday morning,

於凌晨四點半起床，

driving to the prison,

開車去到監獄﹐

getting down, gloved and scrubbed,

到地庫﹑戴上手套﹑消毒﹐

ready to receive the body

準備接收一具

of an executed prisoner,

被處決的死囚的屍體﹐

remove the organs

從之切出器官﹐

and then transport these organs

再將這些器官帶回

to the recipient hospital

接受移植者的醫院﹐

and then graft the gift of life

然後再於同一天下午﹐

to a recipient the same afternoon.

給接受者移植器官﹐從而贈予新生命。

No doubt, I was informed,

當然﹐他們都說

the consent had been obtained.

器官捐贈是獲得當事人同意。

But, in my life,

但於我生命中﹐

the one fulfilling skill that I had

我所唯一擁有的﹑令我滿足的技能﹐

was now invoking feelings of conflict --

現今竟然產生了情感上的衝突　－

conflict ranging

這種衝突包括

from extreme sorrow and doubt at dawn

從清晨時的極度悲傷和疑慮﹐至到

to celebratory joy

黃昏時慶祝

at engrafting the gift of life at dusk.

因器官移植而給予病人重生的喜悅。

In my team,

於我的團隊中，

the lives of one or two of my colleagues

有一兩位同事的一生

were tainted by this experience.

也就因這樣的經歷而矇上污點。

Some of us may have been sublimated,

我們當中的一些人可能已經麻木了﹐

but really none of us remained the same.

但實際上沒有人不受到感染。

I was troubled

我很困擾﹐

that the retrieval of organs from executed prisoners

這種從死囚上取得器官的做法﹐

was at least as morally controversial

至少在道德上是與

as the harvesting of stem cells

從人類胚胎中抓取幹細胞一樣

from human embryos.

受到同等程度上的爭議。

And in my mind,

而且我認為，

I realized as a surgical pioneer

身為一位外科手術的先鋒者﹐

that the purpose of my position of influence

擁有具影響力的地位的存在意義﹐

was surely to speak up

就是在於可以替那些

for those who have no influence.

沒有影響力的人發言。

It made me wonder

這令我自問

if there could be a better way --

究竟有沒有更好的方法 --

a way to circumvent death

一個可迴避牽涉死亡的﹑

and yet deliver the gift of life

而又同時可贈予新生命的方法。

that might exponentially impact

這樣就能為全世界成千上萬的病人﹐

millions of patients worldwide.

帶來指數級的影響力。

Now just about that time,

也就是在同一時間，

the practice of surgery evolved

外科手術的技巧﹐進展到

from big to small,

從大到小，

from wide open incisions

從寬大的切口

to keyhole procedures,

到鎖孔式的

tiny incisions.

微創技術。

And in transplantation, concepts shifted

而且移植手術的概念﹐已從整個器官

from whole organs to cells.

移轉到細胞移植。

In 1988, at the University of Minnesota,

1988年，在明尼蘇達大學，

I participated in a small series

我參與了一系列小规模的

of whole organ pancreas transplants.

整個胰臟移植手術。

I witnessed the technical difficulty.

我親眼見證了此項技術的難度。

And this inspired in my mind

同時這啟發了我

a shift from transplanting whole organs

去考慮將移植整個器官﹐

to perhaps transplanting cells.

轉移到細胞移植。

I thought to myself,

我在想，

why not take the individual cells

何不考慮去將胰臟裡

out of the pancreas --

個別的細胞提取 --

the cells that secrete insulin to cure diabetes --

即那些能分泌出胰島素而治愈糖尿病的細胞 --

and transplant these cells? --

再將這些細胞移植呢？--

technically a much simpler procedure

技術上而言﹐這類程序﹐

than having to grapple with the complexities

相比起要因進行整個器官移植﹐而要應付繁複的事項﹐

of transplanting a whole organ.

來得簡單得多。

And at that time,

同時間﹐

stem cell research

幹細胞研究方面﹐

had gained momentum,

亦繼於90年代時期﹐

following the isolation of the world's first

世上首次成功將

human embryonic stem cells

人類胚胎幹細胞分離以後﹐

in the 1990s.

獲得了新的進展。

The observation that stem cells, as master cells,

能將幹細胞用作母細胞

could give rise

去發育成

to a whole variety of different cell types --

一系列林林總總的細胞種類 --

heart cells, liver cells,

心肌細胞﹑肝細胞﹑

pancreatic islet cells --

胰島細胞 --

captured the attention of the media

這項發現﹐廣泛受到媒體關注﹐

and the imagination of the public.

也激發了廣大市民的想象力。

I too was fascinated

我也因這種全新的﹑

by this new and disruptive cell technology,

具影響力的細胞技術而著迷﹐

and this inspired a shift in my mindset,

思維亦被激發﹑而引起了轉變，

from transplanting whole organs

從將整個器官移植﹐

to transplanting cells.

轉移到細胞移植。

And I focused my research on stem cells

我把研究焦點﹐放在

as a possible source

利用幹細胞

for cell transplants.

作為細胞移植來源之中。

Today we realize

今日﹐我們了解到

that there are many different types of stem cells.

有很多不同類型的幹細胞。

Embryonic stem cells

其中，胚胎幹細胞

have occupied center stage,

已占據了中心地位，

chiefly because of their pluripotency --

主要是因為它的多能性--

that is their ease in differentiating

即是它們能輕鬆的分化成

into a variety of different cell types.

一系列林林總總的細胞種類。

But the moral controversy

但是之所以胚胎幹細胞的範疇

surrounding embryonic stem cells --

在道德上備受爭議 --

the fact that these cells are derived

是因為這些細胞來源於

from five-day old human embryos --

5天大的人類胚胎。

has encouraged research

而正因為這種爭議﹐才更激勵人們去研究

into other types of stem cells.

其他類型的幹細胞。

Now to the ridicule of my colleagues,

我在同事的嘲諷聲中，

I inspired my lab

將實驗焦點

to focus on what I thought

放於我認為

was the most non-controversial source of stem cells,

最沒有爭議價值的幹細胞資源 --

adipose tissue, or fat, yes fat --

脂肪組織﹐即是脂肪﹐對﹐是脂肪 --

nowadays available in abundant supply --

現今可垂手可得的 --

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

至少﹐我想像你和我一樣﹐都很樂意將它擺脫。

Fat-derived stem cells

脂肪源幹細胞

are adult stem cells.

是一種成體幹細胞。

And adult stem cells

而成體幹細胞是在

are found in you and me --

你和我身體內都能找到 --

in our blood, in our bone marrow,

於我們的血液中﹑骨髓中﹑

in our fat, our skin and other organs.

脂肪中﹑皮膚中﹐以及其他器官中。

And as it turns out,

而事實證明，

fat is one of the best sources

脂肪是成體幹細胞的

of adult stem cells.

最佳來源之一。

But adult stem cells

但是成體幹細胞

are not embryonic stem cells.

並不是胚胎幹細胞。

And here is the limitation:

它具有本身的限制﹕

adult stem cells are mature cells,

成體幹細胞是成熟的細胞，

and, like mature human beings,

而就像成年人一樣，

these cells are more restricted in their thought

這些細胞﹐於思維上較為受到局限﹐

and more restricted in their behavior

於行為上亦較為受到局限﹐

and are unable to give rise

因此它們也無法像

to the wide variety of specialized cell types,

胚胎幹細胞一般﹐可以分化成

as embryonic stem cells [can].

多種具特定功能的細胞。

But in 2007,

但在2007年，

two remarkable individuals,

有兩位傑出人士 --

Shinya Yamanaka of Japan

日本的山中伸彌﹐

and Jamie Thomson of the United States,

以及美國的占美·湯臣 --

made an astounding discovery.

作出了驚人的發現。

They discovered

他們發現

that adult cells, taken from you and me,

那些取自你我身上的成體細胞﹐

could be reprogrammed

可以重組還原成

back into embryonic-like cells,

類似胚胎的細胞。

which they termed IPS cells,

他們將之命名為IPS細胞，

or induced pluripotent stem cells.

或稱誘導培養多潛能幹細胞。

And so guess what,

於是如你我所料﹐

scientists around the world and in the labs

世界各地的﹑以及在實驗室中的科學家﹐

are racing

都爭先恐後的

to convert aging adult cells --

去將正在老化的成體細胞轉化 --

aging adult cells from you and me --

那些取自你我身上的﹑正在老化的成體細胞 --

they are racing to reprogram these cells

他們都想搶先將這些細胞重組

back into more useful IPS cells.

成為更有用的IPS細胞。

And in our lab,

而在實驗室裡，

we are focused on taking fat

我們專注于提取脂肪

and reprogramming

以及將一堆堆的脂肪﹐

mounds of fat

重編成

into fountains of youthful cells --

如泉噴湧的幼年細胞 --

cells that we may use

那些可用作

to then form other,

轉化為其他

more specialized, cells,

更為特定的細胞，

which one day may be used as cell transplants.

以便日後可用作細胞移植的用途。

If this research is successful,

如果這項研究成功的話，

it may then reduce the need

它就能減少

to research and sacrifice

要研究和犧牲

human embryos.

人類胚胎的需求。

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

事實上，當中有很多炒作，但亦同時存在

that the promise of stem cells

有朝一日可以利用幹細胞

will one day provide cures

去治療

for a whole range of conditions.

一系列的病症的希望。

Heart disease, stroke, diabetes,

心臟病﹑中風﹑糖尿病﹑

spinal cord injury, muscular dystrophy,

脊髓損傷﹑肌肉萎縮﹑

retinal eye diseases --

視網膜疾病 --

are any of these conditions

以上病症之中﹐

relevant, personally, to you?

有任何病症與您有切身的關係嗎﹖

In May 2006,

2006年5月，

something horrible happened to me.

有件可怕的事發生於我身上。

I was about to start a robotic operation,

我正準備進行機械人手術﹐

but stepping out of the elevator

但當走出電梯

into the bright and glaring lights of the operating room,

來到手術室的明亮炫目的手術燈下的一剎那，

I realized

我感覺到

that my left visual field

左邊視野

was fast collapsing into darkness.

突然陷入一片黑暗。

Earlier that week,

那週的早些時候，

I had taken a rather hard knock

我在春末滑雪時

during late spring skiing -- yes, I fell.

受到了蠻重的一擊 -- 是的，我摔倒了。

And I started to see floaters and stars,

接着我開始看到漂浮物和星星﹐

which I casually dismissed

當時我以為﹐那只是高海拔之下

as too much high-altitude sun exposure.

過份曝晒於陽光下的緣故﹐並很快將事情拋諸腦後。

What happened to me

事件發生以後，

might have been catastrophic,

假如我當時沒有

if not for the fact

機會接受優質的手術治療的話﹐

that I was in reach of good surgical access.

可能就會引致一場大災難。

And I had my vision restored,

而我的視力恢復了﹐

but not before a prolonged period of convalescence --

但亦要經過一段被預期中更長的康復期 --

three months --

3個月 --

in a head down position.

當中一直要保持著頭向下的狀態。

This experience

這次經歷

taught me to empathize more with my patients,

教懂我更加體諒我的病人，

and especially those with retinal diseases.

特別是那些有視網膜疾病的。

37 million people worldwide

世界上有3700萬人

are blind,

患有失明﹐

and 127 million more

另外更有1億2700萬人

suffer from impaired vision.

正承受著患有視力障礙的痛苦。

Stem cell-derived retinal transplants,

利用幹細胞源視網膜進行的移植手術﹐

now in a research phase,

目前正處於研究階段，

may one day restore vision,

它可能有天會幫助成千上萬

or part vision,

視網膜疾病患者﹐

to millions of patients with retinal diseases worldwide.

去恢復部分或全部視力。

Indeed, we live

事實上，我們生活於

in both challenging

一個富有挑戰﹑

as well as exciting times.

亦同時間令人刺激的時代。

As the world population ages,

隨著世界人口老化，

scientists are racing

科學家們會不斷去搶先

to discover new ways

尋求新的方法﹐

to enhance the power of the body

去透過幹細胞提高人體機能﹐

to heal itself through stem cells.

從而讓它自我復原。

It is a fact

事實上，

that when our organs or tissues are injured,

當器官或組織受損時，

our bone marrow

我們的骨髓

releases stem cells

會將幹細胞﹐釋放到

into our circulation.

血液循環系統之中。

And these stem cells

而這些幹細胞

then float in the bloodstream

會然後漂浮於血液中﹐

and hone in to damaged organs

再導向到受損的器官處﹐

to release growth factors

去釋放生長因子

to repair the damaged tissue.

來修復受損組織。

Stem cells may be used as building blocks

幹細胞可以像砌牆用的磚塊一般﹐

to repair damaged scaffolds within our body,

用作修復身體中受損的支架，

or to provide new liver cells

或用作為新的肝細胞

to repair damaged liver.

來修復受損的肝臟。

As we speak, there are 117 or so clinical trials

就在這一刻﹐大約共有117個

researching the use of stem cells

研究利用幹細胞去治療肝臟疾病

for liver diseases.

的臨床實驗正在進行中。

What lies ahead?

那麼﹐前景怎樣﹖

Heart disease

心臟病

is the leading cause of death worldwide.

是世界上死亡的首要原因。

1.1 million Americans

每年有110萬名美國人

suffer heart attacks yearly.

心臟病發作。

4.8 million

有480萬人

suffer cardiac failure.

患有心臟衰竭。

Stem cells may be used

幹細胞可用作

to deliver growth factors

供應生長因子

to repair damaged heart muscle

以至受損的心肌得到修復

or be differentiated

也可以分化成

into heart muscle cells

心肌細胞

to restore heart function.

去幫助回復心臟機能。

There are 170 clinical trials

有170個臨床實驗

investigating the role of stem cells in heart disease.

正在研究幹細胞在心臟疾病中﹐所扮演的角色。

While still in a research phase,

雖然仍處於研究階段，

stem cells may one day herald

但幹細胞可能有朝一日

a quantum leap in the field of cardiology.

會預示心臟病學界的一個巨大的突破。

Stem cells provide hope for new beginnings --

幹細胞帶來可獲得新開始的希望 --

small, incremental steps,

步伐是細小及漸進的﹐

cells rather than organs,

是用細胞﹑而不是用器官﹐

repair rather than replacement.

是透過修復﹑而不是將之取替。

Stem cell therapies

幹細胞療法

may one day reduce the need for donor organs.

也許有一天會減少對於捐獻器官的需求。

Powerful new technologies

有影響力的新科技

always present enigmas.

總是存有它的奧秘。

As we speak,

就在這一刻﹐

the world's first human embryonic stem cell trial for spinal cord injury

世界上首次用人類胚胎幹細胞﹐治療脊髓受損的臨床實驗

is currently underway

在美國食品藥物管理局批准下

following the USFDA approval.

正在進行中。

And in the U.K.,

同時在英國，

neural stem cells to treat stroke

用神經幹細胞去治療中風的研究

are being investigated in a phase one trial.

亦正處於臨床實驗的初步階段。

The research success that we celebrate today

我們今天所慶賀的這些研究成果

has been made possible

是有賴

by the curiosity and contribution and commitment

各位科學家及醫學界先鋒

of individual scientists

於他們的探索精神驅使下﹐

and medical pioneers.

所作出的奉獻以及承諾。

Each one has his story.

每個人都有屬於自己的故事。

My story has been about my journey

而我的故事就是我從器官移植

from organs to cells --

走到細胞移植的一段旅程 --

a journey through controversy,

一段歷盡爭議﹑

inspired by hope --

卻憑著盼望作為動力的旅程 --

hope that, as we age,

盼望隨著我們年長時﹐

you and I may one day celebrate longevity

可有朝一日﹐於更好的生活水平之下

with an improved quality of life.

去歡欣地安享晚年。

Thank you.

多謝。